TomoTherapy: Rays of Hope
Even after available treatments of cancer, it is still the leading cause of death in India. Around 2.25 million people are suffering from the disease. Breast and oral cancers are the most common types of cancer among the Indian population.
From surgery to radiation therapy, early detected cancer can be treated and, in many cases, completely cured with such treatment. Apart from fighting against the disease, it exposes the patients to adverse side effects like anemia, appetite loss, edema, etc. which takes a while to recover. The side effects of cancer treatment with chemotherapy and radiation therapy damage the affected cells and the surrounding cells and organs as well.
Radiation therapy, also known as radiotherapy, uses high-intensity radiation to kill the cancerous cells and reduces the tumor cells in the body. It is commonly used in X-rays at a lower dose to detect broken bones and teeth. But, the use of radiation at regulated (especially low) intensity is not just restricted to X-rays, it is also used for proton therapy and tomotherapy to treat cancerous cell with least damage to the surrounding cells and organs.
According to Dr. Niranjan Naik, Director and Surgical Oncologist at Fortis Memorial Research Institute, “TomoTherapy is a new way to deliver radiation treatment in the fight against cancer. The treatment process combines an integrated process of planning, CT image-guided patient positioning, and treatment delivery. The equipment of TomoTherapy is similar looking to computed tomography (CT) system. During treatment, the patient lies on a couch that moves continuously through a rotating ring. Radiation is delivered from all angles as the ring turns and the couch moves through the gantry”.
But what makes TomoTherapy different from other radiation therapies? To this Dr. Naik said to BW Healthcareworld, “With TomoTherapy, physicians can adjust the size, shape, and intensity of the radiation beam to accurately target the size, shape, and location of the patient's tumor. It also minimizes the damage to surrounding, healthy areas and reduces the side effects of radiation therapy”.
Cancer is being treated with chemotherapy and radiotherapy. But what makes tomotherapy different from other cancer therapies? Answering to this question, Dr. Tejinder Kataria, Chairperson, Radiation Oncology, Medanta, The Medicity said to BW Healthcareworld, “Tomotherapy is the world's only integrated machine for radiotherapy with IMRT (Intensity Modulated RadioTherapy) and IGRT (Image Guided RadioTherapy). Here we have a linear accelerator and a CT scanner mounted on a ring gantry (like that of a CT scan) and the patient couch moves through the ring gantry permitting helical scanning besides moving up and down and helical treatment delivery is done. Helical CT scan on-couch can only be done on a tomotherapy for IGRT verification and is not possible on other Linear accelerators. In other Linear accelerators, the patient couch can move up-down, sideways and rotate around its own axis and either a virtual CT scan or planar digitally reconstructed images are used for IGRT. Secondly, tomotherapy can treat a field of 5mm to 135cms (Magna-field radiation) whereas on a linear accelerator field-sized varies from 3mm-40cms maximum, making whole body treatments & long field treatments time-consuming and difficult for the patient.”
Talking about the treatment, side effects and recovery, Dr. Kataria said, “We have treated over 950 patients since March 2016. The dosimetric promise of reduced dose to adjacent organs and side effects is clinically discernible and the patients are quite happy about the reduced time on the couch with lesser side effects. This is especially true of children and adults taking treatment for total body irradiation (TBI) as conditioning for Bone marrow transplant. Oncologists have reported a lesser incidence of mucositis and minimal 90-day mortality due to pneumonia for patients treated on tomotherapy. In patients with bilateral breast cancer, the treatment time on tomotherapy is 45 minutes as compared to 90 minutes on a Linear accelerator. For a TBI, it used to take almost 2 hours for treatment completion and that has been reduced to 40 minutes. And the post-treatment recovery takes about 2-3 weeks for most patients.”
Cancer treatment costs lakhs in India that is unaffordable for the rural part of India. But, Tomotherapy is affordable for patients and is priced at a lesser cost than a Linear accelerator treatment of VMAT. While explaining the machine, Dr. Kataria adds, “Purchase of machines in India occurs at the international rates and a higher number of patients is throughput on each machine, almost double, as compared to international centers. However, the cost to patient cannot be reduced beyond a certain level otherwise the quality of treatment can suffer, in case a higher throughput is desired.”
Dr. Kataria shared the success of Tomotherapy HD at Medanta the Medicity, a first in the Private sector in India in 2016 and patient acceptability has resulted in a greater demand for tomotherapy treatments in Tier 1 cities. In 2018, about 10 tomotherapy units were sold and are being commissioned in India. So far India has a deficit of over 1400 cancer-treating units or Radiotherapy machines in comparison to developed nations, where one machine is available for 500 new cancer patients/year. We have approximately 650 therapy machines in the country and most of them are concentrated in Tier 1 cities. Only recently the investors have started moving into Tier 2 and 3 cities.
While summing up on this new therapy, he added, “India has come a long way in making high-end Radiation Treatments available to our countrymen since the 1980s when very few linear accelerators were available. The return of well-trained doctors from the UK, US, and Europe have spurred the establishment of quality-assured treatment protocols, the availability of high-power UPS systems has supported the setting up and maintenance of delicate electronic gadgets. Universal health insurance for all Indians can help patients avail of these treatments. The need of the hour is to train the adequate number of Radiation Oncologists, Medical Physicists, Radiotherapy technologists, and cancer care nurses and counselors to remove the fear of radiotherapy from the mind of the public. Radiotherapy is needed in 60-70 percent of cancer patients during their cancer journey and about 80% of patients are cured when they receive radiotherapy as a part of their curative treatment. They have been rightly naming "Rays of Hope", for cancer patients and I do wish that we have many centers in our country in near future so that patients do not have to travel long distances and stay away from their homes, near and dear ones or disrupt their livelihood for a good, curative treatment.
Also, we need to have a public awareness campaign that cancer is curable if detected early. MCI should introduce this subject of cancer therapy in MBBS curricula to facilitate the young doctors training for identifying this disease in early stages when it is curable. Cancer is poised to reach the top position in the next two decades worldwide as the cause of death, if not detected early, replacing heart disease and moving coronary artery disease to the second position.”
