The House of Leningrad Trade (DLT) is the largest department store in St. Petersburg, located at 21-23 Bolshaya Konyushennaya Street.
The site on which the building was built belonged in the 18th century to A.P. Volynsky, a major statesman of the Petrine era and an opponent of the “Bironism”.

Under the Sheremetevs, the former courtyard of Volynsky was divided into two sections - houses No. 21 and 23 along Bolshaya Konyushennaya Street. At the corner of this street and Volynsky Lane, from the 18th century there was a stone two-story house, colloquially called Volynkin (less often Volynsky). It was a cab yard, the carriages from which stood in search of clients on Bolshaya and Malaya Konyushennaya streets.

Nearby in 1836 a small cheap hotel was built (house number 23), the so-called Volkov rooms. It is known that M. I. Glinka and M. E. Saltykov-Shchedrin stayed here. The hotel belonged to the official Alexander Volkov, by whose name the hotel was called "Volkovskiye nomer". From the side of the Moika there were "family" baths, and in the courtyard - "folk" baths. They caused dampness on the walls of the nearby French-German Church, forcing them to cover the ground with a layer of clay and drain walls and floors with lead.

At the beginning of the 20th century, the plot of house No. 21 belonged to the merchants G. Fröhlich and A. Frankfeldt. When they were there, there were carriage and cart drivers, Banukhin's (later Kudryavtsev's) tavern, trading shops, including a sausage shop called "Maria".

In 1907, the Guards Economic Society bought the courtyard plot along Bolshaya Konyushennaya, Volynsky Lane and the Moika River Embankment. In the same year, an international architectural competition was announced, according to the results of which four of the 25 submitted projects were awarded competitive prizes. However, none of the projects satisfied the organizers completely. In July of the same year, E. F. Wirrich was appointed chief architect. The work was carried out by the German company Weiss and Freytag.

As the basis for the new project, Wirrich took his own developments and ideas of engineer Iosif Vladimirovich Padlevsky, who had previously collaborated with Wirrich in designing the building of the Polytechnic Institute. While the project was being drafted, Colonel Bolotov, Chairman of the Construction Committee (he is also Chairman of the Board of the GEO), on the advice of Suzor, went abroad to study the experience of building large shopping centers in Paris and Berlin. Later, Wirrich and his assistant, civil engineer S.S. Krichinsky, were seconded there. The latter soon abandoned the job after a conflict with Wirrich. Their dispute in 1908 resulted in the pages of the magazine "Architect", where Stepan Samoylovich defended the degree of his participation in the project. As a result, the architect Boris Yakovlevich Botkin was taken to replace Krichinsky. Another assistant to Wirrich, architect Nikolai Vasilyevich Vasiliev, contributed to the work. The project, completed in March 1908, was signed by Wirrich and Krichinsky.

Initially, the complex of the Guards Economic Society was conceived as a multifunctional structure, including a trading establishment at the corner of Bolshaya Konyushennaya Street and Volynsky Lane (the future DLT itself), an apartment building on the Moika River embankment and a residential building for employees between them. But later, the volume of the first stage of construction was limited to a corner commercial building. Actually, from everything conceived, only this building was built.

The ceremonial laying of the first stage took place on July 18, 1908. During the construction of the building, the most modern technologies at that time were used.

First three floors shopping complex open wide windows. The fourth floor was intended for administration. On the fifth and attic floors, as well as in the basement, there were warehouses and workshops. The facades of the building are lined with Radom sandstone. Military and trade emblems, mascarons were created in the workshop of the sculptor V. I. Zhilkin with the participation of the sculptor-modeller A. E. Gromov, were made in bronze ceramics under the guidance of the artist-ceramist P. K. Vaulin. The portals are made of Kielce marble.

Part of the building from the side of Volynsky Lane was not all given over to trade. Only the first floor was dedicated to her. Shoe shops were located on the third floor, a dining room was on the fourth, ordinary apartments were on the second, fifth and sixth.

In 1912-1913, under the leadership of I. L. Balbashevsky, the second stage of the department store, the Small Hall, was erected. Initially, the useful area of ​​the building was supposed to be much larger, so in 1912 the neighboring house on Konyushennaya was demolished and a second, small, hall was added, uniting them with a common facade.

The building is made according to the now popular brick-monolithic technology. Bearing structures - monolithic, enclosing - brick. The internal space was not divided by ceilings into separate floors; vice versa, shopping room was made in the form of an atrium.

As a plafond, a triple transparent coating of glass with a metal mesh. The light penetrated into the central hall through the panoramic showcases located along the perimeter of the shopping galleries, based only on reinforced concrete columns three stories high.

The opened department store began to be called the “Guards housekeeper”, since the officers of the guards regiments used discounts here. Its popularity forced many nearby shops to close, unable to compete.

The assortment of the trading house was huge. It was realized by manufactory, stationery, linen, perfumery, economic, glass, fruit, confectionery, sausage, departments. In addition, the guards traded weapons, optics, furniture, silver ...

In 1891, a cooperative was established joint-stock company, the purpose of which was "to deliver to its consumers the items they need, mainly uniforms, equipment, shoes and underwear of quite good quality as far as possible low prices". All officers of the guard units had the right to join the society, but non-guardsmen could become "annual subscribers" by paying a membership fee. Emperor Alexander III, a general of cavalry and a general of infantry, donated 25 thousand rubles, which became the inviolable capital of the company.

The first military department was opened at the corner of Kirochnaya and Liteiny, in the newly built building of the Officers' Assembly (1898). By naming the share number, buyers could purchase both industrial and foodstuffs at reasonable "internal" prices.

Each action was determined strictly according to the instructions. In 1911, they were summarized in an extensive "Collection of Rules of the Guards Economic Society" - a kind of charter, published for official use.

More than six hundred articles of the “Collection of Rules of the Guards Society” regulated every action of employees: “Guides in elevators are forbidden to lift servants separately from their masters”, “Checks must be written out only with a chemical pencil, and not with an ordinary pencil”, “Do not count revenue in the presence of a buyer”, “Anything an application for unkindness or inattention of the clerk to the buyer entails a mandatory deduction of the percentage fee.

Every day at Konyushennaya there were "rows of luxurious cars, elegant carriages, taxis and just cabbies waiting for their owners and riders." We went to the “Guards” and, for the sake of curiosity, gawked at the gilded electric elevators, at the immaculately dressed and polite employees, to drink coffee, sitting in velvet armchairs and looking through the huge windows of Konyushennaya Street.

The stable profit from the store allowed the Guards Society to expand in 1912-1913 and enlarge the building itself. 9 branches were opened, including in Gatchina, Peterhof, Krasnoe and Tsarskoye Selo.

In 1918, a reorganization took place, during which offices and the First State Department Store were located on the existing premises. On November 3, 1927, the department store was transformed into the "House of the Leningrad Cooperation of the LSPO (Leningrad Council of Consumer Societies)", although more often it was called DLK. At the same time, enterprises that produced bread, toys, soft drinks were located here. In the 1930s trading house became known as the central store "Torgsin", and since 1935 the current name - "House of Leningrad Trade" has been assigned to it.

In Soviet times, the building was reconstructed. Escalators and elevators were installed there.

The building of the House of Leningrad Trade was badly damaged during the Great Patriotic War. It was restored in 1944-1947. Shortly after the end of the war, the Central Commercial Department Store was opened here. It was possible to purchase goods not by orders and cards. but for money, albeit very large. Already on the eve of the first post-war September 1, a school bazaar was held in the DLT. On the eve of the New Year, the main hall of the department store was decorated with a 10-meter festive tree.

In the 1970s, DLT began to specialize in the sale of products for children.

Since 2005, Mercury has been renovating the building with the aim of opening a premium department store TSUM St.Petersburg in it, following the example of the Moscow Central Department Store, which is also owned by this company. The updated DLT opened on September 6, 2012.

The history of the largest department store in St. Petersburg began in 1907 when the Guards Economic Society purchased a land plot from Konyushennaya Street to the Moika River. For the construction of a trading house, a special international competition, which involved 25 projects. As a result, the project of the architect Ernest Wirrich won, incorporating the latest at that time innovative technologies: the frame of the building is completely cast from reinforced concrete, under the building at a depth of 3.4 meters lies a concrete slab 80 cm thick.

Even by modern standards, the pace of construction was record-breaking: on December 7, 1909, the Store of the Guards Economic Society opened its doors to the first visitors. The metropolitan press (and then St. Petersburg was the capital of the Russian Empire) wrote: “Every day at 4-5 o’clock, approaching it (the store), you can see long lines of luxury cars, smart carriages, taxis and just cabbies waiting for their owners and riders” . In pre-revolutionary St. Petersburg, the department store was known by the name "Guards Housekeeper".

The political upheavals in the state did not go unnoticed by the store either: on November 3, 1927, it became the House of the Leningrad Cooperation. And only in 1965, when the trading company "House of Leningrad Trade" was created, did the well-known abbreviation appear - DLT.

By the way, one legend is connected with this abbreviation: you must admit that the name “Leningrad House of Trade” would be logical and natural for the Russian language, but then the abbreviation of the main store in Leningrad would resemble the initials of the disgraced Lev Davidovich Trotsky, which was completely unacceptable. The rearrangement of words did not change the meaning, but saved from possible undesirable consequences. Whether this was really so, we, alas, do not know.

Since 1965, DLT began to specialize in children's products. DLT has come a long way, turning from a central "children's" store into the best "family" department store in the city and the dream of most Leningrad children of different generations.

Since 2005, the DLT has been under reconstruction. The building was constructed using the latest technologies, and the interior concept was developed by world-renowned design agencies. Now DLT has become the flagship branch of the Moscow Central Department Store - the main Russian department store.

And, as before, each floor in the department store is reserved for a certain category of goods: accessories, cosmetics and perfumery are presented on the 1st floor; on the 2nd and 3rd floor - men's and women's clothing; youth clothes are presented on the 4th floor; goods for children are planned on the 5th floor, a restaurant area will soon open on the 6th floor.

And there are many more stories to come!

The huge glass building is known to many as a children's goods store, but this was not always the case. During the construction of the shopping complex, it was supposed to sell "men's goods" for employees of the Guards garrison here. When the first voentorg was opened at the corner of Kirochnaya and Liteiny, there was no end to buyers at all, and largely at the expense of civilians. In the wake of economic success in 1907, it was decided to play big - to open a huge department store in the spirit of chic Parisian trading houses.

They decided to build on the site, previously presented to A. Volynsky, who was once executed by Anna Ioannovna. The plans for the construction were grandiose: they wanted to make retail space, apartment building and residential building. An international architectural competition was announced, as a result of which construction began according to the design of Ernest Wirrich. The design turned out to be extremely modern - reinforced concrete buildings were a novelty then. An eclectic building, complemented by cast-iron wreaths, gables and pilasters, adorned the street. And thanks to the atriums, it was very light inside.

The giant store was built in just 8 months. On December 7, 1909, the grand opening took place. Here they did not hang clothes and traded at fixed prices - military discipline had an effect. Luxurious electric elevators were in operation, and guests were greeted by elegantly dressed employees. An internal charter was even developed to regulate the rules of trade. For example, it was forbidden to count money in front of customers, and a fine was waiting for the seller for poor service. In 1912, the building grew in size at the expense of the neighboring house, but outwardly retained its integrity. Then 9 branches of the store were opened.

After 1917 everything changed. The store was nationalized and converted into a distribution point, everything was given to the Red Army. In 1927, the place reopened - as DLK LSPO (House of Leningrad Cooperation, Leningrad Council of Consumer Societies). During a total shortage and a rationing system, felt boots and galoshes are released here. On the wave of “consumer cooperation”, handicraft goods and clothes sewn in artels are in use. In 1935, when the cooperation was canceled, the LDK went to the state.
The store did not close during the war years. The salesmen lived right in the building and distributed the goods left over from the closed department stores. At the same time, air defense fighters were on duty at the corner tower.

After the war, DLT was no different from other Soviet stores. Shortage, long queues, goods on cards - everything is like everyone else. But there were good things too - school bazaars, huge Christmas trees and magical decoration of halls under New Year, amazing toys in the largest children's department, which was a joy to even look at. Because the prices were with the parental salary. Children of the 80s remember the fabulous atmosphere that reigned in DLT, and women will not forget the department with beautiful lingerie - lace!

When department stores began to open in every city district in the early 90s, trade was in full swing in the center in three legendary places: Gostiny Dvor, Passage and DLT. Then, in 2005, a global renovation began. The updated store opened on September 6, 2012. More than 700 brands are represented on 6 floors, New Year's markets and children's events are still held here, as well as fashion shows and other social events. However, those who remember the same old DLT note that its unique atmosphere has disappeared. As if dissolved in the light of bright lamps and inviting signs.

The appearance of a malignant neoplasm is considered one of the most serious human ailments. At the same time, timely access to a specialist can significantly increase the chances of further recovery. Unfortunately, when a cancerous tumor occurs, drug therapy alone is not enough. We have to turn to more radical and aggressive methods of treatment, which include radiation therapy.

Radiation therapy is subdivided according to the type of treatment into external beam beam therapy, contact beam beam therapy and radionuclide beam therapy.

Let's consider such a treatment method as external beam radiation therapy in more detail and carefully.

External radiation therapy, or external beam radiation therapy, is considered one of the leading methods of cancer treatment. During a session of such radiotherapy, the radiation source is located at a certain distance from the site of exposure.

External radiation therapy differs from other types of radiation therapy in that during the procedure there is a destructive effect not only on pathologically altered, but also on neighboring healthy cells of the body.

For a session of DLT, specialized equipment is used that allows you to change the wavelength, while reducing the negative effect of the rays on intact tissues.

Remote radiotherapy of cancer uses special linear accelerators that direct the flow of ionizing rays to a cancerous growth.

The devices differ according to the principle of impact, and are used for specific purposes, for completely different forms cancerous tumors. For example, one equipment is effective for the treatment of superficial cancers, while at the same time, another is recommended for therapy in the development of neoplasms during internal organs person.

DLT is used in long courses that last from 1 to 2 months. In this case, a single therapy session is carried out in just a few minutes.

Remote radiotherapy, as a rule, is used when a lesion occurs in deeper layers. Radiation therapy is also used for cancer of the prostate, breast, lungs, bladder, cervix, larynx and other malignant diseases.

External radiation therapy is carried out in 2 ways of irradiation:

• static (fixed);
• mobile (mobile).

Method 1 consists in the fact that the patient, to whom a statically located radiation source is directed, is in a specific, fixed position.

Method 2 is distinguished by the movement of the radiation source. It is directed to a malignant neoplasm, and the device, moving around the patient, acts on the affected area from all sides.

Types of radiation therapy

At the same time, remote radiation therapy is also divided into several specific types:

3D Conformal Radiation Therapy

The 3D conformal radiotherapy technique is based on three-dimensional volumetric planning. That is, the irradiation zone is extremely close to the parameters of a malignant neoplasm. This type of radiation therapy is preceded by treatment planning based on computed tomography data.

Conformal remote radiation therapy is carried out using linear accelerators equipped with a multileaf collimator.

Thanks to the collimator petals that move independently and line up in the shape of the neoplasm, damage to the tissues surrounding the tumor is limited.

During the procedure, the patient is on the table in a static and comfortable position. The automated table moves in different planes, moves up and down, and also rotates around its axis. In this case, the motionless patient, only by movements of the table, is given the position necessary for more accurate irradiation. This session lasts approximately 10 minutes.

Image Guided Radiation Therapy

Image-guided radiotherapy consists of irradiating and taking pictures during a session at short intervals to increase the accuracy of exposure.

The device is equipped with visualization tools, which allows specialists to monitor the condition and location of the neoplasm. Carried out with the help computer equipment the images are compared with the images obtained during the modeling stage. This helps during the procedure to carry out the necessary formation and adjustment of the beam of rays, and also allows you to quickly change the position of the patient on a special table in order to increase the accuracy of radiation and a high degree of protection of surrounding tissues.

Image-guided radiotherapy with intensity modulation

Often, image-guided radiotherapy is combined with intensity modulation radiotherapy. This technique allows you to quickly and simultaneously change the power and shape of the beam of rays, as well as the angular velocity of rotation of the linear accelerator. The procedure helps to reduce Negative influence on healthy intact tissues located near the tumor, as well as reduce the total duration of one session to a couple of minutes.

Intensity Modulated Radiation Therapy

Intensity modulated radiotherapy is an innovative method of delivering high-precision remote radiation therapy using special computerized linear accelerators that are able to deliver the required dose of radiation directly to a cancerous tumor or to an area inside it.

IMRT guarantees an accurate matching of the beam shape with the 3D contours of the neoplasm thanks to modulation and control over radiation doses. In addition, this method allows you to focus the radiation power on certain areas of the tumor, allowing you to reduce the radiation load on neighboring healthy tissues.

Stereotactic radiotherapy

Stereotactic radiation therapy was specifically designed for the treatment of malignant brain tumors, since ionizing radiation is extremely harmful to healthy brain cells surrounding a cancerous tumor.

It is used for the most accurate irradiation of a neoplasm that has a complex shape and is located next to healthy organs and tissues. In this case, the high dose of radiation is limited to the area of ​​the cancerous tumor, and harmful effect on healthy tissue remains minimal.

After external radiation therapy

Despite the fact that modern remote methods are able to somewhat reduce the discomfort after the session, it is worth remembering that they still remain radiation exposure. And the consequences after radiation therapy are still there:

• There are problems with the gastrointestinal tract. A course of EBRT can cause bowel disorders, nausea, constipation, or diarrhea.
• There may be troubles associated with the genitourinary system of the body.
• In men, there is a decrease in potency and the formation of erectile dysfunction.
• General weakness and constant fatigue.
• The work of the lymphatic system is disrupted, which manifests itself in constant swelling.
• Decreased immune forces of the body.
• Anemia and platelet formation.
• Unstable emotional state and sleep disturbance.

During the course of treatment

The effectiveness of remote radiation therapy depends on the implementation of certain rules:

• During the course of radiation therapy, food should not only be high in calories, but also nutritious, fresh and varied. Dietary nutrition should include all the necessary vitamins and minerals, as well as foods containing sufficient amounts of proteins and carbohydrates. It is necessary to observe the drinking regime (up to 2 liters of water per day).
• Stop smoking and drinking alcohol.
• Clothing should not be tight, tight or made of artificial, synthetic fabrics. It is advisable to keep the irradiated area uncovered, while the radiation injury sites should be protected from direct sunlight.
• For hygiene procedures, do not use soap or aggressive shower gels. While taking a bath, do not forget about the marks on the body.
• If itching, hyperhidrosis, redness and burning appear, you should consult a dermatologist.
• Follow a clear daily routine. During the course of DLT, regular outdoor walks, physical activity and sufficient sound sleep are required.

Rehabilitation after radiotherapy

The recovery period begins almost immediately after the course of DLT. The rehabilitation program includes:

• complete rest;
• healthy sleep for at least 8 hours;
• gentle work regime;
• moral and psychological support;
• correct and complete diet;
• taking vitamin and mineral complexes and immunomodulators;
• quitting smoking and alcohol.

At this time, not only the right lifestyle, medical care or adherence to the regime is incredibly important, during this period, the support of relatives and friends is of great importance.

Since the treatment has not yet been completed and there is a need to attend procedures and numerous examinations, the patient is in a stressful and depressed state.

Under the circumstances, psychologists do not recommend withdrawing into oneself, but advise to communicate more with friends and loved ones. Try to maintain the same rhythm of life, do not give up easy homework. If you feel a surge of weakness or fatigue, lie down and rest for a while. At the same time, if you continue to go to work, ask the management, for a certain time, to transfer you to an easier professional activity. But still, it is desirable to take sick days or vacation days during the rehabilitation period.

The effectiveness of radiation therapy

The effectiveness of the method directly depends on the period in which the treatment was started:

Irradiation at stage 1 cancer is able to replace surgery.

In the later stages of the development of a malignant neoplasm, as a rule, an integrated approach to treatment is already needed.

Remember that the health of your body requires constant attention. After treatment, do not forget to visit specialists regularly for examination. Being under the constant supervision of an oncologist, in the event of a relapse, it will be possible to start treatment in a timely manner and prevent further deterioration in health.

Remote beam radiation therapy (external) destroys cancer cells using radiation directed by a linear accelerator. The most common type of external radiotherapy is the use of high-energy x-rays - photon beams, less often - protons or electrons. Radiation therapy destroys malignant cells in the treated area.

The treatment is carried out in the radiotherapy department using equipment resembling a large x-ray machine. In most cases, a linear accelerator is used, which uses electricity to create radiation.

Tlv.Hospital offers to consolidate the effect of surgical treatment of cancer with external beam radiation therapy, which is carried out in the best Israeli clinics under the guidance of the country's leading radiologists.

• We guarantee the preparation of an individual therapeutic protocol, the implementation of effective medical tourism programs at affordable prices.
• We are official partners of the Israeli Association of Medical Tourism Companies, therefore we guarantee responsible care for the patient at all stages of service.

Write to us by e-mail or call the phone number indicated on the site.

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During therapy, there is no contact with the equipment, the patient does not feel any pain. There may be some discomfort or pain from side effects later on. Before starting therapy, the doctor discusses with the patient the potential short-term and long-term undesirable effects of the treatment. Most of them are temporary, and in most cases are well controlled with medication.

In the process of planning and monitoring treatment, doctors use a range of tests, including X-ray, CT, MRI, or PET. A high dose of tumor irradiation is planned. It is important that the area around the neoplasm is included in this zone. This increases the effectiveness of therapy. Doctors try to reduce the dose of radiotherapy to surrounding healthy tissue to reduce the risk of possible unwanted effects.

The principle of external beam radiation therapy

Radiotherapy damages the tumor cells' DNA, the genetic code that determines how the body's cells behave. In the course of treatment, either direct damage to DNA occurs, or charged particles are created - free radicals that destroy the genetic code.

Malignant cells stop growing and die when the carrier of genetic information is damaged. The body breaks them down and gets rid of the waste. Healthy cells in the treatment area can also be damaged, but they usually have a high ability to repair themselves.

Fractions in External Beam Therapy

Radiation therapy aimed at destroying cancer and possibly healing the body is called radical or curative. The total dose of radiation is usually divided into smaller fractions. This allows healthy cells to recover between treatments. Thus, fractions are a series of sessions.

External radiation aimed at alleviating the symptoms of cancer is called palliative radiation. This type of therapy requires fewer fractions, sometimes one treatment is enough. Palliative therapy is accompanied by a reduced number of undesirable consequences.

External radiation therapy course

In the process of preparing a course of treatment, the doctor takes into account the type of cancer, its localization, previous or planned treatment, and general health. Those. radiation therapy is individual.

A course aimed at treating oncology usually lasts from 1 to 6 weeks, but may be longer. The doctor will tell you exactly how long it will take.

Many people are prescribed treatment on weekdays, with a break at the weekend. Other modes are possible - 3 times a week or 2 times, including on weekends.

In accordance with the type of oncology and its localization, the doctor selects the type of radiation therapy. It can be conformal radiotherapy, intensity modulated (IMRT), image guided (igrt), 4-dimensional radiotherapy (4D-RT), stereotactic radiotherapy, proton therapy.

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Planning for External Beam Therapy

Before starting treatment, the radiation oncology team makes careful planning. This means working to determine the required amount of radiation and the treatment area. Because cancer cells can sometimes spread to tissues near the tumor, this area will also be included in the treatment area by the doctor. In addition, allowance will be made for possible movement of the tumor during treatment due to respiration or movement of body organs.

This preparation ensures that the tumor receives the prescribed dose of radiation while less radiation is given to healthy tissue. The area of ​​the body that is exposed to external radiation is called the radiation therapy field. The part of healthy tissue immediately around the tumor will be exposed to the same dose of radiation, but doctors will strive to reduce the risk of adverse effects of therapy as much as possible.

The planning stages are determined by the type of cancer and its location. The doctor takes into account the type of malignant tumor, its location, size; how close it is to radiation sensitive structures; how deep the irradiation should penetrate deep into the body; general health and medical history.

Sometimes more than one meeting is required during the preparation process. It depends on the size and location of the tumor. It is important to ask all the questions you have. The more the patient has an idea about the treatment, the better he will cope with it.

Radiotherapy planning

The appointment process can take anywhere from 15 minutes to two hours. A CT, MRI, or PET scan is performed to visualize the tumor and structures around it. Markers can be placed on the skin to fix the exact position of the neoplasm.

The radiation oncologist reshapes the body size and shape in the planned treatment area. Sometimes additional steps are needed to get a clearer picture of body structures:

1. A dye injection is given to visualize the kidneys.
2. Use special wires placed around the tumor.
3. A liquid dye is given to visualize the bladder.
4. When planning external radiation therapy in the chest area, a barium fluid is given to more clearly display the esophagus and stomach.

In preparation, doctors may apply tiny tattoos to fix the exact area to be treated - 2 or 3 permanent marks. Also, signs can be applied using indelible ink in the form of small crosses. Over time, they begin to wear off.

If treatment is planned in the head or neck area, a special mask may be needed to ensure immobility during the treatment. Forms are used in the process of therapy of the hand or foot. Masks and forms are made individually.

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Conformal radiotherapy

This type of radiation is also called 3D conformal radiation therapy or 3DCRT. Used very often.

In conformal radiotherapy, a specialized CT scanner is used in the planning process, less often other types - MRI, for example. This provides a visualization of the processing area in three dimensions - in width, height and depth.

1. A CT scan is performed in the radiotherapy department. An MRI or PET scan may also be performed instead of a CT scan.
2. The computer program then creates beams of radiation that closely match the shape of the tumor. Doctors make sure that the malignant growth gets into the treatment area, trying to avoid affecting healthy tissue as much as possible. This reduces the risk side effects.

Marks may be applied to the skin to indicate the desired area. During treatment, plastic molds (for limbs, breast cancer) and masks for head or neck cancer can be used. They provide immobility during radiotherapy.

In conformal radiation therapy, a small amount of healthy tissue is exposed to radiation. Therefore, the risk of negative consequences of treatment is lower. As with any external radiation, side effects occur only in the treatment area.

IMRT - Intensity Modulated Radiation Therapy

This is a form of conformal radiation therapy that produces beams of radiation that closely match the shape of the tumor.

IMRT can be performed using a standard linear accelerator. It has a device called a multileaf collimator. The collimator consists of thin lead plates that can move independently. They create a shape that exactly matches the treatment area. The guide plates are able to move as the accelerator moves around the patient, creating a beam of radiation directed at the tumor while the accelerator turns. This means that IMRT radiation therapy delivers high doses of radiation to the tumor and reduced doses to healthy tissue.

Each beam of radiation is divided into many small ones that can change their intensity. This makes it possible to deliver different doses of radiation.

In addition, IMRT can create a B-shaped (concave) area at the edge of the radiation therapy field. This avoids a high dose of radiation to structures that can be damaged during therapy. This reduces the risk of long-term side effects. This is very useful in areas such as the head and neck area - it prevents damage to the spinal cord or salivary glands.

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Training

The planning process includes several steps:

1. The patient is undergoing a CT scan. MRI or PET may also be performed.
2. Using the obtained images, the team of doctors plans the treatment. Advanced computerized calculations are used to determine the dose that will best match the shape of the tumor. The planning process itself can take longer than with other types of radiotherapy.
3. The processing area can be marked with special signs. Masks and forms are also used to ensure immobility during treatment.

IMRT can be performed using a linear accelerator or tomotherapy.

Tomotherapy is a specific brand of radiotherapy equipment that has an integrated scanner. It combines intensity-modulated IMRT with an image-corrected radiotherapy (IGRT) unit. The treatment procedure takes 15 minutes or more.

Volume modulated arc radiation therapy (VMAT)

VMAT is a new type of IMRT technique. Radiotherapy equipment rotates around the patient during treatment. The intensity of the radiation beam is constantly changing. Advantages of the technique:

• high accuracy;
• short time treatment;
• use of a lower total dose of radiation.

Indications for the use of IMRT radiotherapy

Clinical trials are currently underway on the use of IMRT in the treatment of other types of malignancies, including breast cancer, head and neck cancer. IMRT is the standard form of treatment for some types of cancer.

During the application of radiation therapy with intensity modulation, a very small amount of healthy tissue enters the treatment area. Thus, the risk of negative consequences is quite low. But, unfortunately, they still exist. As with any other external radiotherapy, side effects affect only the treated area.

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Image Guided Radiation Therapy IGRT

IGRT is a type of conformal radiation therapy that has the ability to form beams of radiation around the tumor area.

IGRT uses X-rays and a CT-like scan before and during radiation therapy. Through x-rays and scanning, the size, shape and location of the tumor, as well as surrounding tissues and bones, are visualized.

The planning process aims to provide a high dose of radiation to the tumor. It is important that the area surrounding the malignancy is included in the treatment area. This increases the effectiveness of the treatment. A low dose of radiation to the surrounding healthy tissue is planned to reduce the chance of negative effects.

Types of radiation therapy with image guidance

In some areas of the body, tumors may change location during each treatment. An example would be the prostate gland, which moves depending on whether the bladder is full or empty. Therefore, there is a risk that the tumor will not reach the treatment area. Some types of IGRT allow you to scan before each radiation therapy session.

One such example is - 4D-RT - 4-dimensional radiation therapy makes it possible to scan during treatment and make sure that the tumor is in the treatment area. This equipment can be adjusted to any changes in the position of the neoplasm during radiotherapy.

Some types of 4D CT may turn off automatically if the tumor moves out of the area of ​​radiation therapy. This type of radiotherapy is very useful in the treatment of cancer in areas of movement, such as irradiation of the lungs. The radiation is directed as soon as the tumor returns to a certain position, which can be seen during the scan.

Advantages and possible disadvantages of IGRT

With image-guided radiotherapy, physicians are able to deliver radiation with high precision. The effectiveness of therapy increases, both for the purpose of curing and for the purpose of controlling the disease. It also reduces the risk of side effects. The disadvantage is that the planning process takes longer. In addition, the duration of each session also increases.

IGRT planning

This process includes several steps:

1. The patient undergoes a CT scan in the radiotherapy department. It can also be MRI or PET.
2. computer program designs the irradiation process in such a way that the beams exactly match the shape of the tumor. Doctors make sure that the affected area is completely included in the treatment area and healthy tissue receives as little impact as possible. This reduces the risk of side effects.
3. Radiation oncologists may mark the area to be treated. Plastic molds or masks are also used to keep the patient still.

Small metal marks may be placed inside or around the tumor. During an X-ray or CT scan, a doctor inserts a gold pellet or rod with a needle. These markers can be seen using X-ray or scanning, this technique guarantees high accuracy of treatment.

IGRT is usually given using a standard linear accelerator, specially adapted and with the availability of specific computer programs.

Some types of IGRT are carried out using specially designed equipment - Cyber ​​Knife. It has a robotic arm that moves around the patient, providing radiation from different points.

IGRT can also be done through tomotherapy. It combines a CT scanner and remote radiotherapy equipment. Part of the machine has the ability to rotate around the patient, scanning with CT, and give radiation to a specific localized area.

The treatment procedure takes from 15 to 45 minutes.

IGRT provides less impact on healthy tissue than other types of radiation therapy. Therefore, the risk of side effects is reduced. However, they still take place and develop in the field of processing.

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Stereotactic Radiotherapy (SBRT)

This is a technique in which radiation to the tumor comes from many different directions, providing high accuracy. Thus, a malignant formation receives the maximum dose of radiation, and the surrounding tissues receive a low dose, which reduces the likelihood of undesirable consequences of the treatment. Usually three to eight procedures are performed.

Stereotactic radiation therapy is used to treat brain tumors, as well as for small malignant tumors in organs such as:

• lungs;
• liver (for primary and secondary cancer);
• The lymph nodes;
• spinal cord.

As part of clinical trials, stereotactic radiotherapy is also used in other types of cancer.

Planning

1. A patient is undergoing a CT scan in the radiotherapy department. MRI or PET may also be done.
2. The computer program generates beams of radiation that will exactly match the shape of the tumor.
3. Doctors may mark the skin to accurately mark the area to be treated. Special forms and masks are also used to ensure immobility during the session. Metal markers can be used, which guarantees very accurate treatment.

A variety of equipment can be used to deliver stereotactic radiotherapy. The most commonly used linear accelerator. The procedure lasts 15-45 minutes.

Treatment with cyberknife

CyberKnife has a robotic arm that moves during treatment, delivering doses of radiation from different directions. At the same time, regular scanning is carried out, and the results of the check are sent to the computer. This allows doctors to precisely target the radiation to the tumor if it moves, for example, during exhalation.

The treatment procedure can take from thirty minutes to four hours, the duration is determined by the type of cancer, its position in the body. The treatment can be carried out at one time, or it can be divided into parts with short breaks.

Radiosurgery

Radiosurgery is a type of stereotactic radiation therapy. It provides highly accurate irradiation with extremely high doses of radiation over 1-5 sessions. It is used in certain types of brain tumors. Clinical trials of radiosurgery in the treatment of prostate cancer are currently underway.

High accuracy reduces the risk of damage to healthy tissue. Therefore, the side effects are less compared to other types of radiation therapy.

Questions to ask your doctor about external beam radiation therapy:

1. How often will you need to visit the clinic for treatment?
2. How long will the course last?
3. What is the duration of each procedure?
4. Will there be image-guided radiation therapy?
5. Will conformal radiotherapy be recommended?
6. Will intensity-modulated radiation therapy be prescribed?
7. How can I find out the exact processing area?
8. Will the treatment area on the body be marked?
9. Will the skin markings be permanent?
10. How long after planning will the first irradiation procedure be performed?

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