Breast cancer is the commonest cancer in women in India. Breast cancer patients are often treated with a combination of surgery, chemotherapy, hormone therapy, and radiotherapy. Radiotherapy is generally used after surgery and is given to the whole breast to reduce the chances of recurrence. Patients often are prescribed 20, 15 or 5 courses of radiotherapy, delivered as 5 fractions per week. Most often we would recommend Rapid Arc or IGRT as a treatment option for breast cancers.
Cancers of the head and neck region are one of the commonest cancers in India in men and women. The main cause for these cancers is tobacco and related addictive substance abuse. Depending on the site of cancer and its stage, the treatment will vary for patients. Patients will most often need a 30 or 35 fractions of radiotherapy, with 5 treatments per week, lasting for 6 to 7 weeks. Ethos adaptive radiotherapy will be a treatment option for these patients. Radiotherapy is most commonly used in following situations in head and neck cancers:
- Post operative radiotherapy for advanced cancers of the mouth and throat.
- Radical radiotherapy for early stage throat cancers.
- Palliative radiotherapy for advanced incurable cancers to relieve pain, bleeding or breathing difficulty.
The incidence of prostate cancer in India is increasing rapidly and since it most often develops in older men, needs careful evaluation of treatment options. The treatment options typically include hormone therapy, radiotherapy, and surgery in a few select early stage prostate cancers. If radiotherapy is a the primary treatment option then most often patients are advised 20 or 25 fractions of radiotherapy. If it is used after surgery, then patients will need 30 to 35 fractions of radiotherapy. Ethos adaptive radiotherapy is the treatment of choice for prostate cancer patients.
Radiotherapy plans a vital role in most of the brain tumour treatments in combination with surgery. In primary tumours of the brain such as gliomas, it is used after surgery and patients will need 30 fractions of radiotherapy, over 6 weeks. Rapid Arc will be the treatment of choice in these situations. For small tumours, especially metastatic tumours, we could also use radiosurgery if feasible.
Lung cancers are often treated with a combination of chemotherapy, immunotherapy, surgery, and radiotherapy. For small lung cancers, radiosurgery for 3 to 5 fractions, is used very effectively. For larger lung cancers, a combination of chemotherapy and radiotherapy used for 30 fractions over 6 weeks, most often with Rapid Arc as a treatment.
The treatment options of cancers of the Gastro intestinal or digestive system depend on their location, stage, and a few patient related factors. Radiotherapy pays an important role in curative treatments as well as a palliative therapy to relieve distressing symptoms such as inability to swallow, pain, bleeding etc.
- In patients with oesophageal cancers in the upper part of the oesophagus, the treatment of choice would be radical radiotherapy and chemotherapy. Tumours of the middle and lower part of the oesophagus (food passage) are treated most effectively with giving a combination of radiotherapy and chemotherapy to shrink the tumour, and follow it up with surgery.
- Tumours of the rectum are treated most effectively with giving a combination of radiotherapy and chemotherapy to shrink the tumour, and follow it up with surgery. In patients who are not suited for surgery, a curative radical radiotherapy could also be offered in selected patients. Ethos adaptive radiotherapy is the treatment of choice for rectal cancer patients. The treatment of choice in patients with anal canal tumours is radiotherapy and chemotherapy in combination. Ethos adaptive radiotherapy is the treatment of choice for anal canal cancer patients.
- Tumours in the pancreas can be very effectively treated with radiosurgery if they are small. In select cases, radiotherapy and chemotherapy can be used to shrink the tumours down and follow it up with surgery.
- Many of the liver tumours are targeted with radiosurgery as a curative or palliative therapy. Radiosurgery can be effectively used in a select group of patients as a bridge therapy to liver transplant too.
Most common gynaecological cancer in India is cervical cancer. This cancer can be easily prevented by using a vaccine against HPV infection. Radiotherapy plays an important role of management of gynaecological cancers.
- Cervical cancers are primarily treated with a combination of radiotherapy and chemotherapy. Radiotherapy is delivered using Adaptive radiotherapy for 25 fractions over a period of 5 weeks. After that the patient undergoes 3 to 4 fractions of Brachytherapy for maximising the dose to the tumour.
- Uterine cancers are most often treated with a combination of surgery, chemotherapy, and radiotherapy. If patient needs external beam radiotherapy, it is delivered with Adaptive radiotherapy for 25 fractions over a period of 5 weeks. After that the patient undergoes 2 fractions of Brachytherapy for maximising the dose to the tumour. In select early stage uterine cancer patients, the patient may be treated with surgery, followed by only 3 fractions of brachytherapy.
In some patients we may not be able to offer cancer cure, but it is important to offer them comfort and a good quality of life. Radiotherapy plays an important role in this situation and helps to control the patient’s distressing symptoms. It is commonly used for treatment of metastatic tumours in the brain, bone, lungs, liver etc.