{"id":66882,"date":"2024-11-21T10:38:19","date_gmt":"2024-11-21T08:38:19","guid":{"rendered":"https:\/\/aslimnica.lv\/?p=66882"},"modified":"2024-11-21T10:38:19","modified_gmt":"2024-11-21T08:38:19","slug":"in-a-groundbreaking-procedure-the-east-hospital-employs-intraoperative-radiation-therapy-during-a-complex-pelvic-tumor-surgery","status":"publish","type":"post","link":"https:\/\/aslimnica.lv\/en\/jaunumi\/uncategorized\/in-a-groundbreaking-procedure-the-east-hospital-employs-intraoperative-radiation-therapy-during-a-complex-pelvic-tumor-surgery\/","title":{"rendered":"In a groundbreaking procedure, the East Hospital employs intraoperative radiation therapy during a complex pelvic tumor surgery"},"content":{"rendered":"

For the first time, the Riga East Clinical University Hospital (East Hospital) used intraoperative radiation device during a high-complexity sarcoma surgery. Following a thorough evaluation of the most effective and least invasive treatment options in a multidisciplinary preoperative council review, and by carefully planning each stage of the surgery, the team succeeded in facilitating the patient\u2019s recovery from a profoundly serious and seemingly hopeless condition.<\/strong><\/p>\n

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The patient is a young woman who underwent successful tumor removal surgery 12\u00a0years ago. Initially, she attended regular follow-up consultations to monitor her health, but eventually discontinued these visits and fell out of medical observation. \u201cSadly, oncology patients sometimes display this kind of defense mechanism, choosing to deny their diagnosis rather than come to terms with it. Consequently, they avoid follow-up appointments, fearing that \u201csomething\u201d may be discovered, and this particular patient was no exception. When her illness became impossible to ignore, she returned to seek medical assistance. It was a considerable challenge to prepare her for surgery and to plan the most effective treatment,\u201d pointed out Associate Professor Armands S\u012bvi\u0146\u0161<\/strong>, Head of the Oncology Surgery Clinic of the Latvian Oncology Centre inpatient facility at the Riga East University Hospital.<\/p>\n

First stage of surgery: surgical removal of sarcoma<\/em><\/strong><\/p>\n

By the time the patient arrived at the East Hospital, her health was in a critical state due to the massive size of the tumor. She presented high fever that would not drop for an extended period of time. It was evident that the greatest challenge would be the surgical removal of the massive tumor.<\/p>\n

\u201cThe sarcoma presented as a local recurrence, which most commonly spreads to the lungs. The tumor was lodged in the small pelvis, fused with the uterus and uterine appendages. One of the patient\u2019s ureters was compressed, causing functional issues, and it was necessary to relieve it first to save kidney function. We were prepared to remove all pelvic organs, including the bladder, uterine appendages, and the rectum, but we ultimately managed to preserve the bladder, which is still functioning. However, the tumor had to be removed along with the rectum, uterus, and uterine appendages. Since the tumor had invaded the pelvic walls, some nerves also had to be excised. There was a high risk of local recurrence. As the tumor grew, it pressed into the bone. We removed the tumor, but we cannot be certain if any microscopic cancer cells remain,\u201d explained Associate Professor A.\u00a0S\u012bvi\u0146\u0161<\/strong>, describing the course of the surgery.<\/p>\n

Second stage of surgery: radiation using the intraoperative radiation device directly in the operating room<\/em><\/strong><\/p>\n

This was the first time the intraoperative radiation therapy was employed to irradiate the tumor bed in the abdominal cavity (pelvis). This procedure took place during surgery, immediately following the surgical removal of the tumor by Associate Professor A.\u00a0S\u012bvi\u0146\u0161\u2019 team. The intraoperative radiation procedure itself takes just under two minutes, though substantial planning and preparation are necessary beforehand.<\/p>\n

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\u201cThe planning of radiation therapy primarily relies on radiological examinations. We examined the areas where the tumor was most closely attached, as these would be the most likely targets for radiation. Unlike breast tumors, where we have used intraoperative radiotherapy for some time, this case was more complex and challenging. The tumor was very large, but the pelvic cavity is a confined space from a radiotherapy perspective. In this particular case, it was initially difficult to predict which areas would be exposed during surgery and where additional radiation would be necessary,\u201d explained Gints Rausis<\/strong>, Radiation Oncologist in the Clinical Department of Radiotherapy at the Latvian Oncology Centre inpatient facility at the East Hospital.<\/p>\n

Hands-on training played a crucial role in the successful outcome, involving the entire team of radiation oncologists, radiographers, and medical physicists, who initially worked out the equipment setup and arranged the necessary tools for the radiation procedure.\u00a0 This was followed by a personalized radiation therapy plan for the patient, outlining the specifics of the radiation process. The plan specified the angle and size of the tube, the radiation dose, and the intensity required to irradiate the tumor bed and surrounding tissues. The radiation therapy plan underwent multiple checks to ensure the affected tissues were precisely targeted while healthy tissues were protected as much as possible.<\/p>\n

Conclusion of the surgery and findings<\/em><\/strong><\/p>\n

\u201cWith the successful implementation of intraoperative radiation therapy device at the East Hospital, the patient was able to avoid postoperative radiation therapy, leading to a gentler treatment approach and significantly decreasing the overall treatment time,\u201d summarizes G.\u00a0Rausis.<\/strong><\/p>\n

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The surgery was challenging, yet due to careful planning, it extended for eight hours.\u00a0 The patient experienced sensory disorders during the postoperative period, but she is now able to walk and move on her own without a wheelchair.<\/p>\n

\u201cWe can certainly say that the implementation of intraoperative radiation therapy rendered this surgery safer, which underscores the importance and benefit of innovative technologies. During the surgery, the safest scenario is when surgeons are able see what they are doing or what needs to be done. If visibility is compromised, it leads to stress. For added safety, we successfully employ a new surgical technique through multidisciplinary cooperation. Radiation oncologists and surgeons will investigate and validate the advantages, as our current working philosophy in tumor surgery is \u2013 all or nothing! I must express my deep satisfaction in being able to assist the patient, while also showcasing our collaboration, professionalism, and the use of innovative technologies,\u201d highlights Associate Professor A.\u00a0S\u012bvi\u0146\u0161<\/strong>.<\/p>\n

The surgery was performed by the medical team of the Latvian Oncology Centre inpatient facility at the East Hospital:<\/em><\/strong>\u00a0<\/strong><\/p>\n