In Tunisia, the Salah Azaiez Institute, a pioneer of radiotherapy since 1969, has trained every radiation oncologist in the country and transformed the management of breast cancer. Today, this technique reduces the risk of recurrence by 60% after breast-conserving surgery or mastectomy.
Radiotherapy uses very high-energy ionising radiation to destroy cancer cells and prevent them from multiplying. These high-precision rays target the tumour bed while sparing the surrounding healthy tissue, offering a groundbreaking therapeutic approach.
This technique reduces the risk of recurrence by 60% after breast-conserving surgery or mastectomy.
Breast cancer radiotherapy: a groundbreaking scientific principle
This technique exploits a fundamental feature: only dividing cells are sensitive to ionising radiation. Because cancer cells multiply rapidly, they become the primary targets of this treatment.
The rays produce free radicals that break the DNA molecules of the tumour cells. This selective destruction is carried out with millimetre precision, using the modern technology available in Tunisian centres such as the Ibn Khaldoun Medical Centre or the Ennasr Clinic.
Two complementary technical approaches
External radiotherapy: the most widely used in the treatment of breast cancer. The radiation is produced by a particle accelerator and directed at the area to be treated through the skin.
Brachytherapy: a more specialised technique using iridium-192 in the form of radioactive beads or wires placed directly in contact with the tumour. This method, available in particular at the Hassan II University Hospital in Fez, offers exceptional precision.
Strategic irradiation zones in breast cancer
Radiotherapy targets four key zones depending on the clinical situation:
The mammary gland after breast-conserving surgery, making it possible to preserve the breast while eliminating any residual cancer cells.
The tumour bed after lumpectomy, concentrating the rays on the area where the tumour was originally located.
The chest wall after mastectomy, particularly in invasive cancers with risk factors.
The lymph nodes on the affected side, depending on the nodal involvement determined during the surgical procedure.
Precise indications for breast cancer radiotherapy
In situ and invasive cancers
Radiotherapy acts as an adjuvant treatment, systematically completing breast-conserving surgery. This approach has established itself in every Maghreb centre, driven by the excellent results achieved.
Irradiation of the lymph nodes depends on the histological analysis carried out during the procedure. This tailoring of the treatment is one of the major strengths of modern radiotherapy.
Metastatic cancers
Even in advanced forms, radiotherapy retains its usefulness. It limits the spread of cancer cells and effectively treats bone and brain metastases, significantly improving quality of life.
A radiotherapy session: a meticulous, personalised protocol
High-precision mapping
The process begins with a meticulous mapping of the area to be treated. This step, lasting 30 to 60 minutes, determines the success of the treatment. The radiation oncologist visualises the heart and lungs to protect them from the rays.
Skin markings and individually shaped foam moulds guarantee perfect reproducibility. This mapping is carried out 15 days before the start of treatment, allowing all the necessary settings to be recorded.
Personalised dosimetry
The medical team precisely calculates the dose in grays (Gy) needed to kill the cancer cells without causing adverse effects. This bespoke dosimetry represents the medical art at its finest.
An optimised treatment protocol
Treatment generally extends over 5 weeks, with one session a day, 5 days a week. Sometimes, thanks to modern techniques such as hypofractionated radiotherapy, the duration can be shortened to 3 weeks.
Therapeutic coordination
When chemotherapy accompanies the treatment, it precedes radiotherapy. The radiation sessions begin at most 6 months after surgery and 5 weeks after chemotherapy.
In the case of surgery alone followed by radiotherapy, the sessions begin within the 12 weeks following the operation.
Outpatient care
Each session lasts approximately 15 minutes and takes place on an outpatient basis. The patient goes home immediately afterwards, keeping to their normal daily life.
Cutting-edge technologies in the Maghreb centres
Tunisia: technological excellence
Salah Azaiez Institute: equipped with Varian iX 80 multi-leaf linear accelerators and Eclipse and ARIA planning systems.
Ibn Khaldoun Medical Centre: the first specialised private centre, offering VMAT and stereotactic radiotherapy and FFF beams.
Ennasr Clinic: fitted with two ELEKTA Versa HD and Infinity accelerators, offering 3D, IMRT and VMAT radiotherapy.
Morocco: remarkable innovation
Hassan II University Hospital in Fez: offers intensity-modulated radiotherapy (IMRT) with high-dose-rate brachytherapy.
Cheikh Zaid Hospital: equipped with a 160 multi-leaf accelerator, the only one operational in Morocco and Africa.
Mohammed VI Centre in Casablanca: a centre of excellence with latest-generation equipment.
Algeria: promising development
Fatéma Al Azhar Clinic: a specialised centre with equipment dedicated to stereotaxy.
Sidi Abdellah Centre: a modern new facility.
The well-controlled side effects of radiotherapy
Immediate and transient effects
Skin reactions are the most common effects but remain manageable:
- Redness resembling sunburn (radiodermatitis)
- Moderate breast pain and swelling
- Fatigue that is generally well tolerated
- Difficulty swallowing if the lymph nodes are irradiated
These effects appear during treatment and persist for up to 6 weeks afterwards, but disappear completely.
Exceptional late effects
Late complications, arising between 6 months and 30 years after treatment, remain rare given modern techniques:
- Significant radiodermatitis with pigmentation
- Changes in the appearance of the breast
- Breast fibrosis
- Lymphoedema of the arm after axillary irradiation
- Pulmonary complications
Side effects: summary table
| Type of effect | Manifestations | Period |
|---|---|---|
| Immediate and transient | Redness (radiodermatitis), moderate breast pain and swelling, fatigue, difficulty swallowing if the lymph nodes are irradiated | During treatment, up to 6 weeks afterwards (disappear completely) |
| Late (rare) | Significant radiodermatitis with pigmentation, changes in the appearance of the breast, breast fibrosis, lymphoedema of the arm after axillary irradiation, pulmonary complications | Between 6 months and 30 years after treatment |
The affordable cost of radiotherapy in Tunisia
In Tunisia, the total cost ranges between 1,500 and 5,000 euros, covering consultations, treatment sessions and follow-up examinations. This price remains highly competitive compared with international standards, while guaranteeing excellent quality of care.
Challenges and future prospects
Developing infrastructure
Although the infrastructure is constantly improving, access remains uneven across the region. Tunisia has several modern centres, while some rural areas still require substantial travel.
Ongoing training
The Salah Azaiez Institute continues to train professionals from across the region, maintaining therapeutic excellence. Cooperation with the IAEA and AFRA ensures the teams are kept permanently up to date.
Reference bodies in radiotherapy
Tunisia
- Salah Azaiez Institute: pioneer and national reference
- Tunisian Society of Oncology and Radiotherapy (STOR): training and research
- Ibn Khaldoun Medical Centre: private-sector innovation
Morocco
- Hassan II University Hospital Fez: academic excellence
- Mohammed VI Centre Casablanca: national reference
- Lalla Salma Foundation: national coordination
Algeria
- Fatéma Al Azhar Clinic: advanced specialisation
- Pierre-et-Marie-Curie Centre: regional training
A promising future for radiotherapy
Technological innovations are constantly transforming this field. Image-guided radiotherapy (IGRT), intensity-modulated radiotherapy (IMRT) and stereotaxy are opening up unprecedented therapeutic possibilities.
In our region, expertise is continually growing, fuelled by international exchanges and investment in cutting-edge equipment.
A message of hope and encouragement
Radiotherapy is a major therapeutic weapon against breast cancer. In the Maghreb centres, this technique now reaches levels of excellence comparable to international standards.
For patients facing breast cancer, know that modern radiotherapy delivers remarkable results with well-controlled side effects. This precision technology, now available in our region, contributes significantly to improving both the prognosis and quality of life.
The combination of local medical expertise and cutting-edge equipment is turning the fight against breast cancer into a genuine therapeutic success. Every session brings you closer to recovery, in the safety and comfort of our region's specialised centres.
