Treating tumors with radiation, increasingly effective and “tailored” for the individual patient – time.news

by time news
from Vera Martinella

Today radiotherapy is useful for 6 out of 10 patients and, thanks to a real technological revolution, higher doses can be had with fewer sessions

Radiotherapy an irreplaceable weapon against cancer: it is prescribed to about 60% of patients, it can save lives and, thanks also to its use, an increasing number of people, in Italy and in the world, recover or manage to live with a tumor for a long time. There are several machines and treatments today are more and more personalized, as emerges from the national congress of the Italian Association of radiotherapy and clinical oncology (Airo), which opens today in Bologna: From its birth, more than a century ago, to today this discipline has been revolutionized – underlines Vittorio Donato, president Airo -. For at least twenty years, innovations have been increasingly rapid and now a real paradigm shift is underway in the approach to the patient and the tumor. Today, radiotherapy “cuts” to the individual case the best possible treatment through the analysis of the genetic profile, radiomics and the processing of clinical data with highly sophisticated artificial intelligence software and algorithms.

Tailor-made radiotherapy

Each radiotherapy session usually lasts a few minutes and is performed with machines of different technical complexity (linear accelerators, tomotherapy equipment, cyberknife, gammaknife, etc.) that the specialist chooses according to the indications. It can be prescribed for both solid tumors and blood cancers, before, during or after surgery, alone or associated with other oncological therapies, such as new immunotherapy drugs – continues Donato, who is head of the Department of Oncology and specialist medicines and director of the Radiotherapy Division at San Camillo Forlanini From Rome -. Thanks to research and continuous technological innovations, radiotherapy has changed completely: now it is possible to choose the radiation treatment based on the characteristics of the tumor and the person to be treated, shortening the sessions as much as possible and dividing the doses of radiation even in an extreme way, hitting the target as precisely as possible, thus saving healthy tissues from the toxicity of the treatment. Alongside surgery and the many drugs (chemotherapy, molecular targeting and immunotherapy) used to treat different types of cancer, radiation treatments, once used mostly as palliatives, have also become a crucial strategic option. The reason why the radiotherapist today is an indispensable figure in the multidisciplinary team that should follow every cancer patient, supporting the various experts and their skills to select the necessary and most effective treatments.

Hypofractionation: higher doses and fewer sessions

Radiotherapy uses high-energy radiation, emitted by radioactive substances or produced by specific equipment called linear accelerators. Ionizing radiation, directed against the tumor mass, is capable of damage the cancer cell’s DNA 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. An increasingly widespread concept ishypofractionation: 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 and coordinator of the Scientific Committee of Airo -. Today thanks to imaging that allows us to recognize very small tumors and thanks to sophisticated technology they can be done selective hypofractionated treatments, more convenient because the patient has to go to the hospital not 40 times, but 5. Furthermore, by administering a higher and targeted dose to the cancer cells (sparing healthy tissues) the most effective treatment and the highest cure rate.

Genomics, radiomics and artificial intelligence

Thanks to the integration of genomics and radiomics with the clinic, the radiotherapist then has today the possibility of seeing what the human eye does not perceive, the infinitely small. And artificial intelligence will help build single patient and single tumor intervention models. The ultimate goal? Having better treatments, more healings or in any case better control of the disease, and being able to predict the response of the individual patient in order to better calibrate the entire therapeutic strategy. Artificial intelligence, for which we are only at the beginning even if it is opening new treatment scenarios, allows the analysis of CT, magnetic resonance and PET images through sophisticated software and algorithms. allows to identify those tumor characteristics that are not explorable by the human eye and that allow us to make a prediction on the patient’s and tumor’s response to radiotherapy treatment – explains Jereczek, who is also full professor of Radiotherapy at the University of Milan -. Through these very advanced technologies possible monitor changes in the patient’s body and neoplasm and adapt the treatment. If we can understand more from the images by arriving where the eye does not see, we can better characterize the neoplasm and choose to intensify or reduce the treatment. Genomics, radiomics and artificial intelligence these are some innovations already active in some Italian centers – adds Donato -. a reality that is being consolidated through scientific studies, some of which have already given good results in terms of efficacy and improvement in the quality of life of patients, as regards some types of tumors.

Modernize the machinery fleet in Italy

Despite the great progress made, the fact remains that 40% of the machinery in Italy is old: the new ones, more powerful and precise, are also faster. Several times the Airo specialists have stressed the urgency of updating and expanding the fleet of machines in our country, but in the National Recovery and Resilience Plan (Pnrr) there is also space for the modernization of the technological park in Italian hospitals, with an investment of 1.19 billion euros planned for the purchase of 3,881 new equipment and machinery with high technological content, including linear accelerators for radiotherapy, which will then have to be distributed equally throughout the national territory in order to cover the needs of patients in all regions recalls President Airo. Technological innovation, however precious, cannot ignore the human component – he concludes Roberto Pacelli, head of Radiotherapy at Federico II in Naples and member of the Airo Board of Directors -: the radiotherapist oncologist with his experience and competence he remains the cornerstone of the treatment. To help patients, family members and general practitioners, the Airo website (www.radioterapiaitalia.it) contains information that answers the most frequently asked questions; a space dedicated to information material on radiation, its effects on the type of tumor, the benefits of treatment, possible side effects and how to mitigate them. Finally the site contains the map of all the radiotherapy centers active in Italy and a section for training and updating, with meetings also addressed to general practitioners who are the first interlocutors of patients. We have also included a document on the anti-Covid vaccine and on the most fragile patients for whom vaccination is recommended.

October 15, 2021 (change October 16, 2021 | 17:04)

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