Tests such as Tac or Pet, performed before the treatment, allow to better identify the target and not damage healthy tissues
If it is true that state-of-the-art machinery brings important benefits to patients, it is equally true that the most modern technologies are not always necessary to take care of yourself well. Rather than chasing after the innovative equipment, it would be better to rely on the radiotherapist oncologist who has the skills for choose the radiation doses, the number of sessions and the most suitable execution technique to the individual patient, taking into consideration all the variables of the case, starting from the type of tumor, the stage, the age and the general state of health.
How to choose the type of radiotherapy
Treatment can be conducted on an outpatient basis in most cases, in day hospital or in hospital, in more complex cases – clarifies Barbara Jereczek, director of the Radiotherapy Division at the European Institute of Oncology in Milan -. The radiotherapist then chooses the dose and the number of sessions needed. Each session usually lasts a few minutes, is carried out with machinery of different technical complexity (linear accelerators, tomotherapy equipment, cyberknife, gammaknife, etc.) that the specialist establishes according to the indications. The “one size fits all” in modern radiotherapy no longer works, today everything is personalized. The goal is always the same: to achieve maximum healing effect and reduce the likelihood of damage to healthy organs and tissues. The treatment preceded by a preparation phase that involves the execution of a CT scan (or an MRI or a PET scan) to better identify the target to be hit with radiation and to determine the best treatment technique.
3D, IMRT, brachytherapy
Conformational radiotherapy (the so-called three-dimensional), is used to treat the simplest forms of neoplasms – he emphasizes Marta Scorsetti, director of the Radiotherapy and Radiosurgery Unit at the Humanitas Clinical Institute in Milan -. It is currently performed in all Italian cancer radiotherapy centers. It uses radiation beams conformed and adapted to the shape of the volume to be hit and integrates the radiations emitted by linear accelerators with computerized systems for the three-dimensional reconstruction of the area to be irradiated (using CT, resonance, PET-CT images). Then there is intensity modulated radiotherapy (IMRT), which allows target volumes of complex shapes or located in critical areas to be hit with absolute precision and with higher radiation doses. IMRT today is considered the standard technique for the treatment of most neoplasms, in particular for head and neck, lung, gastrointestinal and gynecological tumors, but its indications for use are progressively expanding. There brachytherapy instead, it uses miniaturized radioactive preparations positioned with minimally invasive procedures inside or in contact with the organs concerned (such as for example vagina, uterus or prostate) – explains Scorsetti, who is also full professor of Radiotherapy at Humanitas University -. They can be removed after a set time or remain in place to deliver the desired dose for cancer treatment. Brachytherapy is a “super-specialized” mode of care, which provides for specific training and is also indicated in some cases of tumors of the esophagus, biliary tract, skin.
Stereotaxic radiotherapy and radiosurgery
It’s still: body stereotaxic radiotherapy a sophisticated high-precision technique that allows the irradiation of small lesions (up to 5 centimeters), with high doses of radiation and a significant saving of healthy tissues. Today considered strategic for the treatment of some early stage tumors (such as those of lung and prostate) as a valid alternative to invasive surgery and for the developmental control of slowly evolving metastases (especially in the liver, lung, lymph node or brain) in oligometastatic patients, i.e. with a limited number of metastases. Finally, the radiosurgery a technique of administering a high dose of radiation to an intracranial tumor target in a single session – continues Scorsetti -. especially useful for brain metastasesbut is also used against other types of benign neoplasia type acoustic neuromas and meningiomas or in case of small pituitary adenomas.
Artificial intelligence
The future, which is already a reality in some hospitals, is made byintegration of genomics and radiomics with the clinic: in practice, the radiotherapist is given the opportunity to see what the human eye does not perceive, the infinitely small. And artificial intelligence, for which we are only at the beginning, is opening up new scenarios – says Jereczek, full professor of Radiotherapy at the University of Milan -: it allows the analysis of CT images, resonance magnetic and PET and allowsidentify those tumor features that we do not see. We can thus both predict what the response will be and monitor over time how the patient’s body and the disease react to radiation to adjust the dose accordingly.
March 10, 2022 (change March 11, 2022 | 09:35)
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