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Background: The addition of intraoperative radiation therapy (IORT) to the multimodal treatment of locally advanced or recurrent rectal cancer may improve local control.Although electron beam IORT is the most common modality, technological advances now permit the use of photon beam IORT.One such approach is the application of intraoperative radio therapy (IORT).In IORT, a precise dose of radiation (typically 10-20 Gy) is delivered to the tumour bed immediately after resection (6).In recent years, the emergence of compact, mobile devices equipped with radiation protection has enabled the expansion of IORT for use in a wide variety of tumour types (8,10).Among these latest-generation devices is the photon radiosurgery system (PRS), a miniature X-ray radiation device most commonly used for IORT in breast cancer [5].

Median duration of IORT was 31.9 (range, 15-36) minutes.

Despite the advances made in recent years, treatment of advanced rectal cancer remains challenging.

Although complete surgical excision of the tumour and margins is the cornerstone of treatment, most patients require a multimodal approach involving surgery, chemotherapy, and external beam radiotherapy (EBRT) (1-4).

Nine of this pts presented recurrent rectal cancer (RRC).

Wanebo staging for the nine PRC cases was: Tr3 (6 pts), Tr4 (2 pts), and Tr5 (1 pt).

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