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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 was organized, in which 25 projects participated. As a result, the project of architect Ernest Wirrich won, which incorporated the latest innovative technologies at that time: the building frame is completely cast from reinforced concrete, a concrete slab 80 cm thick lies under the building at a depth of 3.4 meters.

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 construction of the building was carried out using the latest technologies, and the interior concept was developed by world-famous 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!

In the second half of the 19th century, the salary in the Russian guard was small. The officers of the St. Petersburg garrison, who had no other income, were especially in need, because life in the capital required many expenses. The creation of their own cooperative could reduce them. Draft charter of the Economic Society of Officers of the Guards Corps - a corporate joint-stock company established in St. Petersburg with the aim of "delivering to its consumers the items they need<…>mainly uniforms, equipment, shoes and underwear of quite good quality, at the cheapest possible prices, ”was approved by the highest on December 14, 1891. All officers of the St. Petersburg Guards units had the right to join the society. Military personnel and officials of other army and navy units of the capital, by paying a membership fee, could become "annual subscribers." More than four thousand shareholders joined the Economic Society of Officers of the Guards Corps. The grand dukes became the largest shareholders (all of them served in the guards regiments). The donation of Emperor Alexander the Third - 25,000 rubles - was the inviolable working capital of the company.

In 1892, the society opened workshops and a shop in the warehouse of the engineering department on Glinka Street (now one of the buildings of the School of Railway Troops and Military Communications). A year later, the Guards Society was given a wooden house on the corner of Liteiny Prospekt and Kirochnaya Street.

Although there were enough funds to start commercial activities, the board realized that the real success of the enterprise was impossible without a spacious and well-equipped premises. The commander of the Guards Corps, Lieutenant General Manzei, the chairman of the board of the society, found a way out. He turned to the emperor with a proposal to create a joint meeting of army and navy officers in the capital and build a building for it at the expense of the treasury. Part of the future officer's house was to be rented by the Gvardeyskaya housekeeper store.

The building of the Guards Economic Society at the beginning of the 20th century. Photo courtesy of B.M. Kirikov

Alexander the Third approved the idea and allocated almost one and a half million rubles for the construction. The opening ceremony of the luxurious building of the St. Petersburg Officers' Assembly (now the House of Officers) took place on March 22, 1898. An entire wing of the house along Kirochnaya Street was occupied by one of the first department stores in St. Petersburg, where "everything was there, and in order to pay cheaper, you had to give the share number, but you could buy everything even without a share."

The opening of access to the military department store to civilian buyers alarmed the metropolitan merchant class. While the Guards Store was something of a closed distributor, its low fixed prices were a private matter for the company. Now, complaints about unfair competition have been pouring into the City Council. But the officials answered that the Guards Society paid taxes on an equal footing with all commercial and industrial institutions of the capital, which means that it had the right to sell its goods to everyone.

Not all officers accepted the innovation with enthusiasm. Military periodicals opened the debate about whether commerce is compatible with officer honor, whether visits to the officer's establishment by "demimondantes" and other civilians of dubious reputation are decent. The amount of dividends received by shareholders at the end of the year dispelled doubts. Soon branches of the guards department store were opened in Gatchina, Peterhof, Krasnoe and Tsarskoye Selo, where camps and barracks of parts of the St. Petersburg garrison were located. The experience was adopted in other cities of the Russian Empire.

With the beginning of the Russo-Japanese War, the Guards Society organized a military marching department. The purveyor service of the "Guards" deserved many thanks. Profitability of exit trade has appeared unexpectedly high. The government provided wagons for transporting goods free of charge, which made it possible to keep prices at pre-war levels. In 1907, the Guards Society, already at its own expense, without the help of the treasury, began the construction of a new building.

The history of the construction of the central department store of the Guards Economic Society on Bolshaya Konyushennaya - later the House of Leningrad Trade - is well known. A European-style elegant, state-of-the-art department store opened on December 7, 1909. There was no end to buyers. “Every day at four or five o'clock, approaching it, you can observe long lines of luxurious cars, smart carriages, taxis and just cabbies waiting for their owners and riders,” the capital's newspapers reported. Civilian customers were limited only to the right to order clothes and shoes from workshops created exclusively for the manufacture of military uniforms. The assortment, prices and service in the store were beyond praise. In typical military fashion, every action was carried out 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 issued for official use. "Ekonomka" came out on top in Russia in terms of trade turnover. A stable profit allowed the Guards Society in 1912-1913 to attach a new trading floor to the main building. There were nine branches of the company in St. Petersburg and its environs.

DLT department store building in scaffolding, February 2006. Photo by Yuri Molodkovets

At the beginning of the First World War, the Guards Economic Society organized trade in the front-line areas. "It<…>literally a boon for the army. When the wagons with goods arrive, everyone rushes to stock up on the necessary things: sugar, wine, canned food, sweets, crackers, shoes, clothes, tea, snacks, etc. The prices are the most moderate; it’s only a pity that as soon as the goods are sold out, you have to wait a long time ... ”, - wrote one of the front-line soldiers. In St. Petersburg, due to the difficulties of wartime, the department store gradually turned into a distributor for high-ranking officers. In October 1918, the history of the Guards Economic Society ended with nationalization and looting. A few months later, the Soviet authorities doubted the correctness of the dispersal of consumer societies, but awkward attempts to organize a military cooperative instead of a ruined success were not successful. In 1927, the Guards store again became a trading establishment, but it no longer had any relation to military cooperators.

• initial functional state of the kidney;
• type of lithotripter and characteristics of the source of shock waves;
• the chemical composition and size of the stone, its density;
• the relationship of the stone with the pyelocaliceal system;
• the degree of infection of the urinary tract;
• the ratio of the functional state of the kidney and the physicochemical properties of the stone with the parameters of the shock wave impulses of a particular lithotripter;
• the degree of recovery of kidney function after the first session and the severity of postoperative complications.

The recommended indicative figures were obtained in tests on functionally intact renal parenchyma, in which complete destruction of an average stone up to 1.5 cm is expected. In clinical practice, situations may arise when the use of even 1,000 pulses can lead to severe traumatic complications, while after 4,000 pulses will have no effect. Indeed, in a piezoelectric generator with a narrow focal spot and minimal negative pressure and in URATe-P with low-energy and ultrashort pulses, 3,000 - 5,000 pulses may be required to completely fragment a stone, while Litostar can destroy the same stone in 1 500 impulses. One of the factors of kidney trauma is the desire to quickly (with fewer impulses) destroy the stone using the maximum energies of the lithotripter.

The more pronounced inflammatory-sclerotic changes in the kidney parenchyma, the less high-energy pulses are used and the total number of pulses in a session should be less. It must be borne in mind that the energy of a shock wave, like an atom, can be peaceful, therapeutic, curative, but it can also lead to severe traumatic consequences in the renal parenchyma. And not only in the parenchyma. And often it does not depend on the model of the lithotripter. In clinical practice, it is not clear why, there is an opinion that when crushing ureteral stones, it is possible to use higher energies with a larger total number of pulses. In experiments, it was proved that cavitation (foaming) can also take place in the cellular structures of the ureter wall.

Before the creation of the domestic URAT-P lithotripter, a huge amount of experimental research on animals was carried out to study the effect of various shock wave energies on biological tissues and to search for the most optimal and least traumatic impulses. After all, already in the 1980s, the fact that the first Dornier NM-3 lithotripter often showed various types of hematomas, "which did not require surgical intervention," was alarming, but we believed that any was the result of a traumatic effect on the organ. And at present, it is in this group of patients that pronounced decreases in kidney function and the development of arterial hypertension are noted.

In experiments, we have proved the limits of DLT energy, at which gross changes develop up to cavitation - foaming of cells. The use of high energies of a long pulse with a large negative pressure determines the severity of morpho-functional changes in the parenchyma, and the depth of these changes is directly proportional to the number of shock wave impulses. Defocusing and incommensurability of the applied energy with the initial morpho-functional state of the kidney also predetermined the severity of the traumatic effect of EBRT. Using our open publications of all the results of studies of electrohydraulic shock waves, some authors try to attribute the electrohydraulic generator to the most traumatic ones, while a more careful study of the world literature proves that researchers received severe traumatic injuries to both the kidneys and nearby organs using any lithotripters and shock wave generators. in case of violation of crushing technology.

It is regrettable to state the fact that many companies, as part of the training of Russian young specialists, use a week-long trip to one of the foreign clinics only to get acquainted with the work on the device, but do not provide the trained doctors with the theoretical, practical and fundamental foundations and principles of a sufficiently responsible method, which is DLT. Methodological recommendations on methods and technologies for the use of EBRT in various clinical forms have been discussed more than once at our conferences, and they are fully included in the cycle of postgraduate training for physicians "Remote lithotripsy", approved by the Russian Ministry of Health.

Even with ideally correct application of DLT, the tissue of the kidney parenchyma experiences stress - "bruising". The Canadian physiologist Hans Selye was the first to define stress. Translated from English, the word "stress" means "pressure, pressure, tension." And the encyclopedic dictionary gives the following interpretation of stress: - "A set of protective physiological reactions that occur in the body of animals and humans in response to the impact of various adverse factors (stressors)", which can be attributed to DLT.

In other words, if stress sets in, then soon the stress state subsides, the organ - the renal parenchyma - somehow calms down. If the stressful effect exceeds the adaptive capacity, then the development of severe disorders of the organ function or the emergence of new diseases is possible.

Numerous studies on the restoration of the functional state of the kidney at the cellular level - by biochemical, immunological and radioisotope methods have proved that if the DLT technology is observed and the postoperative period is uncomplicated, the restoration of kidney function occurs on the 5th - 7th day. With initially reduced kidney function or with the development of obstructive, inflammatory complications, the recovery period increases to 11-14 days. Performing a second session before the restoration of kidney function or against the background of obstruction leads to more pronounced and gross morphological and functional changes, and the recovery of these indicators slows down. In recent years, EBRT has become increasingly used to destroy residual stones left after open surgery or percutaneous nephrolithotripsy. Studies aimed at studying the timing of DLT of residual stones showed that with a typical pyelolithotomy, the restoration of functional parameters occurs on the 14th - 16th day, when it is possible to apply DLT, with sectional or partial nephrolithotomy, DLT can be used no earlier than 21 - 25 days, And this is in the absence of inflammatory complications. This is why early repeat sessions of ESWL for residual stones often result in either traumatic or severe inflammatory complications, even in the presence of nephrostomy drainage.

Today, the attitude towards residual stones after EBRT, which most often fall into the lower group of calyces, is very important for the patient and doctor. The very essence of the method implies the fragmentation of a stone in the pyelocaliceal system of the kidney to particles capable of spontaneous discharge, and the presence of fragments in the pyelocaliceal system can occur within a certain period of time.

The issue of mandatory removal of asymptomatic fragments causes a lot of controversy. And although some residual fragments can cause new stone formation, this does not always happen. Patients with residual fragments or stones should be monitored regularly to monitor the course of the disease. In such cases, it is necessary to identify biochemical risk factors and take appropriate measures to prevent stone formation. In the case of patients with symptomatic residual fragments, it is very important to eliminate the obstruction and this must be done immediately. In other cases, to get rid of the symptoms, it is necessary to take certain therapeutic measures.

Large and staghorn stones are one of the most difficult forms for EBRT, and for any other surgical method, whether it is PCNL or open surgery. Until now, there is no generally accepted classification that would allow determining the percentage of effectiveness and the percentage of complications when using monotherapy or combined treatments. Therefore, both EBRT, PCNL, and surgical intervention are an integral part of treatment tactics. With a general decrease in kidney function or with bilateral damage, it is necessary to apply the most optimal method (combination of methods) that will preserve functioning nephrons.

At the dawn of the development of the method, when there were no such concepts as internal stents and percutaneous contact lithotripsy and lithoextraction, we investigated the possibilities of the DLT method as a monotherapy and its effect on the functional state of the kidney in the long-term period. The method of fractional crushing of coral-like and large stones, which we developed, after a detailed discussion and careful preparation of patients, allowed us to achieve positive results, but we never counted how much time and effort it took to achieve this positive result. Taking into account the intervals between sessions, the total course of treatment took up to 2-3 months. Moreover, the design of modern lithotripters does not allow fractional crushing. The use of internal drainage of the kidney significantly improved the results of EBRT, but the method can no longer be considered as monolithotripsy. EBRT with preliminary stent placement can significantly reduce the percentage of obstructive complications, however, in this case, EBRT should also be used for small intrarenal staghorn stones of mixed composition and low density, subject to all previously established indications and contraindications.

Today, taking into account the introduction of modern most diverse endoscopic equipment and based on medical and economic considerations, remote monolithotripsy should be considered as a historical fact. The most optimal today would be an early and wider introduction into clinical urological practice of percutaneous puncture lithotripsy (PPL) and lithoextraction, which allows you to simultaneously remove large and most of the coral stones. In combination with DLT, the possibilities of the method are significantly expanded.

In cases where the bulk of a large staghorn stone is localized in the periphery of the calyces, especially in calices with obstruction, and several percutaneous accesses and several sessions of DLT are required to remove the stone, which may be ineffective in case of a pronounced decrease in kidney function, it is recommended to resort to open surgery. intervention. In the absence of extensive experience in performing this kind of operations to remove stones, patients are best referred to medical centers where the qualifications of urologists allow the use of extended pyelocalicotomy, nephrolithotomy (with preservation of kidney tissue, blood vessels, nerves), directed nephrotomy, as well as renal surgery with hypothermia. Recent advances in this area have been the use of intraoperative ultrasound (B-method) and Doppler sonography to identify avascular area of ​​the kidney in close proximity to stones, or dilated calyxes through which large staghorn stones can be removed using several small radial nephrotomy incisions without the risk of reducing kidney function.

Diametrically opposite results are observed with the use of DLT in children, in whom staghorn stones are more common than in adults - 3-19% of the incidence of KSD among children. In children, stones that are dense in structure are unusually rare. And with minimal energies, constituting 40 - 50% of the total energy of the shock wave, it is possible to achieve fine fragmentation of any stone. High compensatory capabilities and elasticity of intact urinary tract tissues allow a large number of fragments to be removed in the immediate postoperative period, among which there are fragments up to 3-4 mm. By using only low-energy pulses of the LitURAT lithotripter, it is possible to achieve positive results of EBLT with staghorn stones even in a 7-month-old child, in no case trying to destroy a mass of more than 5 cm3 in one session.

So, if in 1993 90% of treated children accounted for the Research Institute of Urology, today 56% of positive results of the use of DLT in children were obtained in various regions of Russia, and most children were treated with a domestic lithotripter. Despite the proven promise of using ESWL in the treatment of children over the years, the latter continue to be operated on by pediatricians in pediatric surgical departments to this day. We need to discuss the possibility of opening children's beds in large departmental urological clinics in Russia to save children from traumatic operations and improve the quality of treatment for children with KSD, the growth of which has been clearly seen in recent years.

Over the past years, the complications of external lithotripsy have not undergone any significant changes, both qualitatively and quantitatively. We have repeatedly and in detail considered them and, as before, we believe that their causes lie not so much in lithotripters, but in incorrectly determined indications, preoperative preparation, the applied EBRT technique and the inadequacy of postoperative treatment of the patient or the untimely appointment of additional measures to eliminate obstructive complications, which are based on obstruction of the upper urinary tract. Thus, complications are divided into 2 groups.

Intraoperative - the most severe and are associated with the direct impact of shock waves on the functional tissue of the kidney - hematuria, non-obstructive acute.

Hematuria - as a result of exposure to shock wave impulses and is observed after any session of kidney stone and ureter DLT in 92 - 96%, but with one important deviation - it should be moderate (pink urine) and take place in 1 - 2 acts of urination. Hematuria in ESWL is not a consequence of traumatization of the mucosa of the pelvis by "flying fragments", but a consequence of "sweating" of erythrocytes through the wall of the mucous membrane and is directly related to impaired microcirculation in tissues located in the area of ​​shock waves. Intensive and prolonged hematuria for 1-2 days indicates a violation of the DLT technology, undiagnosed coagulopathy, the use of anticoagulants in patients, etc. Intensive hematuria should alert the doctor to the possibility of more severe traumatic damage to the kidney parenchyma - hematoma, which is observed in 0.1%. Performing ultrasound, CT in the early postoperative period in this category of patients allows timely diagnosis of hematoma. Small subcapsular hematomas, which do not tend to increase, are treated conservatively and disappear within 2-3 months. With a progressive increase in hematoma or its suppuration, its puncture or open surgery is indicated. It is this group of patients that should be the subject of close dynamic monitoring, since changes in kidney function and the development of arterial hypertension are possible in the long term. Injuries to other organs are so minor that they can be considered an episode, and this is a direct consequence of a gross violation of the ESWL technique.

Postoperative - associated with the passage of fragments of the destroyed stone, such as: 1. Non-stopping renal. 2. Obstruction of the upper urinary tract. 3. Obstructive.

stone path

"Stone path" is an accumulation of small, large stone fragments in the upper urinary tract, which do not depart for a long time, accompanied by a violation of the passage of urine. Stone path is the most common complication seen after ESWL. The formation of stone trembling can be observed after crushing any stone and is largely determined by the destruction of a large stone in one session, the quantity and quality of fragments that have simultaneously passed into the ureter, the anatomical and functional state of the pelvicalyceal system and the ureter. With the use of an internal stent before the start of EBRT, such cases have become much less. It is the obstruction that occurs in the early postoperative period that contributes to the activation of chronic a, since ischemic changes in the kidney that occurred after EBRT and an additional increase in intrapelvic pressure are favorable conditions for the activation of endogenous infection. All patients with infected stones should be treated with antibiotics and adequate drainage of the kidney should be established as soon as possible.

Small fragments usually go away after the installation of the CHPNS. Contact ureterolithotripsy is used with a high percentage of efficiency for hard-to-reach and long-term non-outgoing fragments of the lower third of the ureter. Recommendations for the surgical treatment of stone paths have been developed (see table).

We do not mention the various methods of drug therapy, the use of physio- and balneological methods, which, as previously proven, are highly effective for the spontaneous discharge of small fragments.

15 years of experience in the use of DLT and tens of thousands of patients have proven that external lithotripsy is an effective non-invasive and least traumatic method in the treatment of KSD, subject to all previously developed indications and contraindications. No other method has been introduced in domestic urology with such a thorough and public discussion and has not had similar positive results in almost all regions of Russia, and to complete the conference once again with the need to analyze in more detail and give an objective assessment says only one thing - that every time we for many years presented biased data and the percentage of negative results and complications is constantly increasing.

With the advent of new, less invasive approaches to the treatment of urinary stones, our options have expanded significantly. And today there are all prerequisites for improving the quality of treatment of patients with KSD in adults and children. In order to improve the final result of treatment and prevent recurrence, it is necessary, taking into account the experience of modern research, to develop common approaches to a comprehensive examination and treatment of various forms of urolithiasis and at all stages of treatment. Pages: 2

House of Leningrad Trade (DLT) in St. Petersburg. Historical Art Nouveau building, built in 1907-1909 according to the design of E. F. Virrich, S. S. Krichinsky and I. V. Padlevsky for the needs of the Trading House of the Guards Economic Society. In 1918, the building housed the First State Department Store, renamed by 1935 into the House of Leningrad Trade, today it houses the premium department store TSUM St.Petersburg.

The site on which the DLT building is now located belonged to A.P. Volynsky, a prominent statesman of the Petrine era, in the 18th century. In the 19th century, a small hotel, the so-called Volkov Rooms, was erected here. In 1907, the Guards Economic Society bought the yard area at the intersection of Bolshaya Konyushennaya and Volynsky Lane. An international architectural competition was announced, following which E. F. Wirrich was appointed chief architect. Construction work was carried out by the German company Weiss and Freytag. The grand opening of the trading house took place on December 7, 1909 in the presence of the Minister of War and the high army command.

The building is made using brick-monolithic technology, where the load-bearing structures are monolithic (reinforced concrete), and the enclosing structures are made of brick. The external appearance of the building is stylized in the traditions of Russian classicism - it is decorated with order columns and pilasters. The corner turret on the roof of the building is distinguished by a thin spire with smalt lining.

The interior space has no ceilings on separate floors, the trading floor is made in the form of an atrium with a glass roof. Light penetrates into the central space through panoramic windows located along the perimeter of the shopping galleries. On the upper floors, where the administration and workshops were located, there are pilasters and reliefs. In Soviet times, escalators and elevators were installed in the building.

The store managed to change several names in its life - officially, after the construction was completed, the Trading House of the Guards Economic Society was located here, which quickly became known to the people as the Guards Housekeeper (officers of the Guards regiments were entitled to good discounts). After the revolution, in 1918, the First State Department Store was opened in the building, in 1927 it was transformed into the "House of the Leningrad Cooperation of the LSPO (Leningrad Council of Consumer Societies)" or DLK. In the 1930s, the trading house began to be called the central store "Torgsin", and since 1935 the name "House of Leningrad Trade" was assigned to it, when it was included in the network of Glavunivermag.

There is a legend that the abbreviation DLT was not chosen immediately, at first they wanted to call the department store LDT (Leningrad House of Trade), but they were afraid of the similarity with the initials of Lev Davidovich Trotsky, who was in disgrace with the current government.

After the last reconstruction, a premium-class department store TSUM St.Petersburg was opened in DLT, similar to the Moscow Central Department Store.

The House of Leningrad Trade is included in the Unified State Register of Cultural Heritage Objects (monuments of history and culture) of Russia.

Address: St. Petersburg, Bolshaya Konyushennaya street, 21-23.
House of Leningrad trade on the map:	How to get there: The building is located on Kazansky Island at the intersection of Bolshaya Konyushennaya Street and Volynsky Lane. The nearest metro station is Nevsky Prospekt. Ground transport - stops "Bolshaya Konyushennaya Street", "Nevsky Prospekt Metro Station".

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.

Remote 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 action, and are used for specific purposes, for completely different forms of cancerous tumors. For example, one equipment is effective for the treatment of superficial cancers, while at the same time, another is recommended for therapy with the development of neoplasms in the internal organs of a 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. The images taken with the help of computer equipment are compared with the images obtained at 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 patient's position 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 even more effectively reduce the negative impact 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 the harmful effects on healthy tissues remain 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 sensation 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.