Radiation Oncology in Cancer Care: A less known, even lesser understood and one of the most complex cutting edge weapons in cancer care
Monday - September 21, 2020 2:17 pm ,
Category : HEALTH
By - Dr Dodul Mondal
Consultant Radiation and Clinical Oncologist, Indraprastha Apollo Hospitals, Delhi, India
Cancer is considered as a modern day epidemic and there is no sign that it is going to be cured with any magic wand overnight. The apprehension is that it will be ever-growing with every passing year. At present, worldwide annual incidence rate of cancer is close to 18 million per year causing death of 9 million per year. All of us know that if detected and treated early, most cancers are curable. And many of us know that radiation therapy, surgery and chemotherapy are used to treat cancer. Saying chronologically and logically, surgery or removal of the tumor was the initial and only way of treating cancer since hundreds of years (no matter primitive it was in the earlier times). But needless to say, it did work for many cancers and gave cure to many as well for many years before radiation came into play. It is not difficult to realize that human being learned use of knife earlier. Compared to surgery, radiation therapy is a relatively newer modality which started after discovery of x-ray by Roentgen and radioactivity by Marie Curie, two history changing scientists of the modern medical science. Chemotherapy came even later, in the 1940s, initially for treatment of blood cancers followed by other cancers and its wide application came into picture since 1970s.
Other than surgery, radiation is considered as the only way to cure cancers. Not always surgery is required and not always it can be performed due to various reasons related to patient, tumor itself and many others.Radiation takes a significant role as a curative treatment option in cancer care. As per one of the reports from USA, 50% of the newly diagnosed cancer patients receive radiation for some reason during their anticancer treatment out of which 60% are with curative intent.Putting it simply, 30% of newly diagnosed cancer patients can be cured using radiation as a solo modality or part of their combined modality treatment.
When I look back my initial training days and compare it with current available facilities in Radiation Oncology, I feel astonished. A consistent, rapid and progressive development has been happening since last two decades giving significant benefits to the cancer patients worldwide. Majority of these developments have made radiation planning and delivery complex, sophisticated, extremely precise and accurate. When we talk about the “Precise” treatment, we talk about accuracy within a limit of one tenth of a millimeter on many instances. The concept of “Precision Oncology” can well be equated with “Precision Radiation Oncology”. These have allowed the Radiation Oncologists deliver higher dose to the tumor while safeguarding the surrounding non tumor normal organs. Needless to say, to achieve this successfully, Radiation Oncologists have to be highly trained, accurate and precise with a surgical acumen. Gone are the days when it used to be called as “radiotherapy” which has an uncanny phonetic similarity with “physiotherapy or something similar”. Gone are the days when radiation oncologists used to put square or rectangle marks on patient’s skin with permanent skin markers and patients used to be treated within minutes of applying those marks. Gone are the days when radiation used to cause excessive skin burns making it difficult to provide good cosmesis. Modern day radiation techniques are highly sophisticated with use of computer and software at almost every steps of the treatment. It uses extensive radiology information and knowledge compared to many other contemporary medical disciplines. It uses machines and software which are constantly being upgraded and refined. All these changes have made radiation treatment better tolerated with lesser side effects. Like in any other rapidly changing branches, it also needs highly motivated doctors who can provide the best to their patients and care seekers. In simple words, sometimes it becomes impossible for a fellow medical colleague from a different specialty to realize what goes on inside a radiation oncology department.
There are many instances when a tumor or cancer can be completely cured by radiation even without undergoing a big and risky surgery. For example, many throat cancers, few brain tumors and brain conditions (like an abnormality of blood vessels inside brain), lung cancers in few selected situations, cancer of food pipe in few specific situations, liver cancers on many occasions and even selected group of patients with stage IV cancers can be cured with radiation alone. And the list does not end there! As radiation most of the time does not involve cutting of and organ or anesthesia, it hardly causes death of a person. Since ages however, radiation has been made to be the villain which causes burn. People forget many times that an organ removed by a surgery never comes back. People also forget many times the disfigurement caused by a surgery, loss of an organ function caused by a surgery, trauma and risks associated with surgery and of course the cost! Various technological advancements have taken place and newer techniques like Stereotactic Radio Surgery or SRS (a surgical outcome without a knife), Stereotactic Body Radiation Therapy or SBRT, Image Guided Radio Therapy or IGRT, Tomotherapy etc. have made radiation treatment more precise with lesser side effects. Of course, it would be wrong to assume that surgery is not required. In most of the curable stage cancers, surgery is of course the primary treatment. However, it is important to understand that even when surgery is impossible, radiation can offer cure to many such cancers.
It is especially important to understand the importance of well-trained radiation oncologists who are vital between disease cure and incurability (just like a good surgical skill is essential in providing cure without much damage). As strange it may sound, truth is, even many doctors find it difficult to understand what radiation does in reality, how is it done, how is it planned, how is it delivered and how important it is in providing cure to a cancer patient. I often say, it takes almost a year for a radiation oncology trainee to understand what is radiation oncology!Using this overly complex specialty as part of cancer care at an appropriate time, at an appropriate place and under an appropriate person is crucial to win the war against “The Emperor of All Maladies”!
(Dr Dodul Mondal was previously Asst. Professor at National Cancer Institute of AIIMS Delhi and Fellow, Proton Beam Therapy and Precision Radiation Oncology at Cancer Institute of New Jersey, USA)
Consultant Radiation and Clinical Oncologist, Indraprastha Apollo Hospitals, Delhi, India
Cancer is considered as a modern day epidemic and there is no sign that it is going to be cured with any magic wand overnight. The apprehension is that it will be ever-growing with every passing year. At present, worldwide annual incidence rate of cancer is close to 18 million per year causing death of 9 million per year. All of us know that if detected and treated early, most cancers are curable. And many of us know that radiation therapy, surgery and chemotherapy are used to treat cancer. Saying chronologically and logically, surgery or removal of the tumor was the initial and only way of treating cancer since hundreds of years (no matter primitive it was in the earlier times). But needless to say, it did work for many cancers and gave cure to many as well for many years before radiation came into play. It is not difficult to realize that human being learned use of knife earlier. Compared to surgery, radiation therapy is a relatively newer modality which started after discovery of x-ray by Roentgen and radioactivity by Marie Curie, two history changing scientists of the modern medical science. Chemotherapy came even later, in the 1940s, initially for treatment of blood cancers followed by other cancers and its wide application came into picture since 1970s.
Other than surgery, radiation is considered as the only way to cure cancers. Not always surgery is required and not always it can be performed due to various reasons related to patient, tumor itself and many others.Radiation takes a significant role as a curative treatment option in cancer care. As per one of the reports from USA, 50% of the newly diagnosed cancer patients receive radiation for some reason during their anticancer treatment out of which 60% are with curative intent.Putting it simply, 30% of newly diagnosed cancer patients can be cured using radiation as a solo modality or part of their combined modality treatment.
When I look back my initial training days and compare it with current available facilities in Radiation Oncology, I feel astonished. A consistent, rapid and progressive development has been happening since last two decades giving significant benefits to the cancer patients worldwide. Majority of these developments have made radiation planning and delivery complex, sophisticated, extremely precise and accurate. When we talk about the “Precise” treatment, we talk about accuracy within a limit of one tenth of a millimeter on many instances. The concept of “Precision Oncology” can well be equated with “Precision Radiation Oncology”. These have allowed the Radiation Oncologists deliver higher dose to the tumor while safeguarding the surrounding non tumor normal organs. Needless to say, to achieve this successfully, Radiation Oncologists have to be highly trained, accurate and precise with a surgical acumen. Gone are the days when it used to be called as “radiotherapy” which has an uncanny phonetic similarity with “physiotherapy or something similar”. Gone are the days when radiation oncologists used to put square or rectangle marks on patient’s skin with permanent skin markers and patients used to be treated within minutes of applying those marks. Gone are the days when radiation used to cause excessive skin burns making it difficult to provide good cosmesis. Modern day radiation techniques are highly sophisticated with use of computer and software at almost every steps of the treatment. It uses extensive radiology information and knowledge compared to many other contemporary medical disciplines. It uses machines and software which are constantly being upgraded and refined. All these changes have made radiation treatment better tolerated with lesser side effects. Like in any other rapidly changing branches, it also needs highly motivated doctors who can provide the best to their patients and care seekers. In simple words, sometimes it becomes impossible for a fellow medical colleague from a different specialty to realize what goes on inside a radiation oncology department.
There are many instances when a tumor or cancer can be completely cured by radiation even without undergoing a big and risky surgery. For example, many throat cancers, few brain tumors and brain conditions (like an abnormality of blood vessels inside brain), lung cancers in few selected situations, cancer of food pipe in few specific situations, liver cancers on many occasions and even selected group of patients with stage IV cancers can be cured with radiation alone. And the list does not end there! As radiation most of the time does not involve cutting of and organ or anesthesia, it hardly causes death of a person. Since ages however, radiation has been made to be the villain which causes burn. People forget many times that an organ removed by a surgery never comes back. People also forget many times the disfigurement caused by a surgery, loss of an organ function caused by a surgery, trauma and risks associated with surgery and of course the cost! Various technological advancements have taken place and newer techniques like Stereotactic Radio Surgery or SRS (a surgical outcome without a knife), Stereotactic Body Radiation Therapy or SBRT, Image Guided Radio Therapy or IGRT, Tomotherapy etc. have made radiation treatment more precise with lesser side effects. Of course, it would be wrong to assume that surgery is not required. In most of the curable stage cancers, surgery is of course the primary treatment. However, it is important to understand that even when surgery is impossible, radiation can offer cure to many such cancers.
It is especially important to understand the importance of well-trained radiation oncologists who are vital between disease cure and incurability (just like a good surgical skill is essential in providing cure without much damage). As strange it may sound, truth is, even many doctors find it difficult to understand what radiation does in reality, how is it done, how is it planned, how is it delivered and how important it is in providing cure to a cancer patient. I often say, it takes almost a year for a radiation oncology trainee to understand what is radiation oncology!Using this overly complex specialty as part of cancer care at an appropriate time, at an appropriate place and under an appropriate person is crucial to win the war against “The Emperor of All Maladies”!
(Dr Dodul Mondal was previously Asst. Professor at National Cancer Institute of AIIMS Delhi and Fellow, Proton Beam Therapy and Precision Radiation Oncology at Cancer Institute of New Jersey, USA)
