Fighting cancer requires each time to create a separate strategy and design therapy tailored to each patient. This is particularly important in the treatment of head and neck cancers, emphasize doctors from the Amethyst Radiotherapy Center in Krakow.
Head and neck cancers account for approximately 6% of all malignant tumors diagnosed in Poland. Based on these data, some might think this is a small number, but nothing could be further from the truth. At the Department of Maxillofacial Surgery at the Rydygier Specialist Hospital in Krakow, until a few years ago, the largest group of patients were those with various head injuries, but now oncological diseases have clearly taken center stage. Several hundred cancer patients are treated here annually, 70% of whom are malignant tumors. Most of these are also referred to the Amethyst Radiotherapy Center, which closely collaborates with the Krakow Specialist Hospital. In 2020, the Amethyst Center treated 275 patients with head and neck cancer, representing nearly 10% of all patients undergoing radiotherapy here.
A surgeon and a radiotherapist
The degree of complexity of the anatomy of the head and neck region requires a multidisciplinary approach and appropriate organization. In this case, all available treatment methods are used, such as surgery, chemotherapy or radiotherapy. Today, there is no single effective therapy. Doctors use all possibilities related to combining all types of oncological treatment. In the case of tumors in the head and neck, their location affects whether they will first be surgically removed or whether doctors will use radiotherapy or chemotherapy as the first stage of therapy. In this case, consultations, i.e. consultations with a multi-disciplinary team of doctors dealing with cancer treatment in a given location, are a real brainstorming session.
Radiotherapy of cancers in this region uses not only teletherapy, i.e. irradiation of the patient from a certain distance using linear accelerators, but also brachytherapy. In this method, the radiation source is placed directly in the patient's body. This is done in various ways - using existing body cavities and using special applicators - plastic tubes or needles placed in the tumor. A radiotherapist often participates in the surgical procedure to install the applicators necessary for brachytherapy on the patient during the procedure.
Concentrate the radiation dose
" Brachytherapy enables the delivery of a high dose of radiation with incredible precision directly to the tumor, increasing the chance of cure with a relatively low risk of complications. This is particularly important in the case of head and neck cancers, where many vital organs are located, such as the salivary glands and the pharyngeal sphincter muscle. After receiving the high dose of radiation necessary to cure the cancer, these organs can lose their functionality. This is crucial for the patient's ability to swallow, and therefore to feed, which can lead to significant debilitation and even death, " says Marta Urbańska-Gąsiorowska, a radiotherapist at the Amethyst Radiotherapy Center in Krakow.
Modern research clearly indicates the effectiveness of combined, interdisciplinary treatment in the treatment of cancer. High doses of irradiation combined with simultaneous chemotherapy provide a greater chance for local cure. Unfortunately, not every patient can undergo such intensive therapy, which is caused not only by poor health related to cancer, but also to other comorbidities. In such cases, the Amethyst Radiotherapy Center uses many solutions that allow for safe intensification of treatment.
To compensate for the inability to administer simultaneous chemotherapy, hyperfractionation is used, during which the patient is irradiated twice a day, in the morning and in the evening. Particular effects can be achieved by combining teleradiotherapy and brachytherapy, which allows for a significant increase in the radiation dose in the tumor itself or in the place after its removal. In a situation where there are contraindications to surgery to remove the tumor, the use of brachytherapy in low-advanced head and neck cancers provides comparable therapeutic results with a very good aesthetic effect. This method is also addressed to patients with recurrence of cancer in a previously irradiated area, if surgical resection is not possible.
Treatment is also increasingly supported by immunotherapy. Thanks to the use of appropriate drugs, the patient's immune system is activated to fight cancer. The Amethyst Radiotherapy Center conducts clinical tests of drugs that affect the immune system.
For the sake of patients' quality of life
In the case of head and neck cancer therapy, a major challenge is to control complications and provide patients with a satisfactory quality of life after the disease and its treatment. Therapy may disrupt basic life functions related to the ability to eat, speak or hear. Moreover, patients are afraid of scars and other changes that directly affect their appearance.
When planning radiation therapy to the head and neck, it is necessary to protect critical organs such as the salivary glands, pharyngeal sphincter, and oral cavity. Saliva is essential for formulating a food bite. Dry mouth is a common side symptom during radiotherapy. However, it is important to minimize these effects and ensure that the salivary glands return to proper functioning after completion of radiotherapy.
"Effective therapy can be a significant challenge for the patient. Patients lose weight and may experience more frequent infections. As doctors, we must devote significant attention to guiding the patient through this difficult process. Sometimes, eating disorders are so severe that we resort to so-called industrial nutrition, administered through a special enteral tube. For some patients, this type of nutrition is used even before treatment begins, due to the initial restriction of oral intake, " explains Marta Urbańska-Gąsiorowska.
From the very beginning, when a patient comes to the Amethyst Radiotherapy Center, he is under the care of a dietitian who gives him instructions on how to eat and take care of himself. Before the therapy begins, the patient usually has some time to change his eating habits, nourish himself properly and hydrate his body. This is very important, because such "supplies" may turn out to be crucial during the difficulties of therapy. During the entire treatment process, the patient's weight is monitored. If it falls, quick remedial steps are taken.
Another extremely important aspect of treatment is working with a psycho-oncologist. Most patients and their families require such support, and often pharmacological therapy. Studies have proven that low mood or depression worsen the results of cancer therapy.
" Observing our patients, we see how important good eating habits and support from family and medical staff are. If a patient takes care of themselves and is engaged in their therapy, they will have an easier time following it and a better chance of recovery, " notes Marta Urbańska-Gąsiorowska.
The text was published in the supplement of Dziennik Gazeta Prawna "Oncology - diagnosis and treatment".
Oncology_February2021
The text in the supplement can be read here