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April 13, 2020 Monday 10:35:47 AM IST

Radio Therapy- Cost effective and Targeted Cure for Cancer

Health Monitor

Radiation therapy or radio therapy uses radiation, such as high-energy x-rays, gamma rays, electron beams or protons to destroy cancer cells and stop them from growing and multiplying. It is safe, effective and involves the controlled application of radiation to cancers anywhere in the body. The advantage of this treatment is that healthy non-cancerous cells are relatively less affected as opposed to cancer cells since they recover better from exposure to radiation. Radiation Oncology treatments are tailor made to suit the requirements of individual patients. It significantly improves the chances of cure or in some situations relieving symptoms such as pain. Treatment is focused on the affected area which reduces the negative impact or side effects on other parts of the body.

Types of Treatments
Treatment patterns will differ from patient to patient on the basis of the type, size and location of cancer, spread of cancerous cells in other parts of the body, intention of treatment (whether symptomatic relief or cure), whether treatment is single or used along with other forms of treatment, the general health and personal preferences of the patient. 
External Beam Radiotherapy: In this mode, the radiation is delivered from outside the body. It is painless and similar to taking an X-ray or CT scan. It is completely safe for the rest of the population and caregivers. To further clarify a common query faced in clinics , this will not make patients radioactive.
Brachytherapy: involves placement of applicators/radiation sources within the body. Most situations will not have restrictions on mingling with the general population although in highly selected situations it may involve some restrictions. Benefits 
Approximately 50% of the patients diagnosed with cancer each year could benefit from radiation therapy. About two thirds of it is delivered with a curative intent and the rest with the intention of providing symptomatic relief and to enhance quality of life. It was found that in 40% of all patients who have been cured of cancer, radiation therapy was used.  


It can be used as the main curative treatment, avoid risks of surgery and removal of organs. In the case of prostate, head and neck, bladder, lung, cervix and skin cancers, radiation therapy with or without drug therapy was found useful. 
Radiation Therapy is used in other common cancers such as breast, rectal, esophageal and prostate cancer in addition to surgery. It is helpful in reducing the risk of cancer recurrence after surgery and also to improve the outcome of surgery. It can also cure the cancer if it has recurred locally. 
It also has a very important place in helping patients with cancer that cannot be cured. In advanced cases, radiation therapy is commonly used to shrink tumours and or treat cancers that have spread to provide relief from pain and other symptoms. This is vital for improving a cancer patient’s quality of life. It is very effective for pain and other problems caused by cancer, such as bleeding from the lung or bladder. For example, pain in the bones from the spread of cancer can be reduced significantly in most patients. 
Most such treatments are non-invasive and most are delivered in the outpatient settings and no hospitalization is required. This makes it cost effective too. Each visit for treatment usually takes around 30 to 40 minutes with the actual beam on time generally about 3-5 minutes. This enables patients to carry out routine activities during treatment. 
External beam radiation therapy often requires multiple short visits to the treatment centre over a few days to several weeks (usually Monday to Friday). Generally, a small dose of radiation (known as a fraction) is delivered each time, adding up to the total dose. This minimises damage to healthy cells, as the cells can recover between treatments, and maximises the damage caused to cancerous cells.
Each year of life saved by radiation therapy costs us lesser than one saved using other cancer treatments. 
Side Effects 
Adverse effects will depend to a great extent on the area being treated. Some of the side effects reported are fatigue (in cases of prolonged treatment), skin redness and soreness, bowel upset, bladder symptoms, nausea, sore throat and mouth. Such problems can be treated with medications, creams and medicine management and doesn’t require stoppage of treatment. Hair loss will happen only in cancer of the brain, skull, scalp while those treated for head and neck cancer may find it difficult to swallow food in the later phase of treatment. Majority of side effects usually disappear within a few weeks of completion of radiotherapy. 
Doctors recommend radio therapy only if the benefits outweigh the risk of serious side effects. With the use of advanced linear accelerators such as the Truebeam, treatments have become targeted. This reduces the possibility of side effects. 
The commonly used treatment techniques for external radiation are:

3DCRT 
The three-dimensional conformal radiation therapy (3DCRT) involves imaging, precise radiation dose calculation, computer optimized treatment planning and computer controlled treatment delivery. It is effectively used in the treatment of brain tumors, breast cancer, gastrointestinal cancer, lung cancer and gynecological malignancies. 
IIMRT/RapidArc 
Intensity modulated radiation therapy (IMRT) is an advanced radiation technique employing recent innovations in imaging and computer technology.Using computer optimization, multiple small fields are designed to give a complex and conformal radiation dose distribution, which provides the prescription dose to the tumor target and minimizes dose to regional normal tissues. IMRT may improve cancer control rates and decrease toxicity rates in certain tumor types, such as head and neck cancer, prostate cancer, and some brain tumors. It is used for treatment of prostate, head and neck cancer, esophagus, lungs, skullbase tumours and also tumors in challenging locations. RapidArc is a rotational form of IMRT treatment which enables faster delivery ensuring that patient spends minimum time on the treatment couch.


IGRT 
Image-Guided Radiation Therapy(IGRT) is an advanced and innovative cancer treatment technology. In this system, advanced 2D and 3D imaging is used to ensure correct positioning of tumor for delivering medicine.  It is commonly used in prostate malignancies in conjunction with IMRT/RapidArc.Tumor movements within the body due to breathing and other movements are precisely tracked by the system thus providing effective cure. 
Cranial Stereotactic Radiosurgery
Radiosurgery is an extremely accurate way of delivering focussed radiotherapy. SRS is a non-surgical procedure and does not involve an actual knife; it is called “radiosurgery” because of its precision. Modern Linear accelerators like Trubeam are equipped with High Definition MLC and Robotic 6D Couch for Cranial Radiosurgery and fractionated stereotactic Radiotherapy. The modern imaging facilities and a 6D couch helps in performing Cranial Radiosurgery without an invasive fixed frame. 
Cranial Radiosurgery is used in the treatment of small brain metastases, benign brain tumors such as meningiomas, schwannomas and pituitary adenomas. It is also used in cases of arteriovenous malformations.

Stereotactic Body Radiotherapy
Stereotactic Body Radiation Therapy (SBRT) is a treatment procedure similar to stereotactic radiosurgery for the central nervous system, except that SBRT treats tumors outside of the central nervous system. A stereotactic radiation treatment for the body means that a high-quality onboard imaging system by Cone Beam CT along with a 6D Couch is used for the exact localization of the tumors in the body in order to treat them with limited but highly precise treatment fields. SBRT involves the delivery of a single high dose radiation treatment, or a few fractionated high dose radiation treatments (usually up to five treatments). SBRT is commonly used for liver tumours, lung tumours, paraspinal tumours and some vertebral tumours.


Conclusion 
Modern Radiotherapy is a focussed and cost-effective treatment. It has a big role in improving cancer cure rates and a positive impact on quality of life for patients diagnosed as having a malignancy


Dr. Jose Paul

The writer is a Consultant, Radiation Oncology, Rajagiri Hospital, Aluva.

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