Cancer is the unwelcome guest that must be eliminated at all costs. Today advanced technology in Cancer treatment helps doctors attack and remove cancerous cells, without destroying healthy tissue. However, in spite of the successful treatment, in some cases cancer recurs and not necessarily at the primary site. Secondaries can show up a few years down the line in the brain, lungs, liver or bone (paraspinal region). “Good news awaits these patients,” says Dr. Surendran J – Senior Consultant Radiation Oncology (at Dr. Kamakshi Memorial Hospitals ). Here are excerpts from a conversation with him on targeted radiotherapy using modern technology.
Q: After cancer has been treated and deemed cured, can it recur?
Ans: The short answer is YES, but the good news is that it can be cured once and for all provided there is regular follow-up, check-ups and anticipated screening for recurrence. A certain percentage of Primary cancers arising from the breast, colorectum, uterine cervix, prostate, etc after complete response to initial sequential treatment by surgery, chemotherapy and radiation can recur at sites or organs away from where they primarily occurred. A person who has been treated for cancer is said to be cured when through any treatment option all detectable cancer cells have been removed/ destroyed and remains so for several years. In case there are cells that go undetected, the cancer can recur. This is why in spite of being 'cured' patients are asked to come for recurrence screening check-ups every 3 months for 2 to 5 years. If in this period that cancer does not recur, we can quite strongly say it will not return.
Q: If the cancer recurs, is it possible to be treated?
Ans: Yes it can be treated. Secondaries may occur in the brain, lungs, liver and paraspinal region. Periodic screening will help identify the cancer lesions earlier on. Earlier such a recurrence was considered Stage 4 in the disease, which is an advanced stage and considered hopeless. However, today that is not the case. Chemotherapy has proven effective in treating them, failing which radiotherapy is a sure shot.
Q: What type of Radiotherapy treatment is used in such a situation?
Ans: The way to go today is Stereotactic Body Radiotherapy (SBRT) for new tumors that have spread to the lung, liver and paraspinal region. It offers a second chance to completely eliminate the cancer. SBRT is a specialized radiation delivering technique to deliver ablative tumoricidal doses of radiation with definitive accuracy and minimizing exposure of normal adjacent tissues to the dose.
Q: When is it most favourable to use SBRT?
Ans: Attempting to establish a cure using SBRT when the cancer recurs in few numbers, say 3 or less and of size 5cm or less, in one or two organs (like a lung or the paraspinal region), has proven a promising strategy. However, the best results are possible when the size of the secondary tumors are less than 2cm and at one or two sites in a single organ. Also, when chemotherapy is attempted but it only stops the progression of the disease, SBRT can be used to destroy the cancer cells.
Q: What are the advantages of SBRT?
Ans: It is an outpatient treatment, non-interventional and is generally completed in 3 to 5 sittings spread over a span of 5 to 10 days. Of course, the precision of the treatment means less harm to healthy tissues and hence a quicker recovery time.
Q: Is SBRT an option at Dr. Kamakshi Memorial Hospitals ?
Ans: The soon to be commissioned linear accelerator at Dr. Kamakshi Memorial Hospitals comes equipped with high end technology and SBRT is definitely on the long list of treatment options it can deliver. The system is further enhanced with the Active Breathing Coordinator (ABC) and moderate deep inspiration breath hold technique (mDIBH) to ensure that the patient is comfortable and secure through the session. The superior technology of the linear accelerator enables highly effective treatment.
Dr. Surendran from Dr. Kamakshi Memorial Hospitals is the Senior Consultant in Radiation Oncology with 25 years of experience in Cancer treatment and care. Next week he will take us through the basics of Prostate Cancers and how effectively Radiotherapy can help treat the disease. To view other FAQs by Dr. Surendran, click on the link below Brain Cancer
Breast Cancer
https://www.thehindu.com/brandhub/safe-radiotherapy-for-breast-cancer/article35535002.ece
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