Radiation Treatment in India.
1. Radio oncology--which are the organs that are covered under this subject? Can every cancer be treated by this method? At what stage of cancer can one undergo a radiation therapy? is there any age cut-offs for this treatment?
Radiation Treatment is an important modality of treatment for cancers, whereby X-rays ( most commonly used rays ) are used to ‘kill” cancer cells, or slow their growth or decrease the size of the tumors. This is achieved by causing damage to the DNA of the cancer cells so much so that these cells stop dividing or die.
Radiation can be used in all types of cancers, in all organs, in all stages and for all ages. But it should be realised that not all types of tumours are equally sensitive to radiation, Some tumours like lymphoma, cancers in head neck, cervix are very sensitive to radiation treatment and some of them are cured only with radiotherapy. On the other hand, tumours like sarcoma, some bony tumours are less sensitive to radiotherapy, and hence surgery has been considered as a curative option for treatment.
Similarly, the role of radiotherapy too varies according to the stage of the cancer. In early stages, a cervical carcinoma is treated with a curative dose of radiotherapy. But cervical carcinoma, at an advanced, metastatic ( when cancer has spread to distant organs) stage, is beyond cure. For these patients a short course of radiotherapy is offered only to give relief from symptoms like pain, bleeding, obstruction. So, radiotherapy can be used a Radical or curative approach and a noncurative or palliative approach
2. What is the advantage of a radiation as against chemotherapy? Are there any side effects and if yes how serious are they?
Radiation and chemotherapy are complementary to each other in cancer management. They are not comparable. Chemotherapy is a systemic treatment whereby a drug is given orally or by intravenous route. Radiotherapy is a local treatment, planned for the tumour bearing site.
Radiotherapy is not bereft of side effects. These side effects are due to its impact on normal cells around the tumour bearing area. The kind of side effects produced therefore depends on the area of the body that is being treated. Hence, if the head neck are is being treated, a patient may develop soreness and ulcers in the mouth and throat causing painful swallowing, darkening of the skin of the neck, hoarseness of voice. Radiation given to the abdomen, may cause diarrhoea, pain in the abdomen, some dysuria. The affected normal cells recover within a few weeks of completion of the radiation therapy. Hence most of these side effects are temporary and are cured after the radiotherapy is completed. There are some side effects which appear few months after the treatment. These are called as Late effects. Generally the late side effects can be managed effectively with conservative approaches.
Today, Radiotherapy techniques have evolved enormously with radiotherapy fields being tightly conformed to the tumour and largely sparing the normal tissues around. With these conformal and targeted radiation technologies, effects on normal tissues and hence untoward side effects have been minimized
3.Are there different radiation rays used in different types of radiation therapy? What are the minimum and maximum cycles of radiation does a patient need or can withstand?
Most commonly used radiation rays are X-rays. But electrons have also been used to treat very superficial tumours like those in the skin, lips, scalp etc. Protons, Neutrons are also making entry in the management of some selected tumours.
4.Does India have enough and good equipment in radiation treatment as compared to abroad? Generally, how is the treatment of cancer in India as compared to the western countries? Which is the country where one can avail the best treatment? Which is also the cheapest country to get the best treatment?
Radiotherapy treatment in India can be considered at par with any developed country, except perhaps the proton treatment which is yet to be made available in India. Rest all of the advanced forms of treatment with radiotherapy are available in our country.
But unfortunately, these facilities are available in only private and corporate hospitals at moderate to large expenses. Only a few selected Government hospitals have few of these advanced modalities, at long waiting lists of more than a year.
The cost of radiation treatment is of the same standard as in any advanced nation of the world, but much cheaper. It would probably be 10 times more expensive in dollars, to get treated in US or UK. That means, considering the cost of treatment in dollars or ponds, India is probably 500 times cheaper.
Each year in India, about one million new cases of cancer are being detected and more than 60% of them would require radiotherapy at some point during the course of their treatment. Around 60% of new cancer patients and 23% of previously radiotherapy-treated patients need radiotherapy as a part of their multimodality treatmentAssuming one machine treats 500 new cancer cases, we need a total of 2000 machines at the current incidence rate of cancer. There is a severe scarcity of radiotherapy units in our country. The Directory of Radiotherapy Centres (DIRAC) 2012 of IAEA has grouped India with poorest Sub-Saharan African countries with less than one radiotherapy machine per million people.(R.V. Kumar, Journal of Cancer Policy 4, 2015)
According to recent data, only 36,3% of patients in India have access to radiation treatment. The deficits of radiation units in India is to the order of 899 and deficits in number of radiation oncologists of 2186. By 2020, an additional of 1215 radiotherapy units and 2756 radiation Oncologists would be required. (dutta et al Int J Radiation Oncol Biol Phys, 2014)
70 - 80 % of our population live in villages, which are under Primary Health Care Centres, subdivision and District Hospitals. These are not equipped with any infrastructure like manpower, equipments etc for early diagnosis and treatment. At present the cancer treatment facilities are located in the state capitals and metropolitan cities.
6. Is there any research being conducted in india in radiotherapy? If so where and in what sphere? do we need more research in this field?
Research in cancer management with radiotherapy is being carried out at a few cancer dedicated centres. Yet, needless to say the numbers are meagre and more and more home grown research is urgently required. The lack of funds and facilities, lack of encouragement to doctors to dedicate time for research are major impediments to the disillusionment that is seen in the field of research in India
7.Do you sometimes feel inadequate and helpless while treating a patient? do give us a couple of cases you have handled when you felt completely helpless.
I would not refrain from accepting that the feel of inadequacy and helplessness is ever prevailing for doctors like me who practice in Non-government Institutes. The expenditures needs in cancer treatment at a private centre is high and beyond the reach of most middle class population. Young patients with early stage cancer, which are potentially curable, surrender themselves to death as the cost incurred is unattainable. Although we have programmes for treating curable patients who are below the poverty line, to be treated almost free of cost; but this is not enough to meet the needs of huge number cancer patients.
Most of the government centres are inadequately equipped or unequipped and are struggling with the government policies and beaureaocraticinterventions.Among the available units in government hospitals,many are too old either non-functional or working suboptimally. The gap between demands and availability radiotherapy facilities is soaring every year. This situation is grim and needs serious discussion at national level
Commonly asked questions about Cancer Management during Corona Outbreak in India ---