KOCHI: Radiation therapy, also known as radiotherapy, is a common treatment for cancer, but it takes around 25 to 30 days or sittings. However, patients can opt for radiosurgery treatment which can last from a few minutes to a few hours, depending on the location and type of area being treated.
However, for several reasons - the lack of expertise and awareness, the less time-consuming treatment method is not popular in India. “Lars Leksell, a Swedish neurosurgeon who also specialised in radiation, invented the method in the 1960s. The surgery takes only a day. So, he combined radiation with surgery - to treat tiny tumours in a day.
The primary criterion, to apply the method, is the tumour has to be small/ tiny and the treatment is restricted to the tiny tumour. If a larger area has to be treated - we cannot opt for radiosurgery,” said Dr Arunlal, consultant radiation oncologist at Lisie Hospital, Kochi.
"In the last 10 to 12 years, there has been a shift in terms of indications, data generation and refinement of the treatment. We have 10-year follow-up data that shows how safe and effective radiosurgery is. It has helped to improve the acceptance of radiosurgery," said Dr Debnarayan Dutta, assistant professor with the Department of Radiotherapy at Amrita Hospital, adding that robotic radiosurgery came to India in 2010.
Earlier, the procedure, called stereotactic radiosurgery, was only used to treat brain conditions. The technology can be now used to treat small tumours in the lungs and liver. The procedure is called stereotypic body radiotherapy. “We never used radiosurgery for prostate, liver or lung diseases earlier. Now it has become standard care.
If someone has a small bone metastasis, it is treated with radiosurgery and the outcome is better than the conventional surgery. It is similar for the lungs and liver too," added Debnarayan. The procedure is similar to radiation therapy. "For a patient undergoing radiosurgery, it is pretty similar to standard radiation treatment. An initial planning scan will be performed with an immobilisation device, on which the doctors mark the area to be treated and the normal tissues to be spared.
The planning takes place where angles are decided which will optimally treat the tumour and spare unaffected tissues. On the day of treatment, the patient will once again lie on the couch, scans will be taken to verify the position and treatment will be delivered. It will be painless and completely non-invasive. Unlike earlier, there is no need for fixed frames or fiducials to track in modern radiation oncology. Most of the difficult work is behind the scenes and patients can enjoy the benefits," said Arunlal.
Advantages
“The difference between radiation therapy and radiosurgery is the time required for treatment. Conventional radiation will require 25 to 30 sittings. In radiosurgery, it is given in a single shot. The radiation dose to surrounding parts is reduced and thus the side effect profile of the method is less,” added Arunlal. “Radiosurgery is a short treatment, usually lasting one to five days.
So the recovery time for patients, bystanders, day losses etc is lesser. It does not have many side effects. The quality of life is better maintained in radiosurgery as there aren’t many reactions,” said Debnarayan. “In case of brain metastasis, we don’t have to treat the whole brain. When we treat the brain completely, they may experience memory decline and it can be avoided when radiosurgery is used. Also, in certain cases, it can be an acceptable alternative to surgery,” added Arunlal
Options available
The treatment is available in almost all major cities in India. “High-end Linear accelerator (LINAC ) machines that can give both conventional radiation treatment and radiosurgery are available in all major super-speciality hospitals.
Facilities for gamma knife radiosurgery are available in AIIMS Delhi, NIMHANS Bangalore, Apollo Hospitals etc,” said Arunlal. “We need the expertise, machine and team to perform the procedure to deliver the high dose. We cannot make any errors. Expertise is critical. It is the only thing that stops the expansion of radiosurgery in India,” added Debnarayan.