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April 2010
New Horizon in Radiotherapy
Dr Akhter Jawade
Cancer has emerged as the leading fallout of our fast changing lifestyles. Despite healthcare providers voicing their concerns, there has been very little implementation of the corrective nature. This dreaded disease has thus assumed enormous proportions and is one of the leading killer diseases now.

The treatment of cancer has vastly advanced in the past decade and is evolving every day. It is mainly a multidisciplinary approach that is followed, where three modalities of treatment - surgery, chemotherapy and radiotherapy – are used together. Of this, radiotherapy has advanced with the opening of newer horizons. About 70 percent of the cancer patients need radiotherapy, which can be both curative and/or palliative. But the major concerns are the late toxicities as a result of normal tissue irradiation.

Over the last decade, there have been major improvements in radiotherapy delivery and techniques. The reason for advancement is the need for lesser side effects, sparing of normal tissues as much as possible, delivery of higher dose to the tumour but minimal dose to the surrounding structures. Radiotherapy machines have come a long way from the age of deep X-rays and caesium to cobalt to the age of Linear Accelerators (Linac). With each passing day, the Linacs are being more and more modernised, with the ultimate aim to minimise doses to the normal tissues and precisely target highest dose to the tumour. Apart from the advancements in machines, there have also been major technological advances in treatment planning with CT scan, MRI, PET and computerisation in computation and treatment delivery.

In this respect, one of the most modern machines of the day is Novalis Tx. This latest state-of-the-art machine incorporates radiosurgery and radiotherapy. The salient features include high dose delivery rate, dynamic beam shaping and frameless patient positing. The Novalis Tx allows multiple beams of radiation with varying strength to be delivered into the brain or body for treating deep seated tumours, with the goal of sparing healthy tissues that reside close to the tumour.

Rapid Arc
The Rapid Arc delivery system when combined with the Novalis machine, the treatment time significantly shortens, while improving the target dose conformity to the tumour. Rapid Arc allows Novalis to deliver its treatments two to eight times faster than other systems, while maintaining the precision. Along with this, the delivery of conformal radiotherapy to an accuracy of 1mm is possible. Brain tumours can be treated with 0.1mm accuracy in single fraction. It is able to treat tumours from any angle, which helps protect critical organs. Thus, with the availability of the Novalis Tx machine (currently available at the Hyderabad and Kolkota Apollo Hospitals), treatment with radiotherapy is bound to be most precise and will be delivered in the most sophisticated manner.
Dr. Akhter Jawade is Consultant, Radiation Oncology at Apollo Gleneagles Hospitals, Kolkata

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