2023-10-27 08:14:59
by Vera Martinella
Thanks to innovative and sophisticated techniques and machinery, radiation treatments have reached levels of effectiveness and safety that were unthinkable until recently. Precise and personalized radiation
Harmful, dangerous, capable of burning and destroying, a last resort for treatment, when there is nothing else to do. There are many old prejudices that persist when it comes to radiotherapy, but the current reality is completely different. Radiation today can be the first choice and is also able to cure a cancer patient, alone or in combination with other therapies. Or extend his life. Or even improve it, for example by keeping the pain from bone metastases at bay. They are no longer as toxic as they once were, but increasingly precise, aimed at the target to be hit, sparing healthy tissue. And, just like many innovative drugs, they can be personalized to the individual patient, thanks to techniques and machinery that have evolved over time. The numbers themselves demonstrate the role and importance of radiotherapy treatment: it is prescribed in over 70 % of cancer patients, alone or associated with surgery, chemotherapy, hormone therapy, immunotherapy and the cases in which the first choice underlines Cinzia Iotti, president of the Italian Association of Radiotherapy and Clinical Oncology (Airo), whose national congress is opens today in Bologna.
Radiotherapy to heal
It is estimated that the healing of tumors (both solid and haematological) is due to surgery in 46.5% of cases, radiotherapy in 42% and chemotherapy in 11.5%. The possibility of using rays becomes a precious resource if for reasons of age or particular conditions surgery and certain drugs are excluded because they are too risky – continues Iotti, director of Radiotherapy at the AUSL-IRCCS of Reggio Emilia -. And again: a very relevant option, but still little known by patients and family members, in oligometastatic patients. That is, in the presence of few metastases with a limited number of targeted radiotherapy sessions, it is possible to eliminate individual lesions and even (depending on the case) aspire to recover completely. In short, oncology radiotherapy has made significant progress in the last decade, including hypofractionation, i.e. a type of radiotherapy treatment in which the overall radiation dose is administered in a more limited number of sessions than in the past. .
Precise and personalized radiation
The precision of the rays and the personalization of the treatment, adapted to the individual patient are two key concepts: We have at our disposal a technology that allows us to produce dose distributions that are closely adapted to the tumor target, preserving the adjacent healthy tissues as much as possible – clarifies the president Airo -. The machines we have deliver the dose with millimetric precision and are equipped with verification systems that give the treatment maximum accuracy as they allow us to evaluate and correct, at every single session, any movements of the patient or of the target volume. In some cases, methods are also put in place thanks to which it is possible to irradiate the tumor only during some phases of the respiratory act, with the aim of maximizing the protection of nearby healthy organs, primarily the lung and heart. These and other cutting-edge technologies have given radiotherapy a level of effectiveness and safety that was unachievable until a few years ago.
New: adaptive therapy
And among the innovations in the sector at an international level there is certainly the so-called adaptive therapy which allows the radiotherapy treatment to be adapted day by day to the anatomical conformation of the patient and to the exact position that the tumor has at that moment as well as to the exact position who have healthy facilities around that we want to save. What is it about, exactly? a technique created through equipment that combines CT and nuclear magnetic resonance, one or the other, with the linear accelerator – replies Marco Krengli, professor of Radiotherapy at the University of Padua and director of Radiotherapy at the Veneto Oncology Institute IRCCS of Padua – . This technique is currently associated with the use of artificial intelligence which allows for more precise and faster information on the patient’s internal anatomy and to optimize the treatment. A trend that is developing more and more, even in Italy, is particle radiotherapy, which consists of irradiation with protons or ions. Another very interesting trend, but still in the preclinical and clinical research phase, is flash radiotherapy which allows a very high dose to be given in a fraction of a second. The innovations concern tumors in a locally advanced stage in which we combine precision radiotherapy with pharmacological treatment – continues Krengli, who is president-elect Airo -, but also some tumors in the initial stage, for example those of the lung for which we use stereotactic radiotherapy in cases at risk for surgery.
Evolution at the service of patients
The underlying theme of the 2023 edition of the Airo national congress is the evolution at the service of the patient: A concept that reflects the ongoing change of this discipline, which is increasingly taking on a leading role and position within multidisciplinary teams and in taking care of cancer patients – concludes Pierluigi Bonomo, medical director at Radiotherapy at Careggi in Florence and coordinator of the Airo scientific committee -. Evolution, innovation, today means identifying the target as precisely as possible and reducing the dose as much as possible to the surrounding healthy organs. Today we are witnessing a constant development of new technologies, knowledge and skills with the aim of assisting patients more effectively, ensuring that they receive personalized treatment, improving the quantity and quality of life.
October 27, 2023 (modified October 27, 2023 | 08:14)
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