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February 2011
Recent Advances in Radiation Oncology
Dr. Rathna Devi
 
Today,radiation therapy is considered a standard treatment for cancer and its symptoms. Sixty to seventy per cent of cancer patients are treated with radiation therapy at some point during their cancer care. Seventy per cent or more of these patients treated with radiation are being treated radically, to cure the disease. About 30 per cent are treated for palliation (to ease pain and other symptoms). Here’s how the treatment modality has advanced.

The evolution of radiation therapy has some definite landmarks to go by: from Radium to Cesium to Cobalt units to Linear Accelerators and now we have the Robotic linear accelerator, the Cyberknife. We have advanced from 2D dimensional radiotherapy to more accurate ways of delivering radiation.

3DCRT
Based on the CT scan, 3D Conformal Radiotherapy is the standard of care in many cancer patients. Targeting the tumour and sparing the normal tissue improves tumour control rate and reduces toxicity.

IMRT
Intensity Modulated Radiotherapy (IMRT) is the advanced form of radiation therapy where the target can be covered precisely, thereby reducing the dosage to adjacent normal tissues further. Hence, both acute and late toxicities are less in many cancer patients treated with IMRT. 

In head and neck cancer, salivary gland function is better preserved with this form of radiotherapy. IMRT not only limits skin reactions, it is also beneficial for abdominal and pelvic tumours. Cancers such as head and neck cancer, nasopharyngeal cancer, prostate cancer and few of the brain tumours are among others where IMRT is commonly used.

IGRT
Image Guided Radiotherapy (IGRT) is a treatment delivery system that takes into account the movement of the tumour along with respiration. This technology is most effective in lung cancer and any moving targets such as liver and other abdominal tumours.

SCRT & SRS
Stereotactic Conformal Radiotherapy (SCRT) is another modern radiation therapy with minimal margin is treated with high dose radiation therapy. Stereotactic Radiosurgery (SRS) is an advanced single fraction treatment schedule for mostly benign and low graded brain tumours. 

Cyberknife
This robotic surgery system is a non-invasive alternative to surgery for the treatment of both cancerous and non cancerous tumours anywhere in the body, including the prostate, lung, brain, spine, liver, pancreas and kidney. The treatment – which delivers beams of high dose radiation to tumours with extreme accuracy – offers new hope to patients worldwide. 

Cyberknfie uses pencil beams of radiation which can be directed at any part of the body from any direction via a robotic arm. This tracks the tumour’s position, detects any movement of the tumour or patient, and automatically corrects its positioning before targeting the tumour with multiple beams of high energy radiation, destroying abnormal tissue without damaging surrounding areas.

Brachytherapy
Derived from ancient Greek words for short distance (brachy) and treatment (therapy), it is sometimes called seed implantation,and been in use for over a century. An outpatient procedure used in the treatment of different kinds of cancer, it can treat prostate cancer, cervical cancer and endometrial cancer. Brachytherapy proved to be very effective and safe providing a good alternative to surgical removal of the prostate, breast and cervix while reducing the risk of certain long term side effects.
 
Dr. Rathna Devi is Sr. Consultant - Radiation Oncology at Apollo Speciality & Cancer Hospital, Chennai


    
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