[Fat Bear Popular Science] Pay attention! There are still so many friends asking about radiotherapy. I will sort it out again today. Don’t blame Fat Bear for not talking about it...

In May, Pang Xiong published an in-depth article about radiotherapy, "Radiotherapy contributes 22% of tumor cure rate. Let’s talk about all these radiotherapy issues at once...", but recently, many friends suddenly left messages in the background asking Pang Xiong about radiotherapy.

“Is radiotherapy expensive? It costs a lot of money.”

"Fat Bear, should I choose chemotherapy or radiotherapy?"

"The bag is still small, I'll come back for it when it's bigger."

"The doctor came and said that I had to undergo 30 rounds of radiotherapy. Can you do less?"

"Grandma Wang next door said radiotherapy is annoying, and it causes hair loss and vomiting."

......

Radiotherapy is an important means of cancer treatment. About 70-80% of cancer patients will need radiotherapy at different stages. However, many patients still think that it is very complicated, very expensive, very scary or very easy.

So, radiotherapy patients may have a big question mark hanging over their heads every day, and the lack of knowledge and deviations may sometimes lead to some wrong behaviors and choices. Fat Bear will answer the questions raised by everyone today.

Radiotherapy and chemotherapy, which is better?

In the war against cancer, radiotherapy and chemotherapy are like two different weapons, one is a machine gun and the other is a sniper rifle.

Chemotherapy is like a machine gun with a wide range. It can control lesions throughout the body. However, if it encounters a strong enemy (a large local lump), because the firepower is dispersed, it can at most injure the enemy (shrink the lump, control the disease), but it is not enough to be fatal.

Radiotherapy is like a sniper rifle that can be aimed at an area and fired at short intervals. Because the firepower is concentrated, it can often achieve good local effects.

In a war, both are indispensable, and one must also know how to deploy troops, who is the main force and who is the cover, and sometimes even need to encircle the enemy. This requires formulating battle deployment based on the specific condition of the disease.

However, it should be said that all therapeutic effects must be based on effectiveness. You must believe that the doctor has chosen the most efficient solution for you. However, due to individual differences, some people's tumors are like wearing bulletproof vests, and no matter how many weapons are used, they are still helpless.

I'm not angry now, I'll be angry later

Radiotherapy again?

Radiotherapy is divided into therapeutic, adjuvant and palliative.

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▲ Radiotherapy for patients after radical surgery can be understood as consolidation to improve local control rate.

▲ For patients who cannot undergo surgery or have certain diseases, radiotherapy is an effective local treatment and can even cure the disease in some cases.

▲ It is not for the purpose of treating the cause, but only for solving the symptoms (bone pain, superior vena cava compression), which is sometimes an effective palliative measure.

All of this requires a prerequisite that the body is in good health (good general condition, no major underlying diseases of peripheral organs, etc.). Only with a good body will there be a chance for treatment. Otherwise, killing one thousand enemies will result in eight hundred casualties of your own. It is like rushing into a hail of bullets and fighting with a group of elderly, weak, women and children, which is simply tantamount to sending yourself to die in vain.

Some patients are very willful. They think they are in good health, so they don't listen to the doctor's advice and miss the best time for treatment. They wait until they can't eat, can't walk, and are suffering from systemic failure before asking for radiotherapy.

Often at this time, the risks of radiotherapy have already increased exponentially. Not to mention waiting for the effects, it may be like a death warrant that makes you fall down faster.

There are many side effects of radiotherapy, but what doctors tell each person is different?

Radiotherapy is used to treat lesions in the body. We use CT to outline the appearance of the lesions layer by layer. The final three-dimensional shape is our target area, which is the enemy that needs to be eliminated by radiation.

There are no two leaves in the world that are exactly the same, nor are there two targets that are exactly the same. Our goal is to gather the energy brought by the rays in the shape of the target area, and when it reaches a certain energy, it can achieve the effect of killing the enemy.

Just like boiling water, when the water boils you will find that the pot is hot, and even the air around the pot is hot. This is the side reaction.

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So simply put, the target area is located at a certain position, and the nearby tissues are more likely to be injured. Of course, the closer the target area is, the more serious the injury will be. Similarly, if the target area is larger, the injury will be wider and more serious, just like boiling a pot of water will only heat the surrounding air, while boiling a boiler of water will heat up the whole room.

Also, the size of the radiation dose is definitely an important factor. For example, the heat and range of a pot of 50°C water and a pot of 100°C water are definitely completely different.

Therefore, everyone has a unique lesion and a unique target area, which determines the unique side effects. So don’t just look at whether others are having a smooth journey, but listen carefully to what the doctor says.

Why does radiotherapy need to be performed so many times? Can it be done less often?

Water must be boiled to sterilize and cook food, and radiotherapy must reach a certain dose to achieve the desired effect.

Boiling water is a process, the temperature rises gradually, it is impossible to boil it in 1 second. Even eating has to be eaten bite by bite. If you eat too fast you will choke, if you eat too slowly you will not feel full and accidentally overeat.

Radiotherapy is also a process that needs to be accumulated day by day. The daily dose will vary slightly depending on the condition of the disease, but there is only one goal, which is to achieve the most effective dose in the safest way, that is, to be full without choking or bloating.

Therefore, the radiation oncologist's treatment plan must be considered comprehensively from the beginning, and the price cannot be bargained like buying vegetables. Doing it a few times less may not be a big deal, but if the treatment dose is not reached due to just a few times, there will be no regrets in the future.

We encourage everyone to persevere and persevere, and persistence is victory. However, if special circumstances arise during treatment, we still need to analyze each case on a case-by-case basis and communicate more with the doctor. If the risk is too great, safety still comes first.

I took another scan. Is the tumor smaller?

Radiotherapy is not like peeling an apple, where you peel one less piece at a time. It is more like steaming rice, where the rice slowly starts to cook when the temperature reaches a certain level. So this is a cumulative dose-based process, where quantitative changes lead to qualitative changes. You need to learn to be patient and wait.

In addition, doctors are not all-powerful. Except for many superficial tumors whose changes can be observed with the naked eye, more internal tumors need to be clearly examined to determine their shrinkage.

The shrinkage of radiotherapy is a gradual process, and there are aftereffects not only during the radiotherapy period. The effect can often last for 3 months after radiotherapy, so there is no need to worry every day. The doctor will naturally arrange a follow-up examination in the middle of radiotherapy, 1 month after radiotherapy, and 3 months after radiotherapy.

Common precautions

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▲ Patients with head and neck diseases (such as nasopharyngeal cancer) must undergo oral treatment before radiotherapy. Remove metal crowns, extract decayed teeth/residual roots, etc. Generally, radiotherapy can be started 2-3 days after oral treatment and 1-2 months after tooth extraction after the wound heals. For active wisdom teeth, extraction is recommended. Continue to maintain oral hygiene after radiotherapy, and it is recommended to use fluoride toothpaste. Practice opening your mouth frequently.

▲ The red marking line drawn on the body during positioning and resetting is very important, and determines the accuracy of radiotherapy. Do not erase it! Check yourself every day, and if it becomes blurred or unclear, ask a doctor to draw it in time.

▲ During radiotherapy, protect the skin in the irradiated area, keep it dry and ventilated, and avoid friction, scratching, and contact with chemicals. If there are symptoms such as dryness, redness, peeling, and exudation, report it to the doctor in time. At the same time, don't be nervous, it will heal itself after radiotherapy.

▲ Eat a light diet, with more protein as the main food. Maintain oral hygiene, rinse your mouth frequently, you can use light salt water/chlorhexidine, etc.

▲ Strenuous activities or outdoor sports are not recommended. Keep warm, avoid catching a cold, and avoid going to crowded places.

▲ Radiotherapy must be performed according to the planned number of times. It should not be interrupted or cancelled at will unless there are any contraindications to treatment, otherwise it will affect the efficacy.

▲ One month and three months after radiotherapy are the most important time points for radiotherapy evaluation, which determine the efficacy evaluation and subsequent treatment plan selection. Be sure to check on time.

Text/Fat Bear Photos/Internet (please contact to delete) Review/Wang Ying Li Cong

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Science Popularization China Co-construction Base

Chongqing Science Popularization Base/Chongqing Health Promotion Hospital

Chongqing Municipal Science and Technology Commission Science and Technology Communication and Popularization Project

National Health Commission National Basic Public Health Service Health Literacy Project