Radiation therapy remains one of the fundamental tools against many types of cancer and allows for personalized intervention. Today, thanks to technological evolution, the side effects feared by patients are limited
Before or after surgery, alone or together with drugs, to cure the patient definitively or “only” to alleviate the symptoms of the disease, especially in the presence of such painful bone metastases. With many different purposes and machinery, radiation therapy is prescribed to over half of people facing a cancer diagnosis. Many patients still fear it for its toxicity, but scientific research has made many steps forward in this area too and radiation today is increasingly effective and “tailored” for the individual patient. The equally widespread idea that it is a purely palliative strategy, which cannot completely eradicate the tumor, is also obsolete. This is demonstrated by the data of an official survey by the Italian Association of Radiotherapy and Clinical Oncology (Airo), which surveyed the work carried out in 104 Italian centers during 2020 for some types of cancer such as those of head and neck, prostate, cervix and lung: a correct dose of radiation is sufficient to completely eliminate the neoplasm.
Precise like a scalpel
“Modern radiotherapy can be defined as a” virtual surgery “, a localized treatment in which precision is crucial – underlines Vittorio Donatorecently past president di Airo and director of the Radiotherapy Division at San Camillo-Forlanini in Rome -. Depending on the volume that is treated and the dose that is administered, different efficacy is obtained. Each patient, each type of tumor receives personalized treatment: the more the volume treated is circumscribed, the more it is possible to increase the dose and make it more effective. Innovation today means identifying the target as precisely as possible and reducing the dose at the level of the surrounding healthy organs ». To have the best results, the machinery must be very advanced, with high technology: for this reason they should be renewed periodically, because technological progress is continuous and a machine that has 10-15 years of life is considered obsolete.
Machine park to be renewed in Italy
However, from a recent census conducted by Airo, again in 2020-2021, it emerges that in Italy a large part of the fleet is old: over 40% of appliances have at least 10 years of life. “It is a problem that should not be underestimated, especially in light of the estimates that foresee a 15% growth in people who will need radiotherapy in the coming years: especially due to the aging of the population, the total number of people who they get cancer, “he stresses Cinzia Iotti, director of oncological radiotherapy at the AUSL-IRCCS of Reggio Emilia and new president of the Italian association of radiotherapy. The problems that emerge from the census are not new: for several years Airo has remembered in Italy the lack of qualified personnel and the uneven distribution of equipment throughout the country (with the South, as usual, penalized). To which is added the need to modernize the machinery. In detail, the survey surveyed 183 public and private conventioned radiotherapy centers (3 centers for every million inhabitants), whose distribution is in line with other European countries as regards the North and Center, while in the South it is he found a shortage in both the number of machines and radiotherapy units. “Regarding the age of the equipment, the data is rather worrying: 29% of the machines have more than 12 years of service – says Donato -. Renewing the fleet, especially those over 10 years of age, and expanding it by at least 20% to meet the needs of the sick is a pressing need. We need to invest now in machines that are expensive, but last 10 years: compared to pharmaceutical expenditure, the price is very low ».
Personalized treatments
It should also be borne in mind that only having adequate technological support with state-of-the-art machinery can patients be offered the best performance: the new devices, more powerful and precise, are also faster. And this allows to reduce the therapy cycles up to halve the number of sessions or decrease them by a third and, in some cases, it can even reach a single session. Why? To understand the near future, a premise is needed: radiotherapy uses high-energy radiation, emitted by radioactive substances or produced by specific equipment called linear accelerators. The ionizing radiation, directed against the tumor mass, is able to damage the DNA of the cancer cell to lead to its destruction. In order to save healthy tissues, the radiation beams are shaped and turned from different angles and intersect in the center of the area to be treated, where there will be a quantity of total absorbed dose higher than those of the adjacent areas. Today the radiotherapy treatment is rigorously personalized for each patient depending on the type of tumor, its size, location and general health conditions of the patient. In addition to the most suitable type of radiotherapy, the duration and dose of treatment is established, how many fractions should be administered and how often.
Towards “hypofractionation”
The new concept that is spreading and that we will hear more and more about is hypofractionation: “It means doing shorter, more concentrated treatments, where the radiant dose for each single session is higher than the standard which consisted of small doses and very long cycles – he explains Barbara Jereczek, director of the Radiotherapy Division at the European Oncological Institute of Milan -. Today, thanks to imaging, which allows us to recognize very small tumors, and thanks to sophisticated technology, selective hypofractionated treatments can be made, more convenient because the patient has to go to the hospital not 40 times, but 5. Furthermore, by administering a higher and targeted dose on cancerous cells (sparing the healthy tissues), the treatment is more effective and the cure rate is higher ».
A team of specialists to decide the most suitable treatment
To set the best course of care for each patient, a multidisciplinary evaluation is needed between surgeon, radiotherapist and oncologist. “The various specialists have different visions and skills aimed at the same goal: making a therapeutic choice that heals or that involves the best possible quantity and quality of life – he says. Roberto Pacelli, Head of Radiotherapy at the Federico II University Hospital of Naples -. The radiotherapist is not just someone who has the technical skills to deliver radiation treatments: he can and must participate in every stage of the disease, from pre-operative to the most advanced stages to ensure, together with other specialists, the appropriateness of the choices. therapeutic “. The criteria by which one opts for one strategy or another refers to guidelines shared nationally and internationally, applied also considering the characteristics of the individual patient. But, even to make the most of the technological innovations, specialists are needed or the risk is that of owning a custom-built car without an experienced driver to take it to the track. «Especially in Italian public structures there is shortage of staff in radiotherapy departmentsa problem that in many cases leads to an under-use of precious technologies »remarked Pacelli.
March 7, 2022 (change March 7, 2022 | 16:45)
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