ABSTRACT
This article aims at illustrating the two types and effects of the cancer treatment techniques. Several methods are discussed and analyzed by defining them and showing their impacts on the patient. The article goes further to compare and contrasts the various methods that have been put in practice to treat cancer in an effort to determine the best. Radiotherapy alone, radiotherapy with chemotherapy, 3D CRT and IMRT are some of the discussed techniques in the article. Data was collected among the cancer sick patients who underwent different treatments. The patients were put under different conditions in regard to treatment to ease data collection.
- INTRODUCTION
There have been various techniques and procedures that are carried out on cancer patients to reduce its effect and minimize the negative consequences. Treatment of cancer has been a target for many technology companies which make extensive researches n how to create machines that can detect and diagnose cancer. Cancer attacks various parts of the body with the ability to shift positions. Ahles (2012) asserts that head and neck cancers are some of the most complicated conditions especially at the advanced stage. Patients need specialized care to sustain their lives. Radiation therapy comes in handy in minimizing the effects of cancer and relieving the patient.
- BACKGROUND
According to Karen (1998) External radiotherapy has been rated as one of the most successful outcomes among the treatments for cancer. It has been a common occurrence of patients opting for this method since it is external and does not involve any operation s. external radiotherapy can be combined with thermotherapy to increase the effectiveness of the process. Patients are directed to a beam that is of high voltage that detects and diagnose cancer.
Cancer has become a menace and can be so troublesome when it attacks delicate parts of the body such as the neck and the head. Head cancers sometimes attack very delicate tissues. Because frequent surgery is not possible all the time, it is appropriate to use radiotherapy and or chemotherapy to treat the effects of the disease.
Rades et al (2010) asserts that most cancer patients prefer radiotherapy and chemotherapy to surgeries. This is so because surgical operations in the head and the neck are so complicated and expensive. In addition, it can easily lead to loss of lives or ineffective treatment. Under radiotherapy, a patient is allowed to lie on a flat surface like a table or a couch and a radiation is directed to the part that has cancer. The radiator produces high voltage beams that enter the body from the external source. This is the difference between internal and external radiotherapy.
The rays destroy the cancerous cells in the neck and the head thus relieving the patient. Most of the radiotherapy beams use photons such as gamma and x-rays. The process is painless since the machine emitting the beam does not come into contact with the body of the patient. For the procedure to attain a high level of success, it is supposed to be done on the whole part affected and the neighboring parts to ensure complete elimination (Tipper 2011)
The biological process that takes place inside the body is quite simple. This effectively stops the spread of cancer to other body parts.
- Characteristics of cancer
Cancer cells exhibit both cellular and nuclear deformation. They lose the normal alignment of cells and also develop very distinct mitosis and other chromosomal abnormalities. Cancer cells can easily be identified from the unique metabolic activities that take place in the cells. The cells fail to perform basic roles like protein synthesis. The protein and the enzymes produced aid in growth of tumors.
In summary cancer cells are characterized by;
• Inability to regulate the mitotic rate of the cells
• Cells unable to undergo differentiation and specialization
• Movement where they can move and cause a tumor in another part of the body
• The ability to attack and destroy healthy tissues
The damaging of cancer cells can also interfere with the neighboring normal cells but they repair themselves after the radiation is over. There are various factors that are taken into consideration when admitting patient to radiotherapy.
- Factors to consider when administering treatment to cancer patients
The type of the cancer
Physicians can decide on the method to use in diagnosing the disease according to the type of cancer. The type dictates whether radiotherapy or combined radiotherapy and chemotherapy will be used.
The location of the cancer
This is critical consideration when choosing the method to use. Cancers that are near delicate tissues need a lot care when using beams or drugs.
Previous treatments
It is not wise to repeat the same treatment if it does not work. It is advisable to go for alternative treatments or improve the treatment, example by increasing the intensity of the beam.
The overall health of the patient
Many cancer treatment plans have side effects. There is need to ensure that the patient is healthy and can bear the limitations positively without deteriorating health.
- AIM OF THE STUDY
The study was intended to find out the effectiveness of radiotherapy and chemotherapy in treatment of cancer. In addition, the study expounds the factors that are considered when diagnosing cancer using radiotherapy and chemotherapy with their results. The effects and side effects were also identified in the study to show how the level of toxicities affected the patients and possible remedies.
- RESULTS
The study included 31 patients diagnosed with cancer. Seven of the patients were given 64Gy, 62 Gy was given to two patients. It was observed that one of them developed pneumonia and died. Within the follow-up period of 39 months there were multiple toxic effects of the treatment.
The cancer free life for individuals who received radiotherapy and chemotherapy is higher than the patients with radiotherapy. In fact, the survival was
2.2 years for patients who received chemotherapy and radiotherapy as compared to one year of patients who used radiotherapy. Like radiotherapy alone, chemotherapy is appropriate for specific types of cancers and location. Every type of cancer has its own treatment procedure. Patients who complete the entire dose have a higher chance of survival. This is because cancer cells are completely destroyed. However, this depends on the ability of the physician to easily identify these cells and conduct therapy without harming other tissues.
Xerostomy was present in all the patients who underwent radio chemotherapy. This was accompanied by oedema symptoms where patients developed persistent soft tissues. In totality, 23% of the study sample showed 3rd to 4th grade of toxicity.
A study conducted in 2010 and included 10 patients with stage III/IV SCCHN (five oropharynx, five hypo pharynx) received radio chemotherapy treatment. Some patients were unable to complete the dosage due to the high levels of toxicity (90% versus 13%, p = 0.001). This meant that radiotherapy had to be interrupted for a while (1 week) in a group that comprised between 13% and 20 % of the entire sample.
There was administration of three courses of cisplatin that yielded a high level of P3 toxicity. Two regimens could have proved better results but this was aimed at providing the most appropriate regimen for radio chemotherapy. In a nutshell, for stage III/IV SCCHN radio chemotherapy, two courses of cisplatin were better than three.
- DISCUSSION
- Application and Effectiveness of radiotherapy and chemotherapy
Radiotherapy works on a beam of rays hat pass through the body to detect the cancerous cells. The beams of rays destroy the DNA that is present in the cancer cells. Damaging the DNA is done in two ways; direct damaging where the ray destroys the cells itself or through creation of particles that weaken and eventually damage it. When the DNA in the cells is eliminated, the growth of cancer cells is stopped.
Patients’ responsiveness to the treatment determines the effectiveness of treatment. Treatment of cancer depends on various factors such as type and location plus the stage that the cancer is in. This means that proper dosage should be accorded according to this criterion. The outcome of the radiotherapy depends on how accurate it has been employed. It is a success depending on the type and the part of the body in which it is applied. Cancer can be effectively eliminated after a series of radiotherapy as may be prescribed by the physician. Outcomes can be positive if what is recommended is actually administered to the patient. The chances of recovery are higher when the correct dosage is done.
Intra-operative radiation therapy exposes cancer cells to the beam directly. This is usually done to ensure that the cancer cells are not left after the surgery. Uninfected tissues are removed from the beams and protected by the use of special barriers. Stereotactic radio surgery is used in head cancers since it gives a huge dose in just a single period. It is more specific in affected areas thus minimizes the damage to other cells. The precise location of the cancer is displayed on the CT screens and then the machine sends the radiations to the area
In order to improve the efficiency of chemotherapy, there is need to discover more worthy drug to minimize the effects of cancer. A study conducted by University of California show that tumor angiogenesis is significantly related to the distant metastasis and patients’ survival. Advances in radiotherapy have provided very accurate cancer target while at the same time sparing the body tissues such as the brain and mouth tissues. Therefore, improved techniques in radio-chemotherapy increase the prognosis among the nasopharyngeal carcinoma.
The outcomes of combined treatments are varied. However, the success is higher than radiation alone. A study conducted by ministry of health in the UK found out that the mean survival rate was 4.7 years after a patient received the treatment whereas the same study showed that the patients who received radiotherapy only survived 2.6 years. This is a clear indication that chemotherapy and radiotherapy is more effective than the radiotherapy alone.
Chemotherapy is associated with toxicity where it kills patients who are introduced to it. A study conducted by the Italian government indicated that 8% of all the patients using radiotherapy and chemotherapy died after the process as a result of toxicities. Chemotherapy drugs like BCNU are toxic to the progenitor cells. Since these cells are the major cells dividing in the head and neck, it hinders growth and development. This gives rise to many neurons and the glia. (Fall 1987)Other chemotherapy drugs have been linked to loss of memory due to chemical interference. Studies have been done through mice and the hippo shows that chemotherapy drugs have agents such as Methotextrate that affect the brain negatively.
Radiation mucotitis has been a source of toxicity. The combined radiotherapy and chemotherapy does not seem to improve the situation of patients with head and neck cancers. This means that the addition of hydroxyurea increases the level of toxicity thus reducing the chances of survival of the patients. Chemotherapy is usually associated with high toxicity levels than the radiotherapy alone. It is a common occurrence that not all the patients will respond positively to chemotherapy hence clinical testing and investigations are necessary. Late toxicity undermines the effectiveness of the treatment since it has to be stopped when patients respond negatively. This has very adverse effects especially when the cancer is at an advanced stage with a high possibility of death.
- Effects of radiotherapy alone and radiotherapy with chemotherapy
Both the use of RT alone and the use of RT chemotherapy result to many side effects which could be very dangerous especially for the long-term users. These negative effects that are associated with the use of the Radiotherapy techniques to treat head and neck cancer make it ineffective since in many cases the side effects outdo the benefits accruing from administering the treatment. The survival rates of individuals who have undergone radiotherapy alone have been limited showing a little response an issue that brought about the invention of other treatment means. The first to be adapted was the use of RT and chemotherapy that reduced the advance negative effects the RT thus raising the effect. The introduction of 100mg/m2/d1 cisplatin reduced the negative and administering it with radiotherapy greatly reduced the side effects brought about by radiotherapy alone but never increased survival rates.
In the treatment of any cancer by radiotherapy, some patients may experience fatigue. Neck and head cancer are no different and the effect is not common to all patients. The inclusion of chemotherapy in radiotherapy reduces this effect but in some cases the chemical used is not that effective (Yaeger 2009). Depending on the drug used the effect can be low. Moreover this is a mere effect and when not associated with other complications the fatigue could be could be treated. Any patient experiencing fatigue or changes in sleep patterns is thus advised to report immediately to the radiation oncologist.
Mucositis, irritation of the mucous membranes of the mouth is one of the most common side effects of radiotherapy that occur immediately after treatment. They come up due to the introduction of radiations in the body and could be dangerous. Other patients report reduction of saliva in the mouth it dry, a situation known as xerostomia (Rubin 2008). These are as a result of destruction of the salivary glands by the radiations mucositis and xerostomia can be reduced by using chemotherapy whereby CBDCA is administered together with the radiotherapy. When the CBDCA is given on weekly bases the negative effects are seen to reduce by about .eighty percent rendering the radiotherapy very effective. Another chemical that has been used is CDDP that is seen to reduce the toxicity of the radiations. When a dose of 20mg/m2 cisplastin is administered in a patient, mucositis due to skin toxicity and xerostomia are adverse. To reduce this effect the administration is distributed to three courses. In some patients the effects are not that strong and are manageable unlike in some patients where they could cause severe malnutrition mainly due to the lack of saliva that implies that results to inadequate supply of salivary enzymes and hence incomplete digestion of starch.
Radiotherapy on head and neck cancer sometimes lowers the levels of thyroid hormone and sometimes brings it to very low levels a situation known as hypothyroidism. This enzyme is very important in the body and its inadequacy brings about some other disorders with the common symptoms being weight gain with a feeling of being tired and exhausted. One also feels depressed and the body weakens with nails becoming brittle and the skin color changing and becoming light and sometimes associated with constipation. The use of bleomycin, can reduce the skin effect by radiation. Studies have shown that lower doses of 5g administered twice a week for a full dosage of 70g could be more effective than a full dosage of 150g given stages of 15g. Moreover The reduction of the thyroid enzyme is slow and thus these signs and symptoms are observed later after radiotherapy has been done on the patient. Therefore it calls for regular tasting of the patient after radiotherapy and ensure that these whenever these symptoms are seen an immediate action is take. These bring about an additional treatment expense that is due to the patient hence reducing the efficiency of radiotherapy.
Radiations that are sent to the body are aimed at damaging the cells infected by cancer hence eliminating the disease (Tipper 2011). However in the effort to eliminate cancerous cells, these radiations from radiotherapy especially when used alone have been found to destroy other cells. When healthy tissues are destroyed and their functioning deterred then a second cancer can be formed, a situation that is common in neck and head cancerous cells. The effect takes time but when it occurs it is very dangerous and thus radiotherapy treatment for neck and head cancer maybe more risky with the short-term benefit being overruled by the damage that comes in the long run. Use of cisplastin eliminates second cancer is completely as the radiations only affect the infected cells.
Another effect of radiotherapy that is minor in head and neck cancer is the reduction in blood count (Tipper 2011). The reduction of blood flow in any individual is a crucial effect that has been to the attention of many doctors and health institutions. To curb this, a rule has been set to check blood count in every individual at least once before undergoing radiotherapy
As we have seen chemotherapy is combined to radiotherapy as the presence of certain chemicals in the body reduces the adverse effects of the radiations. Studies have supported these and shown that there is always a great reduction in fatigue, tiredness as well as the other symptoms. However introduction of these chemicals in the body has been seen to cause other body complications due to their toxic nature (Yaeger 2009). The use of cisplatin whether fractionated or not together with radiotherapy pauses causes negative effects. A dosage of 300mg/m2 administered cumulatively results to interruptions. Acute toxicity occurring from introduction of cisplastin and some other chemicals is also a common effect on the patients treated by chemotherapy. The use of radio chemotherapy has been suggested to result to perfect results as chemotherapy eliminates all the disorders resulting from radiation. However studies have shown that there are interruptions in the treatment of cancer due to the toxicity. Conversely, high dosages bring about better performance but for only those on individuals who can overcome the toxicity, and Bossi saw that adding EGFR- antibodies to cisplastin to make it strong and effective in eliminating negative effects brought about by radiations made it very toxic and very few people are able of finishing the dose and thus making it ineffective
- Positive impacts of IMRT
In an effort to treat cancer without causing severe effects, many studies have done. As seen the introduction of radiotherapy brought about complications and thus called for chemotherapy. With time it was discovered that radio chemotherapy was the best method for cancer treated but its effectiveness could only be achieved by some patients with a great percentage not able to complete the dose. This brought about the invention of the Intensity-modulated radiation therapy (IMRT) that involves shaping radiotherapy beams in a manner that they only reach the infected cells (Adelstein 2005). IMRT has been rated as the, best treatment for head as well as neck cancer. The cells found in these two parts are very delicate an also perform great functions that control the entire body. Although damaged cells can repair themselves or be replaced by new ones, damage of neck and head cells may affect the functioning of the entire system and thus should be avoided at all expenses.
The use of IMRT ensures the reach of the targeted cell without much struggle. Since in the head and neck there are strong bones that surround many cells and in most cases growth occurs in between the bones, it is important to direct radiations to the infected parts at the same time preventing other parts and maintaining uniformity in the targeted cells. Studies have found that patients treated with IMRT have higher salivary rates as well as wetter mouths than those who use either radiotherapy alone or combined with chemotherapy (Ozyar 2010). Moreover it’s evident that high doses would completely eliminate cancer unlike chemotherapy that would increase toxicity. Despite the fact that the operation of IMRT hardware requires high expertise, it is not tedious as almost everything is computerized an aspect that increases efficiency as well as reducing the manual mistakes that could be done by the therapist.
- Negative impacts of IMRT
It quite evident that after the introduction of the IMRT and the 3D-CRT, the survival percentage has not increased and the number of those who die from cancer has remained to high (Meyer 2011).
- CONCLUSION
Studies have not yet shown why this has been the case and this calls for many other studies to see how the IMRT impact can be increased on toxicity, tumor control as well as patient survival which has been the key issue. Main limitations associated with IMRT include high equipment and training cost. The time taken to treat a patient using IMRT is also longer that increases the irradiation dose and the patient also requires additional quality assurance since no one believes that a machine with minimal human control could do better than the manual system. This is necessary since some patients die out of disbelieve that they can get well.
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