One Day Radiation Therapy
Cancer can be a very tiring experience for many patients. After the initial mental shock and stress of dealing with the diagnosis, many patients have to undergo a long process of treatment. Some patients need to undergo a combination of two or more modalities like surgery, chemotherapy and radiation therapy as part of their treatment. Consultations, laboratory and imaging studies, scheduling and then undergoing those treatments can take many months. As time passes, both mental and physical fatigue can set in. Frequently, radiation therapy is the last of the three types of treatment that the patient undergoes. Traditionally, radiation therapy has been delivered as a course of many treatments given daily over a period of many weeks. This long process can further tax the minds and bodies of patients who have already been through surgery and chemotherapy. In addition, many patients have problems with transportation, long travel times, work related pressures and financial worries. All this makes it very desirable that the time commitment to cancer treatment should be reduced.
Fortunately, recent scientific developments in radiation oncology have allowed us to reduce the number of visits needed to treat several different cancers. Technological developments and clinical research now allow many patients to receive their radiation therapy in a single day. ‘One Day Radiation Therapy’ is a simplification of the process of delivering radiation therapy in courses that are much shorter than those that have been traditionally used for the last few decades. It is important to realize that not all patients can be treated in a single day. However, many patients can be treated in a half or even a sixth of the time that was previously needed. Dr Vijay Kini has been practicing Radiation Oncology for two decades. He is committed to reducing the treatment times required for any cancer patient.
Here are some examples of shorter courses of radiation therapy:
The majority of breast cancer patients treated today are found to have small tumors which have not spread elsewhere. Following surgical removal, known as a lumpectomy, patients traditionally received 6 to 7 weeks of daily treatment, 5 days a week. Now, there are several different techniques to reduce this time commitment. Recent literature suggests that traditional external beam radiation therapy can be delivered in just 3 weeks of daily treatment. Brachytherapy can also be used to treat some suitable candidates in a single week of twice daily treatment. Some centers are utilizing intraoperative radiation therapy to treat the lumpectomy cavity in the operating room. This treatment needs no additional time commitment and is one form of ‘One Day Radiation Therapy’. However, this last technique is delivered before the final pathology results from the lumpectomy are available and some patients may need traditional external radiation subsequently. Finally, in some patients who are over a certain age and have tumors that have less aggressive pathological features, radiation therapy can be entirely eliminated.
Traditional external beam radiation therapy for prostate cancer can take up to 9 weeks of daily external radiation using techniques like IMRT. Some patients may be candidates for permanent radioactive ‘seed’ implants. This is a single day commitment and is also a great example of ‘One Day Radiation Therapy’. However, patients have to undergo general anesthesia and minimally invasive techniques have to be utilized to place the radioactive material in the prostate, typically in a hospital setting. Another technique known as SBRT is also being utilized to treat some eligible patients with just 5 treatments delivered every other day over 10 days. Recent literature also suggests that some patients with less aggressive prostate cancer can undergo watchful waiting and may never need any form of treatment.
Conventionally, lung cancer can be treated with surgery alone in early stages. Later stages of lung cancer are treated with radiation therapy combined with chemotherapy. These patients need 6 to 7 weeks of daily radiation. Recent literature suggests that early stages of lung cancer can be treated with SBRT using 3 to 5 fractions of radiation alone. Three to five year results of this form of treatment suggest similar outcomes to surgery while avoiding hospitalization and reducing morbidity and mortality.
While shorter courses of radiation therapy and SRT are sometimes used to treat primary brain tumors such as Glioblastomas, ‘One Day Radiation Therapy’ has much more commonly been utilized to treat cancer that has spread to the brain from other organs like the lungs or breast. These tumors, known as metastases, have a very good response to a single very large dose of radiation or 3 to 5 large doses given over one to two weeks. Occasionally, less aggressive or non malignant abnormalities like meningiomas and arteriovenous malformations are treated with similar short courses of radiation therapy with stereotactic techniques.
While conventionally bone metastases are treated with 10 treatments of external beam radiation therapy over 2 weeks, clinical trials as well as newer technological advances like SBRT make it possible for palliative radiation therapy to be delivered in one to five treatments.
Typical courses of skin cancer radiotherapy involve up to thirty treatments of radiation delivered over 6 weeks. However, equivalent results have been achieved with shorter courses of radiation delivered over three to four weeks. Newer techniques use brachytherapy delivered over four days.