When a patient goes to radiation oncology
When a patient goes to radiation oncology, the treatment plan is always to give the patient, for example in cervical cancer both external beam radiation therapy and intracavitary or brachy therapy. The reason that patient’s receive external beam radiation therapy is to control the pelvis or what we call regional control. What you are treating is the tumor bed as well as the lymphatics in the pelvis. When a patient receives an implant or brachy therapy what you are trying to control is what we call central disease or to control the disease itself for example, the cervix that has the cancer. So when a patient receives external beam radiation therapy, they go down to radiation therapy and they receive their dose with a high energy Lanier machines. These high energy Lanier machines are able to produce different amounts of energy. In the old days we used to use cobalt and then went to 250 Kvs and here is a cobalt machine. Each of these are different types of energy produced by different machines, and now, patient’s can receive 22 MEV Lanier accelerator. The reason we have gone to higher energy, is pretend this is the skin of the patient is what you see at lower energy, for example cobalt 50 or 250 MEV is that 100% of the energy is delivered either at the skin or 1 cm below. So what happens is, these are the patient’s, if you re fortunate enough to see a patient who was treated in the 60s, who have severe radiation fibrosis because the energy was delivered directly to the skin. Buy abilify online at cheap canadian pharmacy. With the higher energy machines we use now, 100% of the dose is not delivered at the surface but 3 to 5 cm below the surface, thereby sparing the skin so the higher energy machines spare the skin and thereby cause less problems to the patient.
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When patient’s go down to radiation, they are simulated, what they do when they simulate the patient is basically develop a treatment plan or go ahead and plan out what region they are treating with regard to the external beam radiation therapy. In gynecologic oncology, we usually treat the pelvis, and when we treat the pelvis, the field is usually 15 x 15 cm and the reason is because you want to incorporate the pelvis and the internal iliac obturator nodes as well as part of the external iliac nodes. Occasionally, with ovarian cancer, what one will see is patient’s will receive whole abdomen radiation therapy. In the 1970s, whole abdomen was quite frequently given to patient’s and what happened was we saw a 30% bowel complication and it has gone out of favor until recently because of the Princess Margaret data for microscopic ovarian cancer, it has become an option again. The problem with whole abdomen radiation therapy is you are not only treating the pelvis, but you are treating the upper abdomen. When we treat the upper abdomen, unlike the pelvis, there are many radiosensitive organs. For example, the kidney, the small bowel are extremely radiation sensitive and one cannot give as high a dose to the upper abdomen as to the pelvis. For example, the kidneys, the radiation sensitivity of it is about 1500 centigrade. Small bowel is about 2500 centigrade where the pelvis can tolerate up to 6000 centigrade so the upper abdomen is extremely sensitive with regard to complications that can be associated with radiation therapy. The patient then goes down to radiation therapy and a treatment plan is made and ports are drawn and this is the port of a patient with a gynecologic malignancy and what encompasses as you can see as I mentioned is the pelvis, the external iliac and internal iliac arteries but the periaortics are usually not included in the port unless there is periaortic involvement with regard to the cancer. External beam radiation therapy can be delivered in numerous ways, half the dose can be delivered from the front and half from the back, that’s called APPA port or method of delivering it, four-field means that a fourth of the dose is given from the front, a fourth from the back, and one-fourth from each side, or it can be delivered in the 360 degree rotation where a small dose is delivered as the radiation is being delivered to the patient.
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It all depends really on what your treatment field and what you are trying to accomplish. For example, here is the tumor as you can see, if you go from front to back, is that there is less of a margin with regard to the amount of radiation that is being delivered to periphery, so what happens is that there is a higher complication rate giving APPA versus 360 degree rotation. For radiation to be effective with regard to cancer, the size of the cancer becomes extremely important, as you can see here, is if there is greater than a 2 cm nodule, 5000 to 6000 centigrade is required to kill the cancer. If there is microscopic disease, only 2500 to 3000 is required. What’s important clinically is that for example, for ovarian cancer, one cannot give tumor doses to the tumor bed to a large cancer mass because usually the cancer is over 2 cm. Yet if microscopic disease is remaining, or you are trying to give therapy for adjuvant setting when there is no evidence of disease remaining, then, whole abdomen radiation may be effective because you can give to the upper abdomen from 2500 to 3000 centigrade. The normal tissue is a problem with regard to why can’t you give enough radiation therapy, and each of the tissues in the pelvis and upper abdomen have their own radiation tolerance. As I mentioned before, the kidney is rather radiation sensitive, it can only tolerate 2000 centigrade, the liver about 3000 centigrade. However, if you look at the structures in the pelvis, they are rather radiation resistant. The colon, rectum, bladder ureter are able to tolerate from 6,000 to 7500 centigrade. Viagra professional.