Modern technology of radiation therapy: IMRT, VMAT using simultanting integrated boost (SIB) in the complex treatment of squamous cell carcinoma of the anal canal

Increased survival of patients with squamous cell carcinoma of the anal canal due to improved technical equipment radiotherapy separated to oncology clinics. Creating conditions accurately summarizing the planned dose decrease absorption substituted doses to critical structures, reducing unscheduled interruptions in the course of chemoradiotherapy with modern technology conformal radiotherapy (3D CRT, IMRT, VMAT).Radiotherapy with intensity modulated (IMRT) and intensity modulation arches VMAT («Rapid Arc») held respectively at 9 and 5 paintion of squamous cell carcinoma of the anal canal. At the same time the primary tumor and lymph node involvement is further subjected to daily exposure Simula mutant integrated boost (SIB).Application of these technologies allowed: 1) get high oncological result (complete tumor regression in all patients); 2) to reduce the radiation dose to critical organs (small intestine - the average minimum dose, Dose Mean) 34,0 Gy (with IMRT); 37,2 Gy (with 3D CRT); bladder - (Dose Mean) 24,2 Gy (with IMRT); 26,2 Gy (with 3D CRT), respectively; 3) reduce the frequency and intensity of acute radialdamage critical organs: toxic heavy early mucositis (III-IV degree) from the rectum and bladder were observed in any observation. Early proctitis degree I was diagnosed in 4 (28,6% of patients), proctitis Grade II in 5 (35,7%) patients. Early cystitis degree I was diagnosed in 3 (21,4%) patients, cystitis II degree in 6 (42,8%) patients; catarrhal mucosal epithelium of the female genital organs occurred in 8 (57,1%) patients; 1 month after the end of radiotherapy proctitis degree I recorded in 5 (35,7%) and cystitis I degree in 4 (28,6%) patients; 4) reduce the number of patients with forced interruptions termoradiohimioterapii: only 6 patients (42,8%) due to hematological toxicity grade I-II, II degree cystitis made a short break in treatment, the duration of which was 5-8 days; 5) Use simultanting integrated boost (SIB) has led to a reduction in duration of the full course termoradiohimioterapii 7 working days compared to traditional small fraction 3D CRT radiation therapy; 6) the use of space modulated radiotherapy arches (VMAT - «Rapid Arc») has allowed to reduce the time of a session of radiotherapy with IMRT compared with 20-30 minutes to 3-5 minutes.Volume modulated radiation therapy technology using SIB reduce the time the patient’s treatment, the number of complications and achieve complete tumor regression.