One third of people in Britain will develop cancer at some time during their lives and about half are cured. Opportunities for active treatment are increasing, with improvements in radiotherapy and chemotherapy and the development of novel biological and molecular treatment approaches. Of all cancer patients - 22% are cured by surgery, 18% by radiotherapy and 5% by chemotherapy alone or in combination with surgery or radiotherapy. Radiotherapy remains the most effective nonsurgical treatment modality forming a central provision of treatment in Cancer Centres and is solely responsible for or significantly contributes to cure in 40% of the long-term survivors of cancer. 40-45% of all cancer patients will require radiotherapy at some point during their illness. In two thirds of these cases radiotherapy is given with curative intent, either alone or in combination with surgery and/or chemotherapy. Palliative radiotherapy offer many patients relief from symptoms associated with advanced cancer. As with surgery, radiotherapy is a locoregional treatment modality. The main aim of radiotherapy is to maximize tumour control, whilst minimizing damage to normal tissues. Over the last 20 years, major technological advances have helped greatly to improve the accuracy of treatment with resulting improvements in outcome. The radiotherapy department
Radiation oncology is a multidisciplinary speciality that requires a skill mix of clinicians (radiotherapists and radiologists), physicists, dosimetrists, technicians (workshop, electronic, mould room), therapy radiographers, specialist nursing staff and IT specialists. A wide variety of technical equipment and machinery is required and includes linear accelerators, simulators, treatment planning systems, brachytherapy and afterloading facilities, portal imaging systems, CT/ MRI scanners linked to planning systems, computer networks and software upgrades. The enormous capital costs and specialist staffing necessitate radiotherapy departments to serve a large population to be cost-effective and most centres serve at least a population of a few million. SJIO serves a population of 2.8 million. Clinical use and indications for radiotherapy
Radical radiotherapy is treatment delivered with intent to produce a high rate of local tumour control. It accepts a defined rate of normal tissue complications and demands a certain level of technical sophistication. Radiotherapy may be curative as a single modality or when combined concurrently with chemotherapy. Radical radiotherapy involves complex planning and a protracted fractionated course of treatment. Most radical treatments are given over 4-6 weeks, in 1.8 – 2.75 Gray fractions to a total dose of 55 - 74Gy. Many of the currently used treatment practices and regimes are based on outcome measures obtained by analysing results from individual centres. For many tumours there is a wide range of currently acceptable practice. Concurrent chemoradiotherapy requires scheduling of chemotherapy during the course of radiotherapy. Toxicity is often a significant problem and patients should be monitored closely throughout treatment. Adjuvant treatment.
Radiotherapy is commonly used in the adjuvant setting following initial surgery or chemotherapy. The aim of treatment is to eradicate loco-regional residual microscopic disease. Adjuvant radiotherapy doses are usually slightly less than the doses used for radical treatment of macroscopic disease, but treatment planning may be just as complicated. The following cancers may require adjuvant radiotherapy following surgery: breast cancer, sarcomas, endometrial cancer, and head and neck cancer. Neoadjuvant treatment.
Radiotherapy or chemoradiotherapy may be given prior to surgery either to increase operability by downstaging the disease and/or to treat locoregional microscopic disease. Examples include the treatment of locally advanced rectal cancer and vulval cancer....
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