Various radiotherapy techniques are:

• 3DCRT – 3 Dimensional conformal radiotherapy
• IMRT – Intensity modulated radiotherapy
• IGRT – Image Guided Radiotherapy
• VMAT – Volumetric Intensity Modulated Arc Therapy
• SRS – Stereotactic Radiosurgery
• SRT – Stereotactic Radiotherapy
• Brachytherapy

3DCRT uses multiple carefully shaped and positioned beams of radiation that allow the high dose region of the radiation plan to closely “conform” to the shape of the tumor, thereby minimizing the radiation to adjacent normal structures. A uniform dose of radiation is delivered to the target tissues while keeping the dose to the surrounding normal structures to minimum.

Intensity modulated radiation therapy (IMRT) is a sophisticated, new radiation treatment planning technology that can shape and deliver a high dose of radiation to a tumor while sparing surrounding healthy tissues. The fundamental difference between conventional radiation treatment and IMRT is beam intensity. In conventional radiation therapy the beam intensity is uniform, but in IMRT, the beam intensity varies across the treatment field. During IMRT treatment, where the tumor is the thickest, the beam intensity is at its greatest, and where the tumor is thinnest, the intensity is at its minimum. In many situations, this allows for the high dose region of the radiation plan to more closely conform to the shape of the tumor, and also often allows for greater sparing of adjacent normal tissues.

Image guided radiotherapy is one step ahead of IMRT where radiation delivery technique is similar to IMRT but with enhanced precision and accuracy. The linear accelerator in our department has a specialized CT scanner attached to it which is used to take a CT scan of the patient everyday before delivering radiation. This CT scan is used to precisely confirm that the radiation is being delivered to the intended area and surrounding normal structures are spared. This advanced technology allows us to detect any errors with an accuracy of 0.01cm, which can be corrected automatically. This breakthrough in the technology has improved the accuracy of the treatment and allowed us to minimize the radiation related side effects.

Stereotactic Radiosurgery is a non surgical treatment modality involving high energy radiation to achieve results similar to surgery, especially in patients with small tumours in the brain. The patients are immobilized using rigid masks along with external markers and under go CT scan and MRI to define the tumour. A high dose of radiation is delivered with minimal margins to eliminate the cancer cells while delivering almost no dose to the surrounding normal structures. When the same dose of radiation is delivered in multiple sittings with same precision, is it termed as Stereotactic Radiotherapy.

Brachytherapy

Brachytherapy is a special form of radiation where high dose of radiation is delivered to the cancer cells internally. A minor surgical procedure is often required to place special needles or tubes with in the tumours and a small source of radiation is then inserted into these tubes to deliver radiation. Brachytherapy is able to deliver a very high dose of radiation to the cancer cells while giving minimal dose to surrounding normal tissues and is often used in combination with the external beam radiotherapy. The most common sites where brachytherapy is used are cancer of the womb, breast, prostate, head and neck region, esophagus and sarcomas. At Mazumdar Shaw Cancer Centre, the most advanced 40 channel high dose rate Brachytherapy system is installed.

Details of all the patients are discussed in a tumour board where Radiation Oncologist, Medical Oncologists, Surgical Oncologist, Nuclear Medicine experts, Pathologist, Radiologist and Palliative care specialist decide upon the best management plan for the patient. This ensures that the patients receive a holistic multimodality cancer treatment best suited for them.

A significant number of patients experience cancer pain which can be excruciating and affect their quality of life. We have a dedicated pain management team who would evaluate the nature of pain in detail and advices medication which are best suited for the patient. Patients who have incurable advanced disease are offered palliative care where multiple facets of the disease such as pain management, psychological support, family support, spiritual support are offered to the patient and their families.

We have started a cancer registry program in the hospital where details of each patient in the hospital will be meticulously recorded on a specialized computerized cancer registry. This will not only enhance our understanding about the cancers in India but also help us to shape the treatment for patients in future depending on the results.

This is the first dedicated Retinoblastoma management unit set up in collaboration with Narayana Nethralaya. Retinoblastoma is a rare cancer of eyes seen in children and if not diagnosed early will result in loss of vision and is some cases more serious consequences. Dedicated retinoblastoma specialist evaluates the patients and multimodality treatment involving surgery, chemotherapy and radiotherapy is offered to the children with aim to cure and preserve their vision.

The patients are scanned for the radiotherapy planning on the dedicated Radiotherapy CT scanner which is customized for the radiation planning needs. Thus we are able to offer flexibility of time to the patients for planning as well as reducing their inconvenience of having to go to other departments for scanning as is the case in most of the other cancer centers.

The department has a dedicated operation theater for inserting the brachytherapy applicators, thus unlike most of the other cancer centers, patients don’t have to suffer the inconvenience of traveling from surgical OT to radiation department with the brachytherapy applicators.

We have the largest treatment planning facility in the country which is able to cater to hundreds of patients in a month. The treatment planning systems are capable of developing complex radiation delivery plans to improve the dose of radiation delivered to cancer cells while minimizing the dose delivered to the surrounding normal structure.

After completion of the treatment, the patient will be advised appropriate advice for lifestyle modifications and will be offered appointments for regular follow up.