Overcoming challenges and promoting adoption of precision radiation therapy is crucial to fully harness its potential in India
FICCI and EY recent report mentions that real cancer incidence level in India is estimated to be 1.5 to three times higher than reported incidence as 51 per cent patients take more than a week to conclude diagnosis while 46 per cent take second opinion due to lack of confidence in initial diagnosis and suggested treatment. The reported cancer incidence in India this year is estimated to be 19 to 20 lakh, whereas real incidence is 1.5 to 3 times higher than the re- ported cases, the study revealed.
While diagnosing it on time is important, enhancing and advancing the treatment process is also the need of the hour. Techniques like precision radiation therapy is emerging as a revolutionary approach to cancer treatment. Offering newfound hope and improved out- comes, this technology has the potential to redefine cancer care in the country.
Dr Sumit Basu, Consultant-Radiation Oncology, Kokilaben Dhirubhai Ambani Hospital explains that, “Cancer continues to be a major public health concern worldwide, and India is no exception. As the most populous country in the world, the burden of cancer is significant in India. However, recent advancements in precision radiation therapy have brought about a transformative impact on cancer treatment in the country. Precision radiation therapy, also known as radiation oncology, is an advanced technique that targets cancer cells with remarkable accuracy while sparing healthy tissues.”
The need for precision radiation therapy in India arises from the desire to improve cancer treatment out- comes, minimise side effects, and optimise healthcare resources.
Emphasising on the need for precision therapy, Dr Rishabh Kumar, Consultant, Department of Radiation Oncology, Amrita Hospital said, “In the ever-evolving world of medical science, precision radiation therapy has emerged as a beacon of hope for cancer patients. Its precision-guided approach is akin to a smart bomb that zeroes in on the tumour, leaving the surrounding healthy tissues unscathed.”
“Consider the precision and adaptation needed to hit a moving target – similar are the challenges faced in targeting a tumour that could change size and position within our bodies. Precision radiation therapy, with its accuracy in delivery and adaptive strategies, individualises each treatment plan, optimising the radiation dose and of- ten reducing overall treatment time. The result? More effective treatment and an improved patient experience”, he added.
Talking about how precision radiation therapy solutions in India are transforming cancer treatment, Dr Vikas Kothawade, HoD-Radiation Oncology, Jupiter Hospital said, “Cancer treatment in India has witnessed significant advancements with the transformative impact of precision radiation therapy solutions. This cutting-edge approach, coupled with personalised treatment approaches, is revolutionising the field of radiation therapy, leading to improved out- comes and enhanced patient experiences.”
Advanced technologies in precision radiation therapy
There are significant advancements with transformative impact of precision radiation therapy solutions on cancer treatment in India.
Overall, while traditional radiation therapy remains an essential treatment modality in India, the adoption of precision radiation therapy is growing steadily. Precision radiation therapy offers significant advantages in terms of treatment accuracy, reduced side effects, and improved outcomes, making it a valuable addition to cancer treatment options in the country. However, the choice of treatment modality ultimately depends on factors like tumor type, stage, location, patient health status, and the availability of advanced technologies at the treatment facility.
Dr Vikash Kumar, Associate Director-Radiation Oncology, Asian Hospital stresses that traditional radiation therapy techniques deliver radiation to the tumour and surrounding healthy tissues, leading to potential side effects and damage to healthy cells. He said, “The need for precision radiation therapy arises from the complexity and heterogeneity of cancer tumours. Precision radiation therapy aims to overcome these challenges by precisely targeting cancer cells while minimising damage to the surrounding tissues. This approach improves treatment efficacy and reduces treatment-related complications, ultimately enhancing patient outcomes.
Dr Kothawade mentions, “Traditional radiation therapy techniques often had limitations in accurately deliver- ing radiation to the tumor site, leading to unnecessary exposure of healthy tissues and underdosing of tumour tissue. Advanced technologies have able to locate the tumour and healthy tissues to overcome the problem with conventional techniques.”
Some of the key advanced technologies in precision radiation therapy include Intensity Modulated Radiation Therapy (IMRT), Image Guided Radiation Therapy (IGRT), Stereotactic Body Radiation Therapy (SBRT), Volumetric Modulated Arc Therapy (VMAT), Proton Therapy and Magnetic Resonance-guided Radiation Therapy (MRgRT) etc.
Experts throws light on some of the advanced technologies
Dr Ajay Kolse, Sr. Consultant Radiation oncologist, Holy Family Hospital believes that the concept of precision radiation oncology involves much more than mastery of technology. Mentioning about some of the technologies, he said, “After the era of cobalt 60, LINACs have taken over the most industrialised countries. LINACs delivered 3D CRT, IMRT, IGRT, VMAT/ RapidArc techniques. They utilised real time in room imaging improved accuracy. IMRT & IGRT has shown the way to the concept of focal localised therapy. For small target volume stereotactic radiation therapy applies a large number of radiation fields or arcs to produce a steep dose fall off outside the target volume. This often enables to deliver very high, ablative doses in one to five treatments.”
Dr Basu also explains, “IGRT combines advanced imaging techniques, such as MRI, CT scans, and PET scans, with radiation therapy. This real-time imaging allows oncologists to track tumor movements, enabling precise adjustments to the radiation beams during treatment. IMRT uses computer-controlled linear accelerators to deliver varying radiation doses to different areas of the tumor. This technique optimises dose distribution, conforming to the tumor’s shape, while sparing healthy tissues. SBRT and and Stereotactic Radiosurgery (SRS) deliver high doses of radiation to small, well-defined tumors with extreme precision. These techniques are particularly effective for cancers in the brain, lung, liver, and spine.”
Throwing light on particle therapy, Dr Kolse said, “Particle therapy can deposit energy at or around the target with no exit dose beyond the target, a phenomenon known as “Bragg peak”. The main benefit of particle theory is that normal tissues are significantly less exposed compared with photon therapy or curative radiation dose can be delivered to the tumour closed to critical structure.”
Integration of personalised approaches within precision radiation therapy
Another important aspect that can enhance the overall outcome of precision radiation therapy is via integration of personalised approaches within the technique. It empowers the oncologist with tailored treatment plans which is unique to each patient for maximum effect.
Manikandan Bala, Managing Director, India and Senior Vice President, Inter- continental, Elekta shares “India is in the midst of a transformation in cancer treatment. The integration of cutting-edge technologies and personalised treatment approaches is revolutionising the field of radiation oncology. This is leading to improved treatment outcomes and an enhanced patient care experience.”
Dr Tejinder Kataria, Chairperson, Radiation Oncology, Cancer Institute, Medanta said, “Treatment tailored to an individual patient with due protection of functional and structural integrity of organs and tissues around the cancer is defined as a personalised treatment approach.”
Dr Kumar highlights, “In an era of personalised medicine, radiation therapy isn’t far behind. Armed with genomic profiling, doctors can tweak treatments to match individual patient profiles. Techniques such as adaptive radiation therapy and dose painting ensure treatments can be modified to remain effective even as a patient’s tumour or health status changes.”
Emerging trends and future innovations in precision radiation therapy
Experts believes that emerging technologies like Artificial Intelligence (AI), Machine Learning (ML) and FLASH radiotherapy etc can pave way for new era in cancer treatment.
The future of precision radiation therapy looks radiant with possibilities, says Dr Kumar. He also mentions that with advancements in AI and machine learning, imaging technologies, and emerging techniques like FLASH radiotherapy, biologically guided radiation therapy, and nanotechnology, we are on the cusp of a new era in cancer treatment.
Dr Srinivas Chilukuri, Senior Consultant- Radiation Oncology, Apollo Proton Cancer Centre explaining about another technology added, “Hypofractionation refers to delivering higher doses of radiation over a shorter period, reducing the overall treatment time. This approach is possible due to improved targeting accuracy and the ability to spare healthy tissue, leading to more convenient treatment schedules for patients.”
Pioneering a path to progress: Overcoming challenges and driving adoption
The journey towards widespread adoption of precision radiation therapy in India is not without its challenges. Overcoming challenges and promoting adoption of precision radiation therapy is crucial to fully harness its potential in India.
Raising awareness, collaborative approach within the framework, skill development, enhancing the accessibility and affordability are some of the hurdles that must be overcome that can drive the successful integration of precision radiation therapy into mainstream cancer treatment protocols.
◆ Awareness and education: Bridging the knowledge gap among medical professionals and patients about the benefits of this technique and educating them about the misconceptions via targeted educational programs, workshops, and conferences can be done.
On this, Bala shares, “By embracing cutting-edge technologies and promoting ongoing training & education, we can empower healthcare providers to deliver transformative cancer care that achieves better treatment outcomes for every patient served.”
Emphasising on the shortage of skilled professionals, Dr Chilukuri said, “There is a shortage of skilled healthcare professionals (oncologists, physicists and therapists) trained in precision radiotherapy techniques, leading to a lack of expertise in the field. Limited awareness and understanding among healthcare providers and the general public about the benefits and availability of precision radiotherapy further hinder its adoption. Addressing these challenges requires investments in infrastructure, training programs, and public awareness campaigns to promote the widespread adoption of precision radiotherapy in India.”
◆ Accessibility and affordability: The high initial costs associated with state-of-the- art equipment and infrastructure pose a significant challenge to its widespread adoption, particularly in smaller medical facilities is also one of the challenges accompanied by its accessibility to a broader spectrum of patients and healthcare providers.
On this Dr Kataria mentions, “India is a vast country with heterogenous distribution of advanced medical services across its landscape. Delivering an affordable care is one of the greatest challenges in India. Different cancer types, socio-economic diversity, inequitable access to care, myths with respect to cancer treatment, attitude of the general populace along with infrastructure limitations, complicate timely and effective cancer treatment in our country.”
Dr Chilukuri opines, “Limited access to advanced imaging technologies and high-resolution equipment in many healthcare facilities hinders accurate treatment planning and delivery. The high cost associated with these technologies creates financial barriers for both healthcare institutions and patients. The government charges a large customs duty on most of the equipment which is imported from other countries. We are hoping with the introduction of homegrown linear accelerator technology, the demand for high-precision radiation therapy equipment will improve access to this technology in India.”
◆Role of collaborative approach: Establishing partnerships between healthcare institutions and technology providers can facilitate knowledge sharing, research collaboration, and joint development of best practices. Such collaborations will strengthen India’s position as a frontrunner in precision radiation therapy and expedite its integration into standard cancer care practices.
Dr Vikas Kumar also opines, “Collaboration among radiation oncologists, researchers, and technology developers is of utmost importance in advancing precision radiation therapy solutions. By working together, they can drive research, develop innovative technologies, and establish best practices. Collaboration fosters knowledge exchange, accelerates technological advancements, and ensures that patients benefit from the latest developments in precision radiation therapy.”
Dr Kothawade believes that collaboration among radiation oncologists, researchers, and technology developers is crucial in advancing precision radiation therapy solutions. He said, “By combining clinical expertise, scientific research, and technological advancements, the field can continually evolve and provide the best possible care for cancer patients in India.”
Stressing on increasing the effectiveness of these innovations with collaborative effort, Dr Kumar said, “Imagine a virtuoso orchestra – the radiation oncologists, researchers, and technology developers are the instrumentalists. Each plays a unique and critical part, and together, they create a harmonious symphony that drives innovation and improves patient outcomes. The orchestra extends to include other healthcare professionals, patients, regulators, and policymakers, creating a holistic melody of advanced radiation therapy solutions in India.”
“As the precision radiation therapy symphony plays on, it echoes the promise of revolutionising cancer treatment in India, turning the tide in the battle against this formidable disease. Now, that’s a tune we can all look forward to”, he added.
Way forward
By addressing the current challenges and implementing the collaborative approach, India can enhance the adoption of precision radiation therapy, ultimately leading to improved cancer treatment outcomes and a higher quality of life for cancer patients across the country. As technology continues to advance and become more accessible, precision radiation therapy is likely to play an increasingly pivotal role in the fight against cancer in India.
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