Radiotherapy of breast cancer

Breast cancer have the second or the third rank among malignant tumours in women.

The breast cancer arises in the one place (monocentric). Sometimes there are some separate units (polycentric). It is injured upper-external area of mammary gland (46.8 %), upper -internal area - (11.5 %), lower -external area (7.9 %), area of thele (7.2 %) and lower-internal area (3.8 %).

The basic forms of a breast cancer- central and infiltrative. Clinical forms 1) mastitis-like cancer; 2) erysipelatous cancer; 3) testaceous cancer; 4) Pagets cancer; 5) a cancer of milk ducts; 6) a cancer of an additional segment of a mammary gland.

Distinguish following histologic forms of breast cancer: scirrhous carcinoma, solid carcinoma, mucous carcinoma, colloidal carcinoma and the mixed forms.

Classification of a breast cancer in TNM system.

Т₀ — the tumour is not defined;

T_is —epithelial cancer;

Т₁ — diameter of a tumour up to 2 cm, a skin it is not injured, there is no fixing a tumour to a chest wall, there is no retraction of thele;

Т₂ — diameter of a tumour from 2 up to 5 cm, its mobility it is limited, the tumour is partially soldered to a skin with a chest wall a tumour not connected.

Т₃ — diameter of a tumour is more 5 cm, full fixing with a skin (a symptom « orange crust »), incomplete or full fixing of a tumour to a chest muscle, but there is no fixing to a chest wall.

Т₄ — diameter of a tumour of any size with fixing to a chest wall, a symptom «orange crust».

N₀ —axillary lymph nodes don’t injured.

N₁ — mobile unilateral axillary lymph nodes are palpated.

N₂ — matted axillary lymph nodes palpation on one party.

N₃ — matted unilateral subclavicular or supraclavicular lymph nodes, main succulente.

М₀ — there are no remote metastases.

М₁ — there are remote metastases.

Stage I — Т₁N_0, M ₀; Т₂N₀М₀.

Stage II — Т₁N₁М₀; Т₂N₁М₀.

Stage III — Т₁N₂М₀;  Т₄N₃М₀.

Stage IV — any combination Т and N, including М₁.

Ways metastasis a breast cancer are various. The most widespread is lymphatic way. Treatments of a breast cancerit is more often spent by the combined method. The leading place in the combined method is allocated to surgical treatment.

Radiotherapy of a breast cancer: remote X-ray therapy; remote gamma-therapy; megavoltage therapy (radiation exposure brake radiation high energy, fast electrons); interstitial β-therapy (colloidal solution ¹⁹⁸Аu) and gamma-therapy (radioactive needles and granules ⁶⁰Со in nylon thread).

Treatment of a breast cancer

Stage in situ T_{is or 0}N₀M_0—surgical treatment — a sectoral resection of a mammary gland.

Stage I T₁N₀M₀, T₂N₀M₀ (the tumour is less 3 cm) — the combined treatment: 1Mastectomia with postoperative long-distance gamma-therapy (DGT) on a way lympho-current, TBD 40 Gy; 2) organ-safe operation, DGT in a mode fractional tangential fields (4 – 5 filds in the sizes 10х15 cm) on mammary gland TBD 50 Gy and locally on afteroperation scar TBD 60 Gy, polychemotherapy.

Stage II T_1-2N₁M₀ — the combined treatment: mastectomia, postoperative rate DGT on a way lympocurrent TBD 40 Gy, polychemotherapy.

Stage II T₂N₀M₀ (the tumour is more 3 cm) — the combined treatment: mastectomy, postoperative DGT on a way lympocurrent TBD 40 GY, polychemotherapy.

Stage III T₃N_0-3M₀ — the combined treatment: preoperative DGT the SORT 5 Gy, TBD 25 Gy on a mammary gland, the SORT 5 Gy, TBD 20 Gy on axillary area tangential fields (2 fields in the sizes 9х10 cm), mastectomy, DGT in a mode fractional on a way lympocurrent TBD 40 Gy and on area postoperativ ridge TBD 40 Gy.

Stage IV T₄N_1-2M₀ — the combined treatment: preoperative DGT the SORT 2 Gy, TBD on a mammary gland 60 Gy, on a way lymph outflow - TBD 40 Gy, mastectomia, polychemotherapy.

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