The oncological therapy may include multiple modalities: surgery radiation therapy chemotherapy Hormonal therapy Immunotherapy Often treatment modalities are combined to develop a treatment program that is appropriate for the patient and based on the characteristics of the patient and the tumor, as well as the preferences of the patient. Survival rates for different treatment modalities, alone and in combination are listed for selected tumor diseases (s. Disease-free 5-year survival in multiple tumor therapies). Surgery Surgery is the oldest form of effective tumor treatment. It can be used alone or in combination with other treatment modalities. The size, type and location of the primary tumor can determine the Operierbarkeit and the result. The occurrence of metastases can prevent an aggressive surgical intervention at the primary tumor. Among the factors that increase the operational risk of cancer patients include age comorbidities Physical weakness, which is connected to the tumor disease paraneoplastic syndromes (rare; paraneoplastic syndromes) tumor patients have due to anorexia and the catabolic effects of tumor growth is often a poor nutritional status. These factors can slow or prevent recovery from surgery. Patients may be neutropenic or thrombocytopenic or have bleeding disorders; thus, the risk of developing sepsis or hemorrhage increased. Therefore, the preoperative assessment in this regard is of paramount importance (Preoperative evaluation). Disease-free 5-year survival in various tumor localization method of therapy or stage of the procedure, disease-free 5-year survival (%) operation (exclusive modality) bladder 0, A 81 B1 66 94 I cervix Colon I, II 81 I 74 endometrium kidney I, II 67 larynx I, II 76 Lung (nichtkleinzellig) I 50-70 II 37 oral cavity I, II 67-76 ovary I, II 72 I 80 prostate testis (nichtseminomatös) I 65 radiotherapy (exclusive modality) Cervix II, III 60 esophagus – 10 Hodgkin lymphoma pathological stage IA 80 larynx I, II 76 Lung (nichtkleinzellig) III M0 (not Pancoast tumor) 9 nose nnebenhöhlen I, II, III 35 nasopharynx I, II, III 35 Non-Hodgkin lymphoma pathologic stage I prostate 60 I, II 80 testis (seminoma), II, III 84 chemotherapy (if necessary plus. radiotherapy) Burkitt’s Lymphoma I, II, III 60 choriocarcinoma (in women) All stadiums 95 Hodgkin’s lymphoma IIIB, IVA, B 74 leukemia (in children, ALL) I, II, III 85 leukemia (in children, ANLL) – 50 leukemia (in subjects ? 45 years, ANLL) – 40-50 leukemia (in persons 45-65 years, ANLL) – 25 leukemia (in persons> 65 years, ANLL) – 5 Lung (small cell) “Limited disease” Lymphoma 25 (diffuse large cell) II, III, IV 60 testis (seminoma) 88 III surgery and radiotherapy bladder B2, C 54 II 62 endometrium hypopharynx II, III 33 Lung (Pancoast tumor) IIIM0 oral cavity 32 III 36 testis (seminoma) I 94 70 III colon surgery and chemotherapy ovary (carcinoma) III, IV 15 Radiotherapy and chemotherapy anus (squamous) – 70 CNS (medulloblastoma) – 70-80 Ewing’s sarcoma All stadiums 70 Lung (small cell) “Limited disease” 25 operation R adiotherapie and chemotherapy Mamma (with radiotherapy and / or hormonal therapy) I, II 70-90 embryonal rhabdomyosarcoma All stages 80 kidney (Wilms tumor) All stages 80 oral cavity or hypopharynx III, IV 20-40 rectum II, III = 50-70 ALL acute lymphocytic leukemia, acute ANLL = nichtlymphatische leukemia. Resection of the primary tumor has not metastasized, the primary tumor, surgical intervention may be curative. The success of resection of the primary tumor and the prevention of recurrence, it is crucial that this is completely surrounded in the removal of a seam normal tissue (as in breast cancer surgery). Sometimes intraoperative examination of frozen tissue Shares by a pathologist is necessary. Are in the edges of tumor cells detectable, so direct additional tissue to be resected. (Editor’s note:. Frozen section) However, the investigation of frozen tissue is not as meaningful as the investigation of especially a prepared and dyed fabric. From a later assessment of tissue edges, the need for a more extensive resection may result. Surgical resection of the primary tumor locally spread can make the removal of the regional lymph nodes affected or involved resection of adjacent organs or even a En bloc resection necessary beyond. The survival rates for various tumors treated only by surgery, are shown (see Fig. Disease-free 5-year survival in multiple tumor therapies). has become the primary tumor spread into neighboring normal tissue does, the surgical intervention may be required to be delayed so that other treatment modalities (eg. B., radiotherapy chemotherapy) can be used to determine the size of the area to be resected metastases If verkleinern.Resektion the cancer has metastasized to regional lymph nodes, non-surgical procedures can be the best initial therapy such. As in locally advanced lung cancer or head and neck cancer. Individual metastases v. a. in the lungs or the liver can be resected with a realistic cure rate occasionally. Patients with a limited number of metastases, mainly in the liver, brain and lungs, can benefit from surgical resection of both the primary tumor and the metastases. For example, a 5-year survival can be achieved in a colon carcinoma with liver metastases by resection in 30-40% of cases when <4 liver lesions are present and if a resection with adequate tumor-free margins possible ist.Zytoreduction The cytoreduction, in which the tumor mass by a surgical resection is reduced, then an option frequently when the removal of the entire tumor tissue is impossible for. As in most cases of ovarian cancer. By cytoreduction the sensitivity of the remaining tissue to other treatment modalities can be increased, however, the mechanisms here are based are not entirely clear. Primary renal cell carcinoma and ovarian cancer should, if possible, be resected, even in the presence of metastases. In solid tumors in children and the cytoreduction has positive results gezeigt.Palliative surgery The surgery for symptom relief and preservation of quality of life can be a viable alternative if a cure is unlikely, or the attempt to achieve a cure, would be associated with side effects, for the patients would not be acceptable. Tumor resection may be indicated in order to control pain, to reduce the risk of bleeding or to reduce the obstruction of a vital organ (eg. B. intestine, urinary tract). The supply of nutrients via a feeding tube by means of gastrostomy or jejunostomy can be necessary if a proximal obstruction vorliegt.Rekonstruktive surgery the reconstructive surgery can improve the patient's condition, or increase the quality of life after tumor resection (z. B. breast reconstruction after mastectomy). Radiotherapy Radiotherapy can heal many different types of tumors (s. Disease-free 5-year survival in multiple tumor therapies), in particular those which are located or which can be fully covered by a radiation field. In combination with surgical procedures (for head and neck cancer, laryngeal or uterine tumors) or in combination with chemotherapy and surgery (in sarcomas, esophageal, breast, lung or rectal tumors), the radiotherapy improve cure rates and allows locally more limited resection compared to traditional resection. In addition, radiation therapy provides an important Palliationsmöglichkeit when a cure is not possible: With brain tumors: prolongs the time without functional impairment and prevent neurological complications before For tumors that compress the spinal cord: preventing progression of neurological deficits In vena cava superior syndrome : reduced venous obstruction for painful bone lesions: Usually improve symptoms by radiotherapy no malignant cells can be destroyed without not to damage some healthy cells. Therefore, the risk to the normal tissue compared to the potential gain must be weighed by the tumor treatment. The result of a radiation dose depends on many factors such. B. type of radiation used (type, time, volume, dose) characteristics of the tumor (cell cycle phase, oxygenation, molecular properties, innate sensitivity to irradiation) In general, tumor cells are selectively damaged due to their high metabolic and proliferative rate. Because normal tissue has effective repair mechanisms, it comes to an overall greater destruction of tumor tissue. Among the important considerations for the use of radiation therapy include: Time of therapy (decisively) fractionation of the dose (decisive) normal tissue in or near the planned radiation field target volume configuration of the radiation dose distribution type and energy, which are best suited for the patient Treatment should be adjusted so that the dividing behavior of the cells takes advantage. The goal is a maximum damage to the tumor and minimal damage to the normal tissue. Irradiation starts with the exact positioning of the patient. To ensure accurate positioning at a series of treatments, often customized foam pads or plastic masks are used. In addition, laser-controlled sensors are used. In palliative therapy higher doses of radiation over a period of 3 weeks, are typically used. In curative therapy approaches, the radiation doses are smaller and administered 1 time daily for 5 days per week over a period of 6-8 weeks. Types of radiation There are different types of radiation therapy. External radiation therapy can be done with photons (gamma rays), electrons or protons. Gamma radiation is generated by a linear accelerator is the most common type of radiation therapy. The irradiation dose of adjacent normal tissue can be limited by the use of so-called. Three-dimensional irradiation method which reduce the scattered radiation at the field boundaries. Irradiation with electrons does not penetrate very deeply into the tissue and is therefore best suited for skin or superficial tumors. Depending on the required penetration depth and the type of tumor electrons having different energies. Although their availability is limited, proton therapy has advantages to gamma irradiation, that it accumulates energy in a deep position from the surface, while gamma radiation destroys all the tissue along the beam path. The proton radiation therapy can also provide sharp edges which can result in reduced injury of the immediately adjacent tissues, and is therefore particularly suitable for the irradiation of tumors of the eyes, base of the brain and the spine of use. The stereotactic radiation represents a combination of radiation therapy and surgery, in which a small intracranial stove or other objects with a single high dose or multiple divided doses to be irradiated with the aid of an accurate stereotactic localization of a tumor. It is often used for the treatment of metastatic tumors in the CNS. The advantages are in complete tumor ablation in places where conventional surgery can not be used, with minimal side effects. The disadvantages, however, are in the restriction on the size of the treatable area and the potential danger to adjacent tissues because of the high radiation dose. In addition, the stereotactic radiation can not be used in all areas of the body. Patients must immobilized for irradiation and be completely still held region to be treated. In brachytherapy radioactive sources are introduced into the tumor bed itself (eg. As the prostate or cervix). Typically, the placement CT or ultrasound is controlled with brachytherapy higher effective radiation doses can be achieved over a longer period than would be possible with a fractionated external beam radiotherapy. Using radionuclides which are coupled to monoclonal antibodies (eg., Iodine-131 plus Tositumomab in non-Hodgkin's lymphoma), or by means of systemically administered radioactive isotopes, the radiation can be transported to tumors in organs where these specific receptors for receiving the isotope (z. B. radioactive iodine in thyroid tumors) have. These isotopes can also for palliation of generalized bone metastases (z. B. radioactive strontium for prostate cancers) are used. By other substances or methods, v. a. chemotherapy can sensitize tumor tissue versus administered radiation and the effect werden.Nebenwirkungen increased in this way, the radiation can damage any intervening tissue. Acute side effects depend on the irradiated area, and include lethargy fatigue mucositis skin manifestations (erythema, itching, desquamation) esophagitis pneumonitis hepatitis Gastrointestinal symptoms (nausea, vomiting, diarrhea, tenesmus) urogenital symptoms (frequency, urgency, dysuria) cytopenias Early detection and treatment these side effects are not just for the well-being of the patient and his quality of life is important, but also to ensure the continuation of therapy. A longer interruption may lead to a further growth of the tumor. Chronic radiodermatitis © Springer Science + Business Media var model = {thumbnailUrl: '/-/media/manual/professional/images/419-chronic-radiodermatitis-slide-8-springer-high_de.jpg?la=de&thn=0&mw=350' , imageUrl: '/-/media/manual/professional/images/419-chronic-radiodermatitis-slide-8-springer-high_de.jpg?la=de&thn=0', title: 'Chronic radiodermatitis' description:' u003Ca id = "v38396043 " class = ""anchor "" u003e u003c / a u003e u003cdiv class = ""para "" u003e u003cp u003eChronische radiodermatitis at the site of mastectomy due to postoperative radiotherapy. Note the associated ""radiation hyperkeratotic plaques ""


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