There Is A Chance That The Attitude Towards Radiation Oncology Will Change In The Coming Years

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There Is A Chance That The Attitude Towards Radiation Oncology Will Change In The Coming Years
There Is A Chance That The Attitude Towards Radiation Oncology Will Change In The Coming Years

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Video: Radiation Oncology Update- New Techniques & Ideas 2/5/20 2023, February
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There is a chance that the attitude towards radiation oncology will change in the coming years

In Russia, the federal project "Fight against oncological diseases" has started, among the activities of which is the formation of a network of proton centers. Emil Babaev, vice president of the medical technology company Accuray EIMEA, told Mednovosti about the demand for this and other types of radiotherapy, as well as the industry's readiness to provide the Russians in need of this type of treatment.

"There is a chance that the attitude towards radiation oncology will change in the coming years"
"There is a chance that the attitude towards radiation oncology will change in the coming years"

Photo: Accuray /

In Russia, the federal project "Fight against oncological diseases" was launched, among the activities of which is the formation of a network of proton centers - the most innovative part of nuclear medicine. Emil Babaev, vice president of the medical technology company Accuray EIMEA, told Mednovosti about the demand for this and other types of radiotherapy, as well as the industry's readiness to provide the Russians in need of this type of treatment.

Emil Kairovich, how affordable is radiotherapy treatment in Russia?

- The situation with the availability of such treatment can hardly be called satisfactory. This is especially true for the regions. The country lacks adequate equipment. According to the WHO, radiotherapy treatment is indicated on average in 60% of cancer patients. In developed countries today, 70% of cancer patients can receive radiation therapy, while in Russia it is available to no more than 30% of patients with a confirmed oncological diagnosis.

The Russian Radiotherapy Service has 140 radiation oncology departments with approximately 364 radiation treatment machines. At the same time, most of the installations are already quite old, and most often they do not receive proper maintenance or timely software updates. Of the total number of installations, no more than 60% support IMRT technology (modulated beam intensity radiation therapy), only 12 systems can be used for radiosurgical treatment, and 9 of them are equipped with the CyberKnife robotic system.

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And even with a deficit of such a service on a national scale, many radiation oncology centers, especially private ones, are underutilized. The number of quotas for high-tech medical care is very limited, and not many patients can afford to pay for such treatment on their own. Voluntary health insurance (VHI) is very poorly developed in Russia, and such programs are usually not covered by such programs. Therefore, there are queues for treatment according to quotas, and paid therapy can be obtained, taking into account the preparation, within a week.

What amounts are we talking about? And how does the limitation of quotas correlate with the country's existing program of state guarantees for the provision of free medical care?

- In Russia, the cost of radiation treatment can vary from 100 to 450 thousand rubles, depending on the duration of the course, the method of radiation therapy and the medical institution. The quality of radiation treatment in Russia today is at the level of leading foreign centers, and its cost is lower.

Radiotherapy high-tech medical care (HMP) can be obtained under state guarantees. According to the current legislation, AHR is provided in accordance with the list of types of such assistance included and not included in the basic CHI program. This division is related to funding sources. For example, external beam therapy (including stereotaxic, conmorphic radionuclide radiation therapy in radiotherapy departments) is included in the list of types of upper urinary tract that are not included in the basic compulsory medical insurance program. The average standard for such treatment is 256,740 rubles per unit of medical care.

Until recently, federal quotas were available only to federal agencies (now there is hope that the situation will change by 2020). And only a small number of private medical organizations had access to regional programs. The patient has no opportunity to choose a clinic for radiotherapy if he wants to receive it on a quota from the state.

In addition, not every patient can get a quota for treatment. In addition to quantitative restrictions, there is the concept of a patient model, when in some cases, with a widespread process, a quota may not be provided.

And then there is the problem of conflict of interest, when radiotherapy treatment is underestimated and not prescribed to patients by clinicians, although there are all indications for this

- Unfortunately this is the case. Even despite the improvement of technologies in the field of radiation oncology. In Russia, surgery is traditionally considered the "gold standard" of cancer treatment. And despite the fact that radiation therapy has proven its effectiveness, including as an independent and radical method of treating certain localizations in the early stages, Russian oncologists continue to give preference to surgery.

In Russia, treatment is most often prescribed by a single doctor, although the treatment plan must be adopted collectively by a surgeon, chemotherapist and radiotherapist. In world practice, such a council is called a tumor board, in Russian practice it is rather a rare exception than a rule. For this reason, patients with early stage lung and prostate cancer, for example, will receive surgery faster.

At the same time, in the world practice, radiation oncology is a clinically proven alternative to surgical treatment. Compared to surgery, it can often be a method to achieve local control of the disease and preserve the patient's quality of life. There are many such examples. Surgeons in Russia often disagree and oppose this.

Nevertheless, within the framework of the National Cancer Control Program, considerable attention is paid to nuclear medicine. And there is a chance that the attitude towards radiation oncology will change in the coming years.

Among the activities of the National Program is the formation of a network of proton centers. Is proton therapy a fashionable trend or a necessary alternative to radiation therapy?

- No panacea for cancer has been found yet. Neither is proton therapy. But it can be considered unique in certain clinical cases, especially when it comes to childhood pathologies. There are localizations where it is more difficult for photons to achieve a dose distribution with respect to nearby critical structures, which is equivalent to a proton one. In these cases, when exposed to proton radiation, the risk of radio-induced tumors is lower, as well as the long-term consequences of radiation therapy in the form of, for example, impaired cognitive function. This is why proton therapy is considered more appropriate in pediatrics.

In addition, the integral dose for exposure to protons is lower compared to photons, if we talk about all equipment as a whole. But even now there are modern linear accelerators (for example, "CyberKnife") designed to irradiate a tumor from 140-200 directions, in which the dose distribution in the tumor focus is quite comparable to proton irradiation. Such accelerators are equipped with systems for monitoring the position of the patient and ensure the accuracy of irradiation within fractions of a millimeter and a degree.

In addition, there are still very few randomized trials and experiences with proton therapy in clinical practice. Therefore, it is wrong to say that it should replace high-precision photon radiation therapy. Each method of radiotherapy treatment has its own advantages and nuances.

It is also important that today photon stereotactic radiation therapy is more accessible. Its cost is much lower, and linear electron accelerators generating photon radiation are installed in all modern radiation oncology centers in Russia and in the world. While proton complexes are still rare today - all because of the same high cost and narrow range of applications. In Russia, the first proton center was opened in St. Petersburg by a private company MIBS; in the near future, a center of the Federal Medical and Biological Agency in Dimitrovgrad is being prepared. There are a number of projects for the construction of such centers in the regions, but this is a matter for the future.

What types of radiation therapy exist and how they differ from each other

Among the modern technologies for effective treatment of neoplasms: external beam radiation therapy using linear accelerators, brachytherapy, intraoperative (performed during surgery) radiation therapy, proton therapy, neutron therapy and heavy ion therapy. Each method has its own goals and objectives.

Intraoperative radiation therapy can be useful in cases where the tumor is very close to vital healthy organs. During the operation, the surgeon temporarily shifts them beyond the boundaries of the radiation field, and the radiation beam enters the tumor directly.

Brachytherapy involves placing radioactive sources inside or in the vicinity of a tumor. Depending on the type of tumor, radioactive sources can be placed temporarily or permanently.

Like proton radiation therapy, neutron radiation is a special type of external beam radiation therapy. For the treatment of tumors, not a photon or electron beam is used, but neutron radiation. It is often used in the treatment of radioresistant tumors that are difficult to respond to with classical photon radiation therapy.

The most advanced technique to ensure quality and precision of treatment today is 3D conformal radiation therapy (3D-CRT), which includes intensity modulated radiation therapy (IMRT), image-guided radiation therapy (IGRT), stereotaxic radiation therapy and radiosurgery (SRS and SBRT).

IMRT allows for better preservation of normal tissue, provided the beam is precisely adapted to the shape of the tumor. IGRT is used for more accurate delivery of ionizing radiation to the tumor focus. At the same time, visualization methods (CT, ultrasound or X-ray) are used daily to guide the beam, and studies are carried out directly in the healing canyon before each radiation session.

Stereotactic radiation therapy (SRS / SBRT), a special treatment that uses very high precision beams, allows certain types of tumors to be irradiated with higher doses of radiation than those used in daily radiation therapy. This precision of treatment allows the radiation oncologist to keep more healthy tissue from exposure to ionizing radiation. In some cases, stereotactic radiation therapy is used to re-irradiate tumors. Among the indications for stereotaxic radiation therapy: a number of primary tumors, metastatic lesions, some benign tumors.

3D conformal radiation therapy can be performed with a variety of equipment. For example, CyberKnife and Radixact Tomo Therapy. The stereotactic system "CyberKnife" is the only robotic linear accelerator in the world today, which is designed to affect not only intracranial, but also extracranial "targets". The device is capable of irradiating the tumor, synchronizing with the patient's breathing and providing the highest precision of exposure. This is especially important for moving organs: lung, prostate, etc.

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