Radiation therapy in Nepal

Cancer continues to be a formidable challenge to global healthcare systems, demanding innovative approaches for effective treatment. Radiation therapy, a cornerstone of modern cancer care, has evolved significantly over the years. In Nepal, where healthcare technology is rapidly advancing, radiation therapy has emerged as a critical tool in the fight against various forms of cancer. This comprehensive article explores the intricacies of radiation therapy in Nepal, encompassing its definition, applications, types, effects, paediatric considerations, risks, success rates, costs, prominent hospitals, expert practitioners, insurance coverage, patient reviews, post-treatment care, and the latest advancements.

What is Radiation Therapy?

When healthy cells undergo changes and uncontrolled growth, cancer develops. Every cell in the body undergoes a cycle of growth, division, and multiplication. This procedure is completed more quickly by cancer cells than by healthy cells. Radiation therapy alters the DNA of the cells, causing them to stop growing or to die.

Radiation therapy often targets a localised area of the body, unlike other cancer treatments like chemotherapy that target the entire body. This indicates that it often exclusively affects the body portion where the cancer is present. It’s possible that the treatment will harm some healthy tissue close to the cancer cells, but it normally heals once the treatment is through.

Radiation therapy comes in a wide variety of forms, and they all target cancer cells in slightly different ways.

Applications of Radiation Therapy

Radiation therapy finds application across a spectrum of cancer types, including breast, lung, prostate, head and neck, and brain cancers. The decision to use radiation therapy is based on factors like cancer stage, location, and the overall health of the patient. It serves as a curative, adjuvant, or palliative treatment, depending on the intent of the therapy.
The objectives of radiation therapy depend on the sort of cancer you have, whether it has spread, and how much. Radiation therapy can be administered on its own or as a component of a comprehensive treatment strategy. The following are a few applications for radiation therapy:

• as the main course of action. Radiation therapy frequently aims to completely eradicate the cancer while preventing its recurrence.
• prior to any additional therapies. To reduce a large tumour, radiation therapy can be used before other therapies like surgery. The medical term for this is “neoadjuvant radiation therapy.”
• After other treatments. Radiation therapy can be given after other kinds of treatments to destroy any remaining cancer cells. This is called “adjuvant radiation therapy.”
• To relieve symptoms. Radiation therapy can be used to relieve the signs and symptoms of cancer. This is called “palliative radiation therapy.”

Radiation therapy can be used to treat many different types of cancer. More than half of people with cancer will receive some type of radiation therapy. For some cancers, radiation therapy alone is an effective treatment. Other types of cancer respond best to a combination of treatments. Radiation therapy can also be used to treat recurrent cancer and metastatic cancer. Recurrent cancer is cancer that comes back after treatment. Metastatic cancer is cancer that has spread to other parts of the body.

Types of Radiation Therapy in Nepal

There are two forms of radiation therapy, and your doctor will decide which is best for you based on a variety of criteria, including: Type of cancer, tumour size, and site of malignancy the cancer’s proximity to other radiation-sensitive tissues your general health and well-being if you’ll require additional cancer treatment age.

External Beam Radiation Therapy:

This technique involves delivering radiation from outside the body using advanced machines. A technique called external beam therapy (EBRT) uses an external source to deliver precisely focused, high-energy x-ray or electron beams to a patient’s tumour. A linear accelerator (LINAC) typically produces beams that are directed towards killing cancer cells while sparing surrounding healthy tissues. More deep-seated tumours are treated using megavoltage photons, while skin cancer and tumours located in superficial tissues are treated with electron beams.

External beam radiation therapy (EBRT) is frequently administered to cancer patients using linear accelerators, also known as Linacs. High-energy X-rays that are tailored to the precise size, shape, and location of a tumour are delivered using a linear accelerator that has been programmed to do so. With little damage to the surrounding healthy tissue, the LINAC can precisely target and eliminate malignant cells in a patient’s body.

There are various forms of external-beam radiation therapy, including:

Three-dimensional conformal radiation therapy (3D-CRT): Using computed tomography (CT) or magnetic resonance imaging (MRI) scans, precise 3-dimensional images of the malignancy are produced during this type of radiation therapy. These pictures are used by the medical staff to direct the beam. With this method, the medical staff can safely provide larger radiation therapy dosages while minimising harm to healthy tissue. This reduces the chance of adverse effects.

Intensity-modulated radiation treatment (IMRT): Utilising computer-controlled linear accelerators, intensity-modulated radiation treatment (IMRT) is a highly advanced form of precision radiotherapy. By varying the strength of radiation in a number of tiny beamlets to match the 3D shape of the tumour while preserving the surrounding normal tissues, IMRT enables precise radiation dosing of the tumour. Dose painting, or the targeted administration of high doses of radiation to high-risk locations while low doses are delivered to low-risk areas, is a technique that can be used with IMRT to treat tumour masses. IMRT is utilised to treat a variety of solid tumours, including head and neck, brain, prostate, lung, uterine, gastrointestinal, breast, and others, when there are important surrounding structures and keeping them intact is a top goal.

Volumetric arc therapy (VMAT): A unique form of IMRT technology is volumetric arc therapy (VMAT). The linear accelerator revolves around the patient while delivering radiation in the form of an arc and changing the radiation beam’s strength as it travels around the body. In comparison to IMRT, it offers improved clinical outcomes with shorter treatment times.

Deep inspiration breath-hold (DIBH): Radiation therapy patients are advised to take a deep breath and hold it while receiving radiation treatment. This approach is known as deep inspiration breath-hold, or DIBH. The heart is forced out and the lungs are expanded to almost full capacity. When radiation therapy needs to be administered in the chest area while minimising radiation dosage to the heart, DIBH is especially helpful. DIBH is beneficial in radiation therapy for a left breast carcinoma, chest-regional lymphoma, and more tumours in the chest or upper abdomen.

Total Body Irradiation (TBI): Radiation therapy is known as total body irradiation (TBI) when it is administered to the entire body. Total Body Irradiation (TBI) is used for the treatment of conditions where a bone marrow transplant is planned, such as leukaemia in adults and children, including acute lymphoblastic leukaemia (ALL), acute myeloid leukaemia (AML), aplastic anaemia, etc. Total Body Irradiation

Total Skin Electron Therapy (TSET): Electron beam therapy is referred to as total skin electron therapy (TSET) when it is administered to the entire skin. TSET is used to treat skin conditions including mycosis fungoides, a form of skin cancer that typically affects the entire body. The Kathmandu Cancer Centre (KCC) was the first to introduce TSET to the nation. We have all the tools we need to deliver TSET, and up to this point, we have used TSET to treat 3 patients.

Proton beam treatment: Protons are used in this procedure in place of X-rays. A positively charged particle is a proton. Protons have the power to kill cancer cells at high energies. Protons deliver a precise dose of radiation therapy to the targeted tumour. Proton therapy delivers much less radiation outside the tumour than X-ray beams. This minimises harm to the tissue in the area. It needs specialised equipment to perform proton therapy, a relatively new medical procedure. Presently, only specific cancer types are treated with it. Study up on proton therapy.

Image-guided radiation therapy (IGRT): Imaging is used in IGRT during radiation therapy. Images are compared to those taken before to the start of treatment and while it is being administered. This enables medical professionals to accurately position the radiation.
Stereotactic radiation therapy (SRT): With this therapy, a small tumour area receives a strong, focused dosage. The patient needs to be quite motionless. Moving parts are limited by a head frame or individual body moulds. SRT is frequently administered in a single session or in fewer than ten sessions. More than one SRT training may be necessary for some persons.

Internal Radiation Therapy (Brachytherapy)

In this approach, radioactive sources are placed directly within or near the tumour site. Brachytherapy delivers a concentrated dose of radiation, making it particularly effective for cancers like prostate and cervical cancer.

Internal radiation therapy comes in a variety of forms, including:

Permanent implants: These small radioactive steel seeds are made of steel. The size of the capsules is comparable to a rice grain. Around the implant location, they give the majority of the radiation therapy. However, some radiation may leave the body of the patient. To prevent people from being exposed to radiation, safety precautions are needed. The implants gradually lose their radioactivity. The body still contains the dormant seeds.

Temporary internal radiation therapy: This kind of radiation therapy can be administered via a needle, a catheter, or specialised applicators. The duration of the radiation’s presence in the body can range from a few minutes to a few days. Internal radiation therapy typically lasts only a few minutes per patient. Internal radiation therapy may occasionally be provided for longer periods of time. If so, they stay in a secluded room to reduce radiation exposure to other people.

Other options in radiation therapy:

The following are more radiation therapy remedy choices:

Intraoperative radiation treatment (IORT): This procedure uses internal or external beam radiation therapy to administer radiation therapy to the tumour while it is being surgically removed. IORT enables surgeons to remove healthy tissue from the path of the radiation therapy to prevent damage to it. When crucial organs are close to the tumour, this treatment is beneficial.

Systemic radiation therapy: Targeting cancer cells, radioactive material is injected or ingested by patients. Urine, saliva, and perspiration are three ways that radioactive material departs the body. People who are in close proximity to the patient should follow the safety precautions advised by the medical staff because these fluids are radioactive. Radiation therapy with radioactive iodine for thyroid cancer is an illustration of systemic radiation therapy.

Radioimmunotherapy: Systemic therapy in this sense. To administer radiation directly to the tumours, it specifically makes use of monoclonal antibodies, which are proteins that are drawn to highly particular markers on the exterior of cancer cells. Due to the employment of these unique antibodies, the surrounding normal tissue is less affected by the treatment. Ibritumomab (Zevalin), which is used to treat certain lymphomas, is one instance.

Radioprotectors and radiosensitizers: Radiosensitizers and radioprotectors are being researched. Radiosensitizers are chemicals that make radiation therapy more effective at removing tumours. Healthy tissues close to the treatment region are shielded by radioprotectors. The drugs fluorouracil (5-FU, Adrucil) and cisplatin (Platinol) are examples of radiosensitizers. A radioprotector is an example, which is amifostine (Ethyol).

Paediatric Radiation Therapy

Radiation therapy for children requires specialized expertise due to the unique challenges posed by growing tissues. Proton therapy, an advanced form of radiation therapy, is gaining prominence in paediatric cases. Its precision allows for tumour targeting while minimizing damage to healthy tissues, thereby reducing the potential for long-term side effects. Children’s cancers are distinct from adults’ cancers. There are many different subtypes of leukaemias, lymphomas, brain tumours, and solid tumours of embryologic origin. With the right care, the majority of paediatric malignancies are treatable, with survival rates ranging from 70 to 80%. A paediatric cancer cure increases lifespan by at least 50–60 years, therefore the long-term impacts, patient quality of life, and social integration of the patients are just as crucial as the illness’s treatment.

Although paediatric irradiation is challenging for the radiation oncologist, it is an important part of the treatment of paediatric cancers. Radiation dose limits are substantially lower than they are for adults since radiation may harm developing children. Radiation is also always paired with chemotherapy, which calls for close coordination with paediatric oncologists. During simulation and treatment, anaesthesia and adequate placement are crucial for young patients, necessitating more staff and work. Planning radiation fields with the utmost care is necessary to minimise doses to vital organs.

Risks and Success Rates

Radiation therapy is generally considered safe, but it does carry risks. Risks depend on factors such as the treated area, radiation dose, and patient health. Success rates vary based on cancer type, stage, and treatment approach. Radiation therapy often offers promising outcomes, especially when integrated with other treatment modalities.

Cost Considerations

The following factors could influence how much radiation therapy costs:

• The Type and Severity of the Cancer – The cost of radiation therapy will be based on the type and severity of the cancer the patient has. When cancer had spread to multiple tissues and organs and required high radiation doses and repeated sessions, the cost of treatment was higher. The cost of internal radiation therapy is higher than that of external radiation therapy. The former employs X-rays, but the latter is a sensitive procedure that can involve implanting a radioactive device into the patient’s body.
• Number of Sessions – Radiation therapy for advanced cancer patients usually requires a lot of sessions. This prevents the elimination of all cancer cells at once. To maintain the same degree of efficacy as high-radiation sessions, numerous low-dose radiation treatment sessions are administered in these circumstances.
• Hospital Stay Length – A hospital stay of at least one night is required when radiation is combined with another procedure or chemotherapy. This has a direct impact on the final cost of radiation.
• Dosage required – To treat some cancer kinds, a lot of radiation is required. As radiation exposure increases, the price also grows. Also required is a high dose if the malignancy has spread far.

Prominent Hospitals for Radiation Therapy

Nepal boasts several hospitals equipped to deliver radiation therapy services.

Expert Practitioners in Nepal

The field of radiation therapy in Nepal is fortified by skilled oncologists and radiation therapists.

Insurance Coverage and Providers

Insurance coverage for radiation therapy in Nepal varies depending on the insurance provider and the specific policy. Prominent insurance providers in Nepal, offer different coverage options for patients seeking radiation therapy.

Patient Reviews and Experiences

Patient reviews offer insights into the quality of radiation therapy services in Nepal. Positive experiences often highlight the dedication of medical professionals, the utilization of advanced technology, and the provision of compassionate care. Patient feedback contributes to building patient trust and improving treatment experiences.

Post-Radiation Therapy Care

Post-treatment care is essential to monitor the patient’s progress and manage any side effects. Follow-up appointments allow medical professionals to evaluate treatment efficacy and address any emerging concerns. Patients are provided with guidance on managing potential side effects and adopting a healthy lifestyle post-treatment.

Radiation therapy can induce both short-term and long-term effects. Short-term effects include fatigue, skin irritation, and nausea. Most of these effects are transient and resolve after treatment completion. Long-term effects, such as tissue scarring or secondary cancers, are relatively rare but emphasize the importance of personalized treatment planning.

The patient does not continue to emit radiation following treatment sessions after receiving external beam radiation therapy. Radiation still exists in the treatment area.

However, patients who receive internal radiation therapy emit radiation. Visitors should therefore adhere to these safety precautions unless the patient’s physician gives different instructions:

• If you are expecting a child or under 18 years old, do not visit the patient.
• Keep a minimum of 6 feet away from the patient’s bed.
• Keep your visit to no more than 30 minutes every day.

Latest Developments and Future Prospects

Nepal is embracing the latest developments in radiation therapy technology. Advanced techniques like Image-Guided Radiation Therapy (IGRT) and Proton Therapy are expanding treatment options and improving patient outcomes. These advancements, coupled with increased accessibility, contribute to strengthening cancer care in Nepal.

Radiation therapy serves as a pivotal component of Nepal’s cancer treatment landscape. As the country witnesses rapid advancements in healthcare technology, radiation therapy is emerging as a potent weapon against cancer. With dedicated medical professionals, cutting-edge technology, and a commitment to patient welfare, Nepal is making significant strides in providing effective radiation therapy options. As the field continues to evolve, the potential for enhanced cancer management and improved patient quality of life becomes increasingly promising. The collaborative efforts of healthcare providers, researchers, policymakers, and patients collectively shape a future where cancer can be combated with precision and compassion.