- I.V. Pershukov is a professor and doctor of medical sciences, as well as a Doctor of Philosophy (PhD). He is the head of the Department of Hospital Therapy with a course in Radiation Diagnostics and Oncology at Jalal-Abad State University, and is a fellow of the American College of Cardiology (FACC) and the American Society of Cardiovascular Angiography and Interventions (FSCAI).
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“At the beginning of the 20th century, doctors had only a scalpel and radiation therapy available for tumor treatment. By the mid-century, drug therapy (chemotherapy and hormone therapy) began to be introduced. By the end of the 20th century, methods of biotherapy, cryogenic and laser treatment, as well as photodynamic therapy, were being developed.”
1. Surgical Methods
Surgery remains one of the primary methods for treating malignant tumors. Thanks to advancements in anesthesiology, surgical intervention techniques have significantly improved, allowing for more complex operations, including combined interventions with the resection of multiple organs.
In the last 15 years, surgeries for treating brain tumors, spinal tumors, and mediastinal tumors have been actively developed. For example, the N.N. Blokhin Russian Oncology Scientific Center has experience with over 100 nephrectomies in patients with kidney cancer, including the removal of a thrombus from the inferior vena cava. The indications for surgical intervention in cancer patients with comorbid heart diseases are expanding, allowing for coronary bypass surgery to be performed simultaneously with the removal of malignant tumors.
The future of surgery in oncology is associated with the development of organ-preserving operations for tumors sensitive to drug and radiation therapy, as well as with the rehabilitation of patients after radical surgeries.
Organ-preserving interventions are performed for breast cancer and bone tumors, and endoprosthetics and breast plastic surgery are actively applied. Methods of endoprosthetics after extensive surgeries are being studied.
2. Radiation Therapy
Radiation therapy, as a primary, combined, or palliative treatment, is used in nearly 70% of patients with oncological diseases. The effectiveness of ionizing radiation is enhanced by experimental developments aimed at managing the radiosensitivity of both normal and tumor cells. Radiomodification techniques include irradiation with large fractions, dose fractionation, the use of hypothermia, thermoradiotherapy, and hypoxic radiotherapy, as well as contact radiation therapy methods.
2a. Proton Therapy
Proton therapy is a modern method of radiation therapy that uses proton beams to treat oncological diseases. This approach allows for precise targeting of the tumor while minimizing damage to healthy tissues.
Mechanism of Action of Proton Therapy
The feature of protons is the Bragg peak — a phenomenon where maximum energy is released at a specific depth, after which it sharply falls to zero. This allows the proton beam to be adjusted so that it reaches the tumor and stops within it, without damaging normal tissues. This is especially important for tumors located near vital organs.
Modern devices often use the pencil beam scanning method, in which the tumor is “shaded” layer by layer, ensuring high precision of irradiation.
Advantages of Proton Therapy
- Minimal impact on healthy tissues. Side effects are significantly lower compared to traditional radiation therapy and chemotherapy methods.
- Treatment of complex localizations. The method is effective for tumors located near critically important organs.
- Reduction of the risk of secondary tumors. This is particularly relevant in pediatric oncology, as proton therapy reduces the likelihood of new malignant formations.
- Applicability in children and weakened patients. The method helps maintain quality of life and prevents growth and cognitive function disorders.
- Possibility of repeated treatment courses in case of recurrences.
Indications
Proton therapy is used for:
- malignant and benign tumors of the brain and central nervous system;
- tumors of the head and neck;
- neoplasms near critical structures;
- spinal and pelvic sarcomas;
- lung, breast, liver, and prostate cancer;
- eye diseases;
- tumors in children.
Contraindications
- severe patient condition;
- active phase of tuberculosis;
- decompensation of comorbid pathology;
- acute conditions (heart attack, stroke);
- sepsis;
- tumors in the stage of decay;
- pregnancy;
- certain mental illnesses;
- general severe condition.
Where to Get Treatment
Proton therapy is available at specialized centers with proton accelerators, such as Obninsk and Dimitrovgrad in Russia, as well as in clinics in the Czech Republic, Spain, France, Germany, and South Korea.
Important: The decision to conduct proton therapy is made by an oncologist after a thorough assessment of the patient's condition.
2b. Carbon Therapy
Carbon therapy is a more advanced, although less common, method of treating oncological diseases using carbon ions. This approach is considered safer and more effective compared to traditional photon therapy.
Principle of Action of Carbon Therapy
Carbon ions have high ionizing capability, which allows for maximizing the concentration of the radiation dose on the tumor while minimizing damage to healthy tissues.
Advantages of Carbon Therapy
- Effectiveness against radioresistant tumors.
- Shortening of treatment duration due to high effectiveness.
- Minimization of damage to healthy tissues.
Areas of Application
Carbon therapy is being studied for the treatment of various malignant neoplasms, including:
- intracranial tumors;
- tumors of the head and neck;
- lung cancer;
- gastrointestinal tumors;
- prostate cancer;
- sarcomas;
- skin cancer;
- gynecological malignant neoplasms;
- pediatric oncological diseases.
Features of Conducting
Carbon therapy can be conducted using both passive scattering and active scanning, which allows for avoiding the use of complex equipment.
Limitations
- High cost of treatment.
- Technological complexity.
- Limited number of centers.
Prospects
The possibility of combining carbon therapy with immunotherapy, as well as the potential of FLASH therapy, is being studied.
3. Drug Methods
Drug treatment methods (chemotherapy, hormone therapy, immunotherapy) are actively developing, and today oncologists have more than 100 anti-tumor drugs at their disposal. In recent years, some types of malignant tumors have become curable solely with medications, such as choriocarcinoma of the uterus.
There are also tumors that require the mandatory inclusion of anti-tumor agents in the treatment plan. Research in recent years is opening new possibilities for treating even those tumors that were previously poorly responsive to medications.
4. Physical Impact Methods
Methods of physical impact on tumors, such as cryogenic treatment, laser therapy, and radiofrequency ablation, are actively developing and showing promising results.
