Understand the preventive treatment initiated by Lula

President Luiz Inácio Lula da Silva (PT) underwent, this Monday morning (25), the first session of preventive radiotherapy at Hospital Sírio-Libanês, in Brasília. The treatment takes place after the removal of skin cancer on the scalp, a procedure carried out in April.

According to information released by the hospital, radiotherapy is part of a complementary stage of treatment against basal cell carcinoma, the type of cancer diagnosed in the president. Experts interviewed by CNN Brasil explain that the measure is preventive in nature and seeks to reduce the risk of the disease returning in the operated region.

Understand the treatment
"The treatment mentioned is complementary/preventive radiotherapy, carried out after surgical removal of the lesion. It is a localized and superficial treatment, directed to the region where the tumor was, in this case, the scalp", explains Heloisa de Andrade Carvalho, radiotherapist and Coordinator of the Radiotherapy Service at the Institute of Radiology (INRAD).

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"The indication appears to be preventive in nature, to reduce the risk of tumor cells remaining or returning, especially when there is a small surgical margin or an area considered to be at greater risk", he adds.

Experts highlight that adjuvant radiotherapy is usually indicated in situations where surgery cannot remove a larger area without compromising important structures or causing relevant aesthetic impacts.

"Complementary radiotherapy may be indicated when, after surgery, there is some concern about narrow surgical margins, called exiguous margins, or when the location of the tumor makes a wider removal difficult, as can happen in the scalp. It can also be considered when there is greater local risk, depth close to structures such as bone, or when the removal of a larger area would require procedures such as graft or flap", adds Heloisa.

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The treatment is carried out on an outpatient basis, without the need for hospitalization in most cases, and with few side effects. The main reaction is usually skin irritation in the treated area.

Oren Smaletz, oncologist at Einstein Hospital Israelita, explains the frequency of sessions.

"Just talking a little more about radiotherapy: radiotherapy tends to be daily sessions, usually for a few days, maybe 14 to 15 days. They are small daily doses. Many patients do not need to be hospitalized; sometimes they are just for convenience, but it can often be done on an outpatient basis. There are few side effects. Local radiotherapy ends up causing a little more irritation in the region", says Smaletz.

According to Heloisa de Andrade Carvalho, the duration of treatment may vary depending on the medical evaluation and the result of the surgery. "Radiotherapy regimens may vary depending on the outcome of the surgery and medical evaluation. In this case, treatment can occur for around 15 to 20 days, reaching 20, 25 or even 30 sessions, depending on the case."

Lula's type of cancer
The president was diagnosed with basal cell carcinoma, one of the most common types of skin cancer. Despite the high incidence, experts point out that this type of tumor tends to present less aggressive behavior and high cure rates.

"President Lula was diagnosed with skin cancer of the basal cell carcinoma type, located on the scalp. This is one of the most common types of skin cancer and, in general, presents a more favorable behavior, with a high chance of cure when diagnosed and treated appropriately. The prognosis can vary depending on the size of the lesion, location, depth and margins obtained in surgery", explains the INRAD doctor.

Doctors explain that there are important differences between the main types of skin cancer.

"There are basically two types: melanoma skin tumors and non-melanoma skin tumors. Non-melanoma skin tumors are divided into two types: basal cell, which appears to be the one the president had, and squamous cell. These non-melanoma tumors are very common.

It is even believed, according to American data, that one in every two people will have this tumor if they live long enough, and it is probably related to sun exposure and is usually in areas exposed to the sun", reveals Smaletz.

Also according to experts, non-melanoma tumors rarely spread to other parts of the body.

"These are tumors that rarely metastasize, they rarely go to other places, so they are less worrying tumors at first. Unlike melanoma skin tumors, which are more aggressive and can metastasize, even leading to death", says the specialist.

Despite this, there is a possibility of the tumor returning in the same location, which is why complementary radiotherapy is indicated in some cases.

"Non-melanoma tumors, such as basal cell and squamous tumors, do not usually metastasize and, as a result, do not usually lead to the patient's death. But they have a risk of falling back into place. And this chance of recurrence or recurrence at the operated site depends on the size of the lesion, the margins and how deep the tumor was", adds Smaletz.

According to him, "in certain circumstances, for example, positive margins, or when the tumor is very deep, or when it was not possible to completely resect it because the aesthetic aspect did not allow it, you undergo radiotherapy that we call adjuvant and that the press ends up using as preventive radiotherapy."

The procedure, therefore, is to prevent the tumor from returning to the site, sterilizing that region after surgery so that the cells that may be left make the chance of it returning increase.

After the end of the sessions, Lula must undergo periodic medical monitoring, in addition to maintaining skin care and sun protection.

"After surgical removal of the lesion, the recommended treatment is complementary radiotherapy, with a preventive objective, directed to the region where the tumor was located. After this stage, the approach is usually periodic medical monitoring, in addition to local skin care and sun protection of the treated area, as patients who have had skin cancer may be at risk of developing new lesions over time", concludes Heloisa de Andrade Carvalho.

Understand when cancer does not need chemotherapy or radiotherapy

Source: CNN