Role of Radiation Oncology in Cancer Management

• 16th January 2024

What is Radiation Oncology?

Radiation oncology is a medical discipline that involves the use of ionising radiation, such as
high-energy X-rays, in treatment of different diseases. It is a critical component of cancer care,
aiming to kill or shrink cancer cells while minimizing damage to surrounding healthy tissues.
Radiation oncologists (also known as Clinical Oncologists) work closely with a multidisciplinary
team to develop personalized treatment plans for a cancer patient. This ensures the highest
level of precision and effectiveness in delivering radiation therapy to patients. In this day and
age, Radiation Therapy plays a pivotal role in the comprehensive treatment of cancer, alongside
surgery, chemotherapy, and other modalities, to improve patient outcomes and enhance the
quality of their lives.

How does Radiation Therapy work?

• Radiation therapy can cause direct and indirect damage to the DNA of the cancer-
  affected cell. Post radiation, DNA inside the cell breaks and this prevents further growth
  of the cell. As a result, the cancer cell dies.
• Sometimes radiation is the only treatment a patient needs. Or else, radiotherapy may be
  combined with other cancer treatments like surgery, chemotherapy, targeted therapy
  and/or immunotherapy.
• To get the best results, radiotherapy may be given before, during, or after the other
  treatments as per international standards of care.

Types of Radiation Therapy:

Primarily, there are two types of radiotherapy. These are as follows-

1. External Beam Radiation Therapy:

This is a specific type of treatment where the tumor is irradiated from the source placed outside
the patient’s body. This therapy is usually delivered in more than one session. The entire course
of radiotherapy is divided into multiple smaller radiation doses. This may take a few days or a
few weeks. This approach gives time to the surrounding healthy tissues to recover and thus
minimizes the risk of any damage to the normal cells.

With the application of modern external beam radiation techniques, the advantages of
radiotherapy have increased both in terms of tumor control and normal tissue sparing. The
below-mentioned techniques are now routinely used for more precise treatment of cancer-

• 3DCRT (Three-Dimensional Conformal Radiotherapy)
•  IMRT (Intensity Modulated Radiotherapy)
• VMAT (Volumetric Modulated Arc Therapy)
• IGRT (Image Guided Radiotherapy)
• SRS (Stereotactic Radiosurgery)
• SBRT (Stereotactic Body Radiotherapy) / SABR (Stereotactic Ablative Radiotherapy)
• Electron Beam Radiotherapy

2. Brachytherapy:

• The procedure involves the use of applicators/needles, which are inserted into or near
  the tumor site. Unlike earlier, here the radioactive source is positioned directly inside the
  body or very close to the tumor. This type of treatment ensures a highly concentrated
  dose of radiation to the cancerous cell, sparing the healthy tissues of the surroundings.
  This localized treatment helps in increasing the effectiveness of the therapy.
• Brachytherapy implants can be either temporary or permanent types, depending on the
  type and stage of cancer. In temporary brachytherapy, the radioactive sources are
  removed from the body after a specified period of irradiation, while in permanent
  brachytherapy the implants may remain in the body for a longer period.

Overview of Radiation Oncology Workflow:

• Radiation Oncologist clinically evaluates the patient and comes up with a comprehensive
  treatment plan, appropriate for his / her disease.
• If external beam radiotherapy is indicated, patient is first scheduled for “Simulation”. On
  the predetermined day, he / she is simulated in the treatment position in an X-ray / CT
  machine (known as Simulator). The diseased body portion is meant to be immobilised
  during this step.
• Radiation Oncologist with the help of Medical Physicists carefully creates the individualised radiotherapy plan so that the delivery of radiation to the tumor is maximized and exposure to healthy surrounding tissues is minimized. This is achieved through expertise on the part of Radiation Professionals and simultaneous use of
  complex radiation dose calculation algorithms.
• Finally, treatment is delivered at the Radiation therapy machine (such as Medical Linear
  Accelerator) with the help of Radiotherapy technologists. Additionally, advanced imaging
  techniques, such as X-ray / CT scan / MRI are used to verify treatment positions when
  indicated / required.
• Radiotherapy treatment is administered over few days to few weeks depending upon the
  diagnosis. Patient’s treatment is closely monitored with regular review of treatment.
  Interval clinical assessments are done by the concerned radiation oncologist.

Benefits of Radiation Therapy:

1. As Definitive Therapy – Radiation therapy is highly effective at destroying a significant portion of cancer cells within a tumor.
2. As Adjuvant Therapy- Sometimes cancerous cells may be left behind in the tumor bed or elsewhere after surgery. In such cases, radiation therapy may be used to eradicate the remaining microscopic disease.
3. As Neoadjuvant therapy- Radiation therapy can reduce the size of tumor, thereby rendering previously inoperable tumors amenable to surgical removal.
4. Organ Preservation Approach- In some cancers, surgical removal of body organs can be prevented by using this radiation therapy.
5. Synergistic action- When radiotherapy is combined with other modalities of management (for example, chemotherapy), the effectiveness of the treatment is enhanced.
6. To reduce recurrence- For many common cancers, such as breast cancer, head and neck cancer, cervical cancer, skin cancer, etc. radiation therapy is highly effective in reducing the risk of cancer recurrence.
7. As Palliative Therapy- For conditions like bone metastases, brain metastases etc., radiotherapy may be used with palliative intent. Here the goal of radiation therapy is to ease the symptoms and improve the quality of life.

Summary:

• Radiation oncology has emerged as a transformative force in the domain of cancer, reshaping the landscape of oncology care.
• The advancements in this field, including cutting-edge techniques like stereotactic ablative radiotherapy, proton therapy, carbon ion therapy, and AI-driven treatment planning, have altered the precision, effectiveness, and personalization of cancer treatment.
• These innovations offer new hope, minimizing side effects and targeting tumors with more accuracy, ultimately enhancing treatment outcomes and quality of life.
• As radiation oncology continues to evolve and merge with other medical disciplines, it paves the way for a brighter, more hopeful future in the fight against cancer.

Why would you choose Desun Cancer Institute?

At Dept of Radiation Oncology, Desun Cancer Institute, radiotherapy treatments are planned &
delivered by a highly trained team of professionals who offer compassionate, patient centric,
and precise treatment. The team consists of:

• Radiation Oncologists: Specialist doctors who offer clinical care, develop the treatment outline, create the medical aspects of the radiotherapy plan and monitor the patient’s progress towards the best possible outcome.
• Medical Physicists: Physics experts who develop the technical aspects of the radiotherapy plan for treatment, and also ensure radiation safety for patients and staff.
• Radiation Therapy Technologists (RTT): Machine experts who deliver radiotherapy by operating the radiation machine and ensure patient care and safety during the treatment delivery.
• Nurses, who look after the patients and check their fitness for therapy on a daily basis.
• Support staff, such as the operations staff, patient service executives, housekeeping workers, security staff tend to support patients and their care givers, to make their journey through treatment as smooth as possible.

As we have iterated before, treatment of cancer is complex and is best done by a
multidisciplinary team of specialists to ensure the best possible outcomes. We at Desun
Hospital aim to offer the best multidisciplinary treatment options combining Radiation Oncology
with medical oncology, surgical oncology, radiology, pathology, nuclear medicine, rehabilitation,
and other supporting specialities. The team conducts multidsciplinary meetings in regular
intervals with all stakeholders to discuss specific cases in order to offer the best possible
treatment options as per international standards of care.

The Radiation Oncology department is currently archiving patient data both digitally and on
paper. This helps us to plan treatment more accurately, eliminate errors owing to missing data
and quick revival of patient information. However, for seamless delivery of service, we are
aspiring to become truly digital and paperless in near future.

As a new Oncology centre in the City of Joy, we are geared up to offer the most accurate and
precise cancer therapy to our patients in alignment with our core values of providing excellence
at an affordable cost.

• ByDesun Hospital