Cancer patients requiring sophisticated radiotherapy treatment, brachytherapy needed go outside Kashmir, to other parts of the country like TATA Memorial Hospital, AIIMS New Delhi, Rajiv Gandhi Cancer Hospital, Fortis etc where this sophisticated radiotherapy treatment is in use for the last few years.
However, the cost is an issue, as the treatment costs Rs 1 to Rs 2 lakhs. Besides, patients and attendants need to stay there for months, thus putting expenditure at too high a level that a middle class family fails to afford.
This results in compromise in treatment options, a crisis for the patient, family and treating doctor, be it surgical oncologist, radiation oncologist, medical oncologist or any other domain of medicine dealing with cancer.
The Department of Radiation Oncology SMHS Hospital, accomplished this goal of providing this costly treatment through commissioning of state of the art Brachytherapy machine Microselectron HDR for which funds were received from NDMA through Hon’ble Prime Ministers help.
This long awaited dream that our patients must receive this sophisticated and costly treatment at home was achieved on Friday 24th March 2022 when our trained team of faculty members, medical physics team, faculty from anaesthesia department, nurses and radiotherapy technologist team took the biggest successful challenge in executing first brachytherapy treatment at SMHS Hospital.
We highly appreciate the help of Dr Vikas Roshan Head Radiation Oncology at American Oncology Centre in assisting and providing hands-on training.
Ms A (name changed) a 54 year old female male, suffering from cervical cancer is the first patient being offered this treatment in SMHS Hospital Srinagar that too free of cost. Meeting this challenge has made our esteem go heaven high both academically and technically giving a solace to all levels of Staff in being of help to poor and suffering patients of cancer who because of communication gap between patient and treating physician never attain a satisfaction to the level of having better treatment option delivered at door step.
Most of the time Kashmiri patients used to reschedule treatment at outside institutions because of quite different geographical conditions thus patients who should have received treatment in summer would delay till winter to accommodate to the quite different weather conditions. COVID19 situation would never allow any patient to move to outside institutions and this crisis had already rendered many cancer patients hopeless.
Most cancer patients and their educated attendants know about various forms of radiotherapy treatment and usually discuss with staff on availability of this and that of each protocol being prescribed for patients of cancer at reputed centers of country and world.
For general public who don’t know what is brachytherapy,I must explain some basic information:
External radiation (or external beam radiation) is the most common type of radiation therapy used for cancer treatment. A machine is used to aim high-energy rays (or beams) from outside the body into the tumor.
These machines focus the radiation on the exact location where it needs to be, so that normal tissues are affected as little as possible.
External radiation is usually done during outpatient visits to a hospital or treatment center. Most people get external radiation therapy over many weeks. Usually, they visit the treatment center every weekday (Monday to Friday) for a certain number of weeks. Treating physicians helps every patient about decisions such as how much radiation is needed to treat the cancer and how often you need to get it.
Photon beam radiation therapy is another name for what is usually known as external beam radiation therapy. It uses photon beams to get to the tumor but also can damage healthy tissue around the tumor. Photons are used in treatments that are given by a machine called a linear accelerator. The photon beams are invisible like X Rays and cannot be felt when they are passing through the body without any pain or discomfort to the patient.
Types of external radiation therapy available at SMHS Hospital
Three-dimensional conformal radiation therapy (3D-CRT) delivers radiation beams from different directions designed to match the shape of the tumor. This helps to reduce radiation damage to normal tissues and better kill the cancer by focusing the radiation dose on the tumor’s exact shape and size.
Image guided radiation therapy (IGRT) is a form of 3D-CRT where imaging scans (like a CT scan) are done before each treatment. This allows the radiation oncologist to adjust the position of the patient or re-focus the radiation as needed to be sure that the radiation beams are focused on the tumor exactly and that exposure to normal tissues is limited.
Intensity modulated radiation therapy (IMRT) is like 3D-CRT, but it also changes the strength of some of the beams in certain areas. This allows stronger doses to get to certain parts of the tumor and helps lessen damage to nearby normal body tissues.
Stereotactic radiosurgery SRS.
Stereotactic radiosurgery isn’t really surgery, but a type of radiation treatment that gives a large dose of radiation to a small tumor area, usually in one session. It’s used for brain tumors and other tumors inside the head. Once the exact location of the tumor is known from MRI or brain scans, radiation is sent to the area from many different angles. The radiation is very precisely aimed to affect nearby tissues as little as possible. It’s called “radiosurgery” because it is so exact in where it delivers the radiation beams, almost like how exact surgery can be. But there is no cutting or incision involved at all.
Treatment outside the brain is called stereotactic body radiation therapy (SBRT). SBRT may be used for certain lung, spine, and liver tumors.
In many radiation therapy clinics this technology is called by the name of the company that makes the machine. You might hear these names being used at the treatment center or when talking to your cancer care team or other patients. X-Knife, CyberKnife, and Clinac: These machines move around to target the tumor from many different angles. Other brands of this type include Synergy-S, Edge, Novalis, and the latest Linear Accelerator TrueBeam (available at SMHS Hospital).
Gamma Knife uses about 200 small beams of radiation at one time, creating a very large dose. It’s usually given in one treatment session. It’s important to remember it doesn’t use a knife and there’s no cutting.
Although most patients will be given the full radiation dose using external radiation, some patients need brachytherapy where placement of the radiotherapy source is to be kept within the tumor itself or in close proximity to it.
Various types of brachytherapy in use are the intra cavitary, interstitial and mould therapy. Though all the three options are available in SMHS Hospital but to start with we used intracavitary mode on our first patient.
Under able guidance of Principal Dean GMC Srinagar Prof Samia Rashid, and Medical Superintendent Dr Kanwaljeet Singh, the first priority at our Hospital is the patient care. It is through their persistent help that we continue to offer our patients the most advanced technologies available in the treatment of their disease. Starting brachytherapy treatment represents yet another step after SRS, IMRT, IGRT and VMAT in the fulfillment of our ongoing mission.
The author is the Head of Department, Radiation Oncology SMHS Hospital, GMC Srinagar
Disclaimer: The views and opinions expressed in this article are the personal opinions of the author.
The facts, analysis, assumptions and perspective appearing in the article do not reflect the views of GK.