Surgical stage.

To obtain a good cosmetic effect, when the tumor is located in the medial quadrants or the central zone, surgery is performed from 2 separate sections. The tumor node is located in the center of the removed sector, the surrounding glandular tissue is excised before the fascia of the large pectoral muscle. With the central location of the tumor node, the central part of the gland, including the nipple and areola. When the tumor is localized in the outer quadrants of the breast, a "classic" radical resection.

Intrastates for interstitial irradiation of the "bed" of the removed tumor are carried out at the end of the operation after suturing the operating wound. After hemostasis in the "bed" of the tumor through the guide plates, ensuring the creation of a clear geometry of the sources, intrastats are introduced. The needle (intrastat) is inserted into one of the plates, passes through the remaining tissue of the breast and enters the opposite plate through the "mirror" hole.

Depending on the size of the mammary gland, intrastats are placed in 1-2, rarely in 3 planes, with equal distances between individual intrastats and planes, which makes it possible to create a uniform dose distribution in the irradiated volume of tissues. For uniform irradiation of the "bed" of the tumor after its excision, guide plates with apertures are used, through which intrastats are introduced. The interval between intrastats and planes is 1.5-2.0 cm.

On the postoperative stage of pre-radial preparation, a topometric study, dosimetric and radiobiological planning of interstitial irradiation is carried out individually for each patient, taking into account all the features of the implant and its position relative to normal tissues and critical organs. The parameters of the implant are determined: the number of intrastats, the distance between them and the planes, the length of the intrastates and the volume of tissues involved in irradiation.

Topometric preparation to visualize the location of intrastats and calculate the dose field is carried out on the following day after the operation: two x-rays are taken at an angle of 90 ° or close to it using a box with radiopaque labels or two implant projections per film at different positions of the simulator tube. Used implants with hard intrastats and fixing plates reproduce well the planned layout of sources.

health. sumy. ua.

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