New Delhi: Radiation therapy facility started in Lady Hardinge Hospital

New Delhi [India], April 13 : The first radiation therapy treatment of a cancer patient at Lady Hardinge Medical College (LHMC) was done using sophisticated Brachytherapy (internal radiation) equipment in its newly constructed Radiation Oncology Block on April 9, 2024. The department has been providing OPD and chemotherapy services for cancer patients until now.
With newly installed high-dose rate Brachytherapy equipment on the ground floor and a CT-simulator unit on the first floor of the block, LHMC will now be able to provide much-needed state-of-the-art radiotherapy services to cancer patients. Modern radiotherapy techniques require accurate information about the tumour as well as surrounding structures during radiation planning for targeting the cancers. The CT-Simulator machine is used for image-based planning of highly conformal radiotherapy treatment, which helps in targeting the tumour and sparing the normal structures.
The 20-channel high-dose rate Brachytherapy system utilising the Iridium-192 radioactive source will be used to provide internal radiation therapy to cancer patients suffering from cervical, uterine, prostate, breast and other cancers. The brachytherapy treatment is very effective at destroying the cancer cells while minimising damage to surrounding normal tissue.
The newly installed equipment, which costs approximately Rs 13 crore, will be a boon for poor cancer patients who are not able to afford radiation therapy treatment at private hospitals. There are very few government hospitals with radiation therapy facilities, and they have very long waiting times, during which their disease often progresses.
Shortly, a High Energy Linear Accelerator (LINAC) machine for External Beam Radiation Therapy (EBRT) will also become functional in LHMC's Radiation Oncology Block for the treatment of a wider range of cancer patients. The LINAC machine generates high-energy x-rays and electrons in the range of mega-voltage energy, or MV, for cancer treatment. The high-energy X-ray beams penetrate deep into the body and spare more superficial tissues, whereas electron beams are more beneficial for superficial lesions and can spare deeper normal structures.
X-ray and electron beams of different energies allow the radiation oncologist to customise the treatment based on the shape and location of the tumours. It will be particularly beneficial for patients with Brain tumours, Cancer that has spread to the brain or a recurrence of a brain tumour, cancer around the head and neck area, Spine, prostate, lung cancer, etc. The LINAC machine, whose order has been placed for approximately Rs 22 crore, will be shipped from the United Kingdom in a few weeks.
The External Beam Radiation Therapy treatment on LINAC would complement the internal radiation therapy treatment with HDR Brachytherapy, as some cancer sites are treated by external and some by internal radiation therapy and few by both. One example is cervical cancer, which is one of the most common cancers in females in our country and is generally treated with external beam radiation therapy first, followed by internal brachytherapy treatment.
There are many applicators by which brachytherapy treatment is delivered to tumours in different organs, such as the oral cavity, vaginal cavity, anal canal, breast, prostate, soft tissue, oesophagous and bronchus. Each of these applicators is unique in providing ease of placement of implant and according to the need for radiation dose distribution in a particular organ.
In early breast cancer cases for patients who want to retain their breast, following removal of the tumour by surgery, the remaining breast requires to be irradiated. In such scenarios, in selected cases, brachytherapy implants or balloon catheters can provide the treatment in a shorter span of time, producing equivalent results to external beam radiation treatment, which is longer and more time consuming.
Early buccal mucosa, tongue and prostate cancer patients benefit from brachytherapy delivered by interstitial implants, either alone or in combination with external beam radiotherapy. Those patients who have a recurrence of disease in the pelvis arising from the cervix, endometrium, or other gynaecological sites and cannot undergo surgery to remove them can achieve benefit by undergoing brachytherapy with the help of interstitial implants.
Many brachytherapy procedures are performed under general or regional anaesthesia, especially the interstitial implant types, and hence require in-patient care both before and after the procedure. The treatment in these scenarios is delivered by several fractions spanning a few days in overall duration.
Some of these procedures are quite painless and application can be done on an OPD basis with or without mild sedation and pain control. Vaginal brachytherapy, oesophageal, and bronchial luminal brachytherapy are usually done with the help of special applicators without the requirement of anaesthesia.
One particularly interesting application of brachytherapy is in a few types of early skin cancer where specially designed catheters catering to individual tumour sites can be applied like an external appendage and brachytherapy is delivered painlessly, producing excellent results with patient convenience.
The complications associated with brachytherapy alone are relatively few. This modality of radiotherapy requires less time for actual treatment delivery, especially with the use of the high dose rate (HDR) remote afterloader machine, which has now become functional at LHMC.