Thursday, March 6, 2014

Radiation therapy in modern era of cancer management:

Radiation therapy in modern era of cancer management:

Radiation therapy is being used successfully in cancer treatment for more than a century and is one of the corner stone of success in fight against cancer.  In early days, radium, caecium, radon capsules, which are radioactive materials were inserted in cervix for management of cervical cancer. Dramatic response in these tumours had resulted in interest with radioactive material in cancer management. Initial euphoria regarding the usage of radioactive materials attracted many researchers and there was surge in the indications of it's usage. The potential of gamma rays and x-rays in damaging the tumour cells were used to cancer. With gamma and x-rays, the tumour cell DNA is damaged more than the normal cells, and hence tumour cells are killed where as normal cells are relatively spared. After invent of x-rays, deep x-rays were used to treat tumours. Several x-ray machines were introduced and x-ray was being used to treat almost all diseases including peptic ulcer, ankylosing spondylosis (bone problem), psoriasis (skin problem). However, the progress was halted with evidences of reactions, second malignancies and other toxicities. There was a lull period for few decades in the development of radiation oncology specialty. And, during 1960s and 70s after the discovery of artificial radioactive materials, there was again revival of this specialty with 'tele-cobalt' machines. There was 'simulator' for planning treatment, scientific dose calculation methods, and accurate treatment delivery technology. 'Shields' and 'blocks' were being used to protect normal tissues and deliver higher dose of radiation to the target- 'tumour'. Favourable outcome with this modern radiation therapy gave the required confidence to the clinicians and more and more cancer patients were treated with radiation therapy with success. However, still there was lot of limitations in both treatment delivery and planning. There was no imaging to see the target, no proper computer assisted planning tools and there was visible scope of improvement of treatment delivery technology.
Modern day radiation therapy coincided with the advent of computers, imaging and mechanical revolution and also incorporation of technology in medical science. In 1990s, with advent of computers, CT and MRI scan and most importantly active involvement of technologists in research and development has revolutionized radiation therapy speciality. Modern radiation therapy is one of the 'most sort after' and 'high tech' medical specialty. Computer guided planning enables us to deliver high dose of radiation to the tumour and spare normal tissues. Intensity modulated radiation therapy and Image guided radiation therapy is the advanced radiation therapy delivery technology with most modern techniques. Now, robotic radiosurgery has enabled us to deliver high dose of radiation in very short time and complete radiation therapy in less than one-week time. Side effects of radiation have dramatically reduced and now radiation therapy is more acceptable to the patients. Radiation therapy is the standard of care in early head & neck cancer, cervical cancer and an important component of organ preserving procedures such as breast conservation. After surgery, majority of advanced cancers are treated with radiation therapy. Stereotactic radiosurgery is now the alternative to surgery in deep-seated 'difficult to do surgery' cases. There are numerous randomized studies with level-I evidences showing survival (mainly loco-regional control and also over all survival) benefit of radiation therapy in brain tumours, head & neck cancers, breast cancer, cervical cancer and other cancers.
Radiation therapy is a cost-effective option in management of metastatic diseases and palliative situations such as bone metastasis and brain metastasis. In developing countries like India with resource constraints radiation therapy should be used in most of the clinical situations, especially in palliative and management of pain.
In future, proton beam therapy, intra-operative radiation therapy and shorter course of radiation therapy (fractionated radiosurgery) will be the one of the main ammonium to fight against cancer. However, there are still many challenges in radiation oncology that needs to be addressed.

More than 70% of cancers need radiation therapy at some point of time. In 2020, India will have one of the largest numbers of cancer patients in the world and there will be two times than the present cancer burden. Unfortunately, there are in a severe scarcity of radiation therapy facilities in developing countries like India. At present situation, with available radiation facility in India only 30% of patients who require radiation treatment can avail radiation therapy. Majority of the patients need to travel far from their native place for treatment, only a small proportion of patients who need treatment receive radiation therapy, there is lack of awareness and cost of the treatment (facility) is also an issue. There is a need for more number of cancer facility including radiation therapy machines in different small cities and towns in India.  


The author of this article is Dr.Debnarayan Dutta, consultant, Apollo Speciality Hospital 



For More information feel free to blog your comments or write to lakshmipriya_b@apollohospitals.com or I can be reached @9940675877

1 PINEAL REGION LESION - CYBERKNIFE TREATMENT.

1  PINEAL REGION LESION - CYBERKNIFE TREATMENT.

     This 32 year old lady was evaluated for headache and visual disturbances. She has also had urinary and bowel incontinence. She was found to have a pineal region space occupying lesion with hydrocephalus. She underwent a VP shunt and was referred for radiotherapy. She was initially treated with SRT and cyberknife was used to deliver the additional boost dose with maximal sparing of normal structures in November 2010. She is on follow up. She is asymptomatic and good resolution of the lesion.

The patient was under treatment with Dr.Rathna Devi, senior consultant Radiation Oncologist. 


For More information feel free to blog your comments or write to lakshmipriya_b@apollohospitals.com or I can be reached @9940675877

CAVERNOMA TREATMENT WITH CYBERKNIFE

    


CAVERNOMA TREATMENT WITH CYBERKNIFE    

This 36 year old lady was evaluated for giddiness, vomiting and imbalance while walking. She was found to have a cavernoma in the left cerebellum. She was taken up for cyberknife radiosurgery due to the complications associated with surgery. She was treated with a single fraction radiosurgery as an out patient procedure in July 2012. She is on follow up with marked reduction in the volume of the cavernoma  and symptomatic improvement.

The patient was under treatment with Dr.Rathna Devi, senior consultant Radiation Oncologist. 


For More information feel free to blog your comments or write to lakshmipriya_b@apollohospitals.com or I can be reached @9940675877

Monday, October 7, 2013

CAVERNOMA - VASCULAR MALFORMATIONS _ CYBERKNIFE

     


 A 36 year old man from Kolkata was evaluated for the complaints of double vision and swaying while walking for 2 months. MRI showed a cavernous malformation in the brain stem. He was referred for radiotherapy as the location was eloquent. He was irradiated with fractionated radiosurgery keeping in mind the site of the lesion. 6 months after treatment he came for follow up. His gait was steady, his vision had improved and the MRI showed a dramatic decrease in the size of the lesion.


Vascular malformations of the brain pose threat by their propensity to bleed and cause neurological deficits. The brain stem location of this cavernoma makes surgery an obsolete option. The effective and conformal dose delivery helped in reduction in the volume of the malformation and improvement of symptoms.

Apollo Hospitals has treated more than 1000 cyberknife cases.


The patient was under treatment with Dr.Rathna Devi, senior consultant Radiation Oncologist. 

For More information feel free to blog your comments or write to lakshmipriya_b@apollohospitals.com or I can be reached @9940675877

CYBERKNIFE TREATMENT - ACOUSTIC SCHWANNOMA


      A 47 year old lady from Kolkata was evaluated for decreased hearing in the left ear. MRI revealed an acoustic schwannoma. BERA (audiometry) revealed profound to severe hearing loss on the left side. She came for radiosurgery. She was irradiated with cyberknife radiosurgery technique in January 2013. Six months later she came for follow up. Her hearing had improved and it was confirmed with an Audiometry then. MRI also showed a decrease in the size of the lesion.


Acoustic schwannoma is a benign neoplasm in the eight cranial nerve.  Surgery for these lesions are complicated by the fact that preservation of hearing is a difficulty. Cyberknife radiosurgery delivers adequate dose to control the tumor growth with preservation of hearing.


We have successfully completed more than 1000 cases 


The patient was under treatment with Dr.Rathna Devi, senior consultant Radiation Oncologist. 


For More information feel free to blog your comments or write to lakshmipriya_b@apollohospitals.com or I can be reached @9940675877