“Many people today still ignore the curative value that radiotherapy has in common only with surgery. It is often feared and considered harmful, dangerous: opinions that are the result of ancient heritage and misinformation, which today do not find justification or support in clinical practice and studies scientific. Currently, with precision radiotherapy we have a technology available that allows us to produce dose distributions that closely adapt to the tumor target, while maximally preserving the adjacent healthy tissues.” Thus Cinzia Iotti, president of the Italian Association of Radiotherapy and Clinical Oncology (Airo) and director of SC Radiotherapy Ausl-Irccs of Reggio Emilia, on the occasion of the XXXIII Airo National Congress.
Over 70% of patients suffering from cancer are treated today in our country with radiation therapies. Oncology radiotherapy – we read in a note – knows no setbacks and literally gallops towards unthinkable technological innovation, efficacy and safety. Precision radiotherapy allows the treatment to be modulated on the radiological, biological and genomic characteristics of the tumor; stereotactic treatments have a high ablative action and a very low risk of side effects; the ‘adaptive’ techniques use combinations of CT scans, magnetic resonance imaging and artificial intelligence which allow the tumor target to be hit millimetrically.
“The machines we have at our disposal – underlines Iotti – deliver the dose with millimetric precision and are equipped with verification systems that give the treatment maximum accuracy since they allow us to evaluate and correct, at every single session, any movements of the patient or of the volume In some cases, methods are also put in place thanks to which it is possible to irradiate the tumor only during some phases of the respiratory act, with the aim of maximizing the protection of nearby healthy organs, primarily the lung and heart. Cutting-edge technologies have given radiotherapy a level of effectiveness and safety that was unachievable until a few years ago.”
The underlying theme of the 2023 edition of the Airo Congress is in the title ‘Oncology radiotherapy: evolution at the service of the patient’, to underline the ongoing change of this discipline, which is increasingly taking on a leading role and position in the within multidisciplinary teams and in the care of patients with cancer. “The two key elements present in the title of the Airo 2023 Congress – highlights Pierluigi Bonomo, SOD medical director of Aou Careggi Radiotherapy of Florence and coordinator of the Airo Scientific Committee – converge in the same objective: optimal patient care with radiation therapy alone or in synergy with other pharmacological therapies”. This edition of the congress “is enriched with some aspects of particular interest – adds Bonomo – such as moments of discussion on the therapeutic index, i.e. the cost/benefit balance of treatments in particularly complex situations, and how this can impact on management and communication. We will a reflection on the equity of access to radiotherapy treatments and there will be various meetings and exchanges with patient associations”.
Among the main innovations “there is the technique – remarks Marco Krengli, professor of Radiotherapy at the University of Padua and director of the Uoc of Radiotherapy at the Veneto Oncology Institute Irccs of Padua, president-elect Airo – which we call ‘adaptive’, translation of the English term ‘adaptive ‘, which allows the treatment to be adapted day by day to the anatomical conformation of the patient and to the exact position that the tumor has at that moment, as well as to the exact position of the healthy structures around it, which we want to save. This technique is carried out through equipment which combine CT scanning and nuclear magnetic resonance (MRI), one or the other, with the linear accelerator. This technique is currently associated with the use of artificial intelligence, which allows for more precise and faster information on the internal anatomy of the patient and to optimize the treatment”.
Furthermore, “a trend that is increasingly developing in Italy too is radiotherapy with particles or ‘particle therapy’ – explains Krengli – which consists of irradiation with protons or ions. Very interesting, but still in the research phase preclinical and clinical, it is ‘flash’ radiotherapy which allows a very high dose to be given in a fraction of a second. Speaking of tumors, the innovations concern tumors in a locally advanced stage in which we combine precision radiotherapy with pharmacological treatment. For some tumors in the early stage, for example in the lung, we use stereotactic radiotherapy, in cases at risk for surgery”.
Despite its irreplaceable role in the treatment of cancer – the note specifies – radiotherapy continues to be greatly neglected in the oncology ‘narrative’. To improve the perception and institutional status of the discipline, Airo is acting on various levels.
Firstly to ensure, among other things, the presence of radiotherapists at all tables of oncology programming, secondly by involving patient associations, which play an important role in the oncology path. Added to these critical issues is the dramatic decline in the vocation of young doctors for this specialty: among the many causes, not least, the lack of visibility from which oncology radiotherapy suffers.
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