Italian oncological radiotherapy in continuous evolution: this is confirmed by the results ofnational survey promoted by Airo, the Italian Association of Radiotherapy and Clinical Oncology, on the quantity and quality of services provided in radiotherapy centers throughout the country, focusing on radical treatments for four specific types of cancer: head and neck cancers, prostate cancer, cervical cancer and non-small cell lung cancer. There are 104 radiotherapy centers surveyed; almost 100 thousand patients underwent radiotherapy in 2020, of which 47,044 in the North, 34,686 in the Center and 18,014 in the South. The patients who received radiotherapy treatment with a radical purpose, that is to completely eliminate the tumor, are over 15 thousand: approximately half (48%) for prostate cancer, 21% for head and neck cancer, 9% for cervical cancer and non-small cell lung cancer (22%).
Overall, the investigation confirms the fundamental role of modern radiotherapy in the treatment of some solid tumors. “The survey carried out by Airo once again reaffirms the role of radiotherapy and its value in oncology”, declares Vittorio Donato, President of Airo and Head of the Oncology and Specialized Medicine Department, Director of the Radiotherapy Division, Ao San Camillo-Forlanini of Rome. “The data that emerged, some of which are still being processed, are very encouraging, in that the investigation was carried out during the year of maximum acuity of the Covid-19 pandemic also to evaluate how much and how radiotherapy has responded to the needs of cancer patients in a critical period for oncology departments. Italian radiotherapy, the numbers tell us, has been able to cope in most cases with the demand of patients suffering from cancer and overcome the critical issues. This is thanks to the expertise of the radiotherapists and professional figures involved in the radiotherapy centers and to the ever-increasing advancement of new technologies “.
Cancer treatment – reads a note – today is made up of multidisciplinary and multi-professional collaboration, there are no protagonists but cohesive forces with a strong interconnection between radiotherapist, medical oncologist, surgeon, radiodiagnostic, nuclear doctor, technicians, engineers, molecular biologists and even with integrated medicine. “It is important to extend as much as possible the knowledge of the fundamental role of radiotherapy in the treatment of both localized and advanced cancers”, says Cinzia Iotti, SC Director of Radiotherapy oncology Ausl-Irccs of Reggio Emilia and president-elect Airo.
“For many tumors – he explains – radiotherapy is a valid alternative to surgery and for others it represents the only possibility of cure. Its use, alone or in association with other therapies, is gaining ever wider fields, too. in the metastatic patient who was once administered only purely palliative treatments and who today can instead count on much more ambitious therapeutic approaches aimed at improving his life expectancy. Current technologies (radiotherapy and not only) – he continues – allow us to perform increasingly effective, safe and personalized treatments. Airo can and must contribute so that these technologies are available to patients throughout the national territory and in the same way has the task of offering the radiotherapy community the opportunity to keep up-to-date and gain new knowledge “.
“Modern radiotherapy uses sophisticated equipment that allows much more selective and circumscribed treatments – explains Barbara Jereczek, director of the Ieo Radiotherapy Division in Milan, professor of Radiotherapy at the University of Milan and coordinator of the Airo Scientific Committee – all this has allowed us to increase the efficacy and reduce any inflammatory side effects. The innovations concern advanced oncological imaging diagnostics with visualization of the tumor at an early stage or of the most aggressive parts of the neoplasm, integration with target drugs and immunotherapy and new forms of radiotherapy, for example, proton therapy “.
I head and neck tumors they are ‘rare’ and complex pathologies in which radiotherapy, like surgery, plays a fundamental role if associated, where necessary, with chemotherapy, to bring the patient to recovery. According to the survey, however, the centers capable of autonomously administering chemotherapy in conjunction with radiotherapy within the radiotherapy department are only 40% of the total of those who responded, mainly from universities and large hospitals. There is still a lot to work in this area.
Specifically, 3,258 patients with head and neck cancer were treated for radical purposes. The larynx, a phonatory organ for which radiotherapy has achieved great successes in respect of organ conservation, was treated separately in the investigation. Although surgery continues to be the therapy of choice in head and neck cancers, radiotherapy is steadily advancing, especially when combined with chemotherapy that enhances the effect of ionizing radiation. “Over 56% of head and neck cancers are treated concomitantly with chemotherapy, which means that multimodal treatment is successful and leads to optimal results even if difficult to manage”, comments Marcello Mignogna, SC director of Oncology Radiotherapy San Hospital Luca di Lucca and Airo National Councilor.
The prostate cancer is the great protagonist of radiotherapy treatments in recent years: there are 7,364 cases of prostate cancer treated for curative purposes. 94% are treated with radiotherapy machines capable of delivering beams at modulated intensity (Imrt) which allows to administer the effective dose of rays at geometrically complex volumes, minimizing the dose to the surrounding tissues. Hypofractionation techniques have established themselves with a reduced number of sessions and higher doses per session.
“Oncological radiotherapy plays a transversal role compared to surgery and medical oncology, being indicated with radical intent for the treatment of localized disease but also in the recovery of disease after surgery and in oligometastatic disease”, underlines Alessandro Magli, director of Oncological Radiotherapy, San Martino hospital in Belluno. Another important fact that emerges from the Airo survey concerns the quality of the treatments provided, which prove to be up to the international standards required for the treatment of prostate cancer. On the other hand, the well-known problem emerges of the lack of aptitude for multidisciplinary evaluation by urologists, radiotherapists and oncologists aimed at a shared choice of treatment which in the genitourinary field is unfortunately still in the embryonic stage compared to other oncological pathways “.
The survey data on the cervical and non-small cell lung cancer they are currently preliminary and under review. 1,345 patients underwent radical radiotherapy for cervical cancer, with the use of completion brachytherapy or contact radiotherapy. The predominant treatment also in this case is the one with modulated intensity; in 63% of cases multidisciplinary evaluation is used. 3,623 patients with non-small cell lung cancer underwent radical radiotherapy. 64% of cases are discussed within the multidisciplinary team (Gom).