Radiotherapy, fewer side effects and increasingly effective treatments for treating tumors – breaking latest news

Innovation, precision, sustainability. These are the three key concepts that emerge from the national congress of the National Association of Radiotherapy and Clinical Oncology (Airo), with the primary objective of increasing efficacy and decreasing side effects, in order to improve survival and quality of life of cancer patients.

Innovation in radiation oncology

The radiotherapy oncologyhas made remarkable progress in the last decade: the machines have improvedincreasingly faster and capable of monitoring the administration of doses in real time; increased effectivenesswith ever more precise targets; Image quality has been optimized, essential to guide radiation as much as possible on the tumor while sparing healthy tissue; in the end, both the number of sessions and toxicities have been reduced, to the benefit of patients and with increasingly sustainable treatments also for the national health system. But the experts gathered in Bologna for the Airo congress also highlighted how innovation has passed and will pass more and more in the future from personalized therapies for each patient, which cannot ignore the professionalism and training of the radiation oncologist. Innovation in the DNA of radiotherapy, whose impressive evolution has allowed us to implement increasingly effective, safe and personalized treatments – he explains Cynthia Iotti, president of Airo and director of Radiotherapy at the AUSL IRCCS of Reggio Emilia —. We consider that in the future the curative role of radiotherapy will further increase and that a greater number of patients will be spared destructive operations or those that cause loss of important functions.

Accuracy

Today about 60% of cancer patients are prescribed radiotherapy treatment, alone or associated with other treatments (surgery, chemotherapy, hormone therapy, immunotherapy). Innovating in radiotherapy means use new, cutting-edge machines, equipped with advanced artificial intelligence systems that allow the treatment to be adapted in real time to the variations in volume, shape and position that both the tumor and the healthy tissues can undergo during the therapies – continues Iotti -. Innovating also means studying and applying new integrations with other therapeutic methods, especially with new biological target drugs and immunotherapy. And, again, collect and analyze multiple data from which to obtain useful information to define a therapeutic approach tailored to the individual. Among the crucial points for specialists and for patients is accuracywhich concerns both the personalization of the treatment in terms of strategy, choices and therapeutic sequences (always better guided by the greater knowledge of the biology and therefore of the behavior of the tumor), and the use of advanced technologies which allow the delivery of the radiation dose in a very selective way and with fewer side effects.

For patients who have few metastases

Radiotherapy can then be very useful for so-called oligometastatic patients, i.e. those who have developed a limited number of distant metastases and who are now believed to be able to recover. In this clinical situation radiation combines best the radical nature of the treatment and minimal invasivenesscompared to surgery, for example,” he says Marco Krengli, president-elect Airo and director of Radiotherapy at the AOU Maggiore della Carit of Novara —. It takes stereotactic radiotherapywhich delivers a very high dose, with millimeter precision, on the site of the metastasis leading in the great majority of cases to the eradication of the disease site. The identification of small distant metastases possible with advanced diagnostic techniques with CT, PET and MRI and the use of image-guided radiotherapy, which allow a very high precision with saving of healthy tissues and minimal side effects. The treatment can make it possible to reduce and/or delay the pharmacological treatment with chemotherapy, hormone therapy and drugs with a molecular target, which however can be combined in an optimal way, since the radiotherapy is delivered in very few sessions. A very interesting perspective in oligometastatic disease the combination of radiotherapy and immunotherapycurrently undergoing clinical trials.

Hypofractionation, or fewer sessions

Among the important steps forward made in recent years is also hypofractionation, a type of radiotherapy treatment in which the total dose of radiation is administered in a more limited number of sessions than in the past. The certain advantage for patients and their families, who have to go to the hospital less often. This therapeutic modality was particularly appreciated and advantageous during the pandemic, allowing for greater facilitation of patient access to treatment in a phase of extreme difficulty in accessing hospitals – underlines Pierluigi Bonomo, medical director at Careggi Radiotherapy in Florence and coordinator of the Airo scientific committee —. And it remains profitable under normal conditions, for all those structures that have waiting list problems. certainly a type of therapeutic choice that it presents a good cost/effectiveness profile, precisely because the number of accesses to hospitals is reduced. For example, in the cases of breast cancer there are growing pressures on its use because instead of the classic five weeks of radiotherapy, in some cases it is possible to proceed with a treatment of one or more commonly three weeks. Numerous and solid scientific evidences in the world support this type of therapeutic choice.

Sustainability

I’m over a thousand new cases of cancer diagnosed in Italy every day and the numbers are destined to increase due to the general aging of the population (it is above all people over 65 who get sick). With 377 thousand new diagnoses per year and an army of three and a half million compatriots who are alive and have had a tumor, the great challenge for the health system: how to be able to cure everyone and guarantee the best therapies through the coverage of the NHS? Because of this sustainability is a crucial step. Italy needs a structural, technical and organizational adaptation of radiotherapy services, starting with the modernization of the machines – he concludes John Carta, director of Oncological Radiotherapy ASP Caltanissetta and advisor on the Airo board -. The clinical features of radiotherapy treatment are primarily related to technology, which has evolved a lot in recent decades, becoming competitive with other therapeutic modalities; secondly, the other peculiarity the precision of radiotherapy treatment and its efficiency; thirdly, it is possible today reduce the duration of treatments increasing patient adherence to therapy. All of this allows for a reduction in side effects, travel and expenses incurred by the patient to go to the hospital, with a clear improvement in his quality of life. The positive impact also on the National Health Service, as parking spaces are freed up and waiting lists are reduced. Finally, it must be emphasized that the costs of a radiotherapy treatment are minimal: the expense sustained by the healthcare companies for the linear accelerator is amortized over ten years and in any case an investment for the hospital.