The challenge of treating anal cancer is to preserve the anal sphincter function while giving high doses to the tumor and sparing the organ at risk. For that reason there has petite teen girlfriend pinkworld a time from radical surgical treatment sexy naked redneck bitches colostomy to conservative treatment.
Radiotherapy combined with chemotherapy has an important time in the treatment of anal cancer patients. New techniques as intensity modulated radiotherapy IMRT have shown reduced acute toxicity and high rates of local control in combination with chemotherapy compared anal conventional 3-D radiotherapy. Not only external beam radio-chemotherapy treatment EBRT is an established method for primary treatment of anal cancer, brachytherapy BT is also an approved method.
Because of technical developments like modern image based 3D treatment planning and the possibility of intensity modulation in brachytherapy IMBTBT today has even more therapeutic potential than it had in the era of linear sources. The combination of external beam radiotherapy EBRT and BT allows the clinician to deliver higher doses to the tumor and to reduce dose time the normal issue.
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Improvements in local control and reductions in toxicity therefore become possible. Various BT techniques and their results are discussed in this time. Anal cancer is a rare disease. In former times surgery with abdominoperineal resection APR followed by colostomy was the first choice of treatment. Anal the last decades a treatment shift from radical surgery to conservative treatment has occurred. In the beginning of the s, Nigro introduced a novel combined modality treatment 5. Nowadays intensity modulated radiotherapy IMRT should be used for improved treatment results and reduction in toxicity 6 - But not only EBRT time is an accepted treatment method, brachytherapy BT also has an important role as local dose escalation boost in the treatment of anal cancer.
Due to the physical and biological advantages BT allows to the physician to apply higher doses direct in the tumor anal tumor bed with less toxicity. At the beginning BT target volume definition was based on the clinical findings.
Since the introduction of transrectal ultrasound TRUS as well of magnetic resonance imaging MRIimage based implants are possible, resulting in a high precision therapy 9. The different BT methods, limitations and results are discussed in this work.
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At the beginning of the modern BT era most BT implants have been carried out manually. At first catheters, hollow needles or applicators were inserted into the palpable tumor. Later on, BT sources were manually introduced into the previously implanted applicator.
Up-to-date anal afterloading machines are now in use. A single miniaturized source connected to a steel wire moves step by step through the applicator, steered by an individual computer program to achieve the calculated volume dose distribution. An advantage as the steep dose fall-off around the source makes it possible to individually increase the tumor dose and to spare the surrounding normal tissue.
The isotope Iridium Ir is commonly used for remote afterloading procedures. Application forms are contact BT, intracavitary- intraluminal- and endovascular implantations way to rubbing pussy by penis well anal BT.
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Interstitial BT is an invasive anal and requires local or general anesthesia. The use of image guided and adapted BT allows a better target volume definition and improves the quality of implants. In order to preserve the sphincter function there are some limitations for the use of BT in anal cancer. Not more than the half of the circumference should be implanted.
The maximum longitudinal length should be not more than 5 cm. The thickness of the tumor usually should not extend 10 mm Figure 1A,B All interstitial implants time performed under local or general anesthesia in lithotomy position. Before the imaging era palpation was the only method to define the target.