IMRT, IGRT, VMAT: New Tools For Fighting Lung Cancer by Cancer Hospital India

2011-08-11T02:28:00.000-07:00

Magnitude Of The Problem

There are 25 Lakh cancer patients in the country. Ten lakh new cases are detected annually and 4 lakh people lose there lives to cancer. Cancer is now the third biggest killer in our country. Lung cancer is one of the most common cancers in India. It is the most common cause of cancer related deaths in men and the second most common cause of death in women (after breast cancer). This cancer is alone responsible for 13 Lakh deaths worldwide annually.

Causes And Risk Factors Of Lung Cancer

1. Smoking is the single most important cause ----
Smoking, particularly of cigarettes, is by far the main contributor to lung cancer. Across the developed world, almost 90% of deaths are caused by smoking. Passive smoking can also lead to lung cancer.

2. Air pollution - Gases emitted by industries & vehicles are carcinogenic.

3. Radioactive Chemical exposure - Arsenic, nickel, chromium.

Warning symptoms of lung cancer

4. Smoker's cough that persists or becomes intense.

5. Increase in volume of sputum

6. Wheezing

7. Nonsmoker's cough that persists for more than 2 weeks.

8. Change in color of sputum.

9. Blood in sputum.

Prevention

More than 90% of the lung cancer cases are due to active and passive smoking and hence preventable. The earlier one stops smoking, better it is.

Prevention is the most cost-effective means of fighting. While in most countries, industrial and domestic carcinogens have been identified and banned, tobacco smoking is still widespread. Eliminating tobacco smoking is a primary goal in the prevention of this cancer, and smoking cessation is an important preventative tool in this process, especially in the youth.

How lung cancer is DIAGNOSED?

1. Chest x-ray is the most easily available and cheapest modality for diagnosis of this cancer which will show the tumor in the lung or in the air passage.

2. CT scan is the most important modality because it not only shows the tumor but also gives information about the progression of the disease; whether the tumor is operable or not.

3. MRI and PET-CT may also help to know the progression of the tumor.

Treatment

Treatment for cancer depends on the cancer's specific cell type, how far it has spread, and the patient's performance status. Common treatments include surgery, chemotherapy, and radiation therapy.

Surgery

Surgery is the main modality of treatment for early lung cancer. If investigations confirm lung cancer, CT scan and often positron emission tomography (PET) are used to determine whether the disease is localized and amenable to surgery or whether it has spread to the point where it cannot be cured surgically.

Radiotherapy

Radiotherapy is used with curative intent in patients with lung cancer who are not eligible for surgery. This form of high intensity radiotherapy is called Radical Radiotherapy. Chemotherapy may be added concurrently with Radiotherapy to increase the efficacy of cell kill.

Radiotherapy has undergone dramatic changes in the last decade. IMRT (Intensity Modulated Radiation Therapy) is being used to target Lung cancer for the last ten years. But as we all know, lungs move during respiration and so the tumor target may be missed during Radiotherapy. This problem has now been overcome with the new technique of delivering IMRT, which is called IGRT (Image Guided Radiation Therapy). In IGRT, a low dose KV CT Scan is done before treatment and the position of the patient is corrected in all three dimensions if there is any shift from the original position.

Active Breathing control devices are also available with the help of which we target the tumor only during a specific phase of respiration so that the Radiation Beam hits the tumor more precisely and normal tissues are spared of unnecessary Radiation. This is also known as gated or 4D Radiotherapy.

Another major breakthrough in the treatment delivery of IMRT and IGRT is VMAT (Volumetric Modulated Arc Therapy). VMAT is a highly advanced and sophisticated treatment planning system which is available at very few select centers worldwide. Treatment planning with VMAT is far more precise and normal tissues receive only a fraction of Radiation as compared to older techniques. Another major advantage is that with VMAT, the treatment time is reduced from 25 to 30 minutes to just 2 to 5 minutes. Treatment with VMAT is thus not only faster but also more accurate with minimal side effects.

Chemotherapy

Chemotherapy is an important aspect of treatment of lung cancer. Most lung cancer patients require chemotherapy. The latest development is the treatment of lung cancer includes targeted therapies. These "targeted" therapies hit specific targets which are present on cancer cells. Hence, these therapies are considered superior than conventional chemotherapies as they kill specifically the target bad cells and spare the good (normal) cells.

How to improve chances of cure in lung cancer?

1. Cancer Screening of high risk population.

2. Annual Health Check ups.

3. Complete diagnostic check up and staging work up to know the disease stage.

4. Tumor Board Evaluation by a panel of cancer experts.

5. Integrated treatment at dedicated cancer centers with NABH Accreditation.

6. Surgery by dedicated thoracic surgeons skilled in Lung cancer surgery.

7. Use of highly effective targeted chemotherapy under expert medical supervision.

8. Use of advanced Radiation techniques such as IMRT, IGRT, VMAT and ABC.

9. And most importantly, the will to succeed, because with the latest technology available, we will now win the battle against Cancer.