Cancer can become anywhere in the human body almost including trillions of cells. Cancerous tumors spread or invade into the tissues to form new tumors that named as the process of metastasis. Radiation therapy (RT) was first used to treat cancer over a hundred years ago. The progress has been made to improve the effectiveness of this awesome modality and minimize side effects. RT also has been used with surgery, chemotherapy or immunotherapy in combined modality approaches for numerous malignancies to maximize tumor control while minimizing toxicity and preserving the organs and tissues. We intend to present our patient population whom delivering radiotherapy in our radiotherapy center. The data includes the patients who still delivering radiotherapy, initial or last day of radiotherapy. This article is about a snapshot of a treated patient population in one day at our center. Mean KPS (Karnofsky Performance Score) was 90 (70-100). 2 patients were in stage 1 (2%), 25 (28%) were in stage 2, 35 (39%) wee in stage 3 and remaining 23 (26%) were in stage 4. 4 (5%) of all were benign.
Keywords: Cancer; Radiotherapy; Experience; Single center
Cancer is a disease that some body’s cells grow uncontrollably and spread to other regions of the body. Cancer can become anywhere in the human body almost including trillions of cells. What human cells do is to grow and multiply to form baby cells as the body requires them. If cells grow old or damaged, new cells take their place of died ones. In case this process breaks down, abnormal or damaged cells grow and may form tumors. Tumors can be cancerous or benign. Cancerous tumors spread or invade into the tissues to form new tumors that named as the process of metastasis. Cancerous tumors may also be malignant tumors. Benign tumors do not spread or invade the tissues. If they are removed, benign ones often do not grow back. Benign tumors can rarely be quite large which can cause serious symptoms or life threatening such as in the brain.
Radiation therapy (RT) was first used to treat cancer over a hundred years ago. The progress has been made to improve the effectiveness of this awesome modality and minimize side effects. RT also has been used with surgery, chemotherapy or immunotherapy in combined modality approaches for numerous malignancies to maximize tumor control while minimizing toxicity and preserving the organs and tissues. Multidisciplinary team of clinicians, including surgeons, medical oncologists, radiation oncologists, and other specialists determine the best approach for the indivualized treatment [1,2]. RT may be the sole treatment or be given concurrently with chemotherapy, or may precede or follow surgery to minimize the microscopic disease after treatment. Additionally, RT might be used palliatively for incurable cancers. The duration of RT can vary from a single shot to eight weeks of daily irradiation.
Randomized clinical trials have established similar outcomes between surgery and organ-preservation treatment with an RT for selected patients with prostate cancer, oropharyngeal cancer, breast cancer, laryngeal cancer and sarcoma, Some trials have shown the appropriateness of organ preservation for patients with bladder cancer and early-stage lung cancer. Definitive RT is a very important option for treating selected patients with potentially curable malignancies. In this original article, we intend to share our real data of single radiotherapy center with characteristics, doses, cancer types and treatment approach of all patients.
We intend to present our patient population whom delivering radiotherapy in our radiotherapy center. The data includes the patients who still delivering radiotherapy, initial or last day of radiotherapy. This article is about a snapshot of a treated patient
population in one day at our center. Age, gender, diagnosis, stage,
treatment, fraction size, radiotherapy device and Karnofsky
Performance Score were collected from files as the patient
characteristics. The radiotherapy devices in our center are
tomotherapy (HI-ART) and linear accelerator (ELEKTA, UK).
Statistical Package for the Social Sciences, version 26.0 (IBM
Corp. Released 2019. IBM SPSS Statistics for Windows, Version
26.0. Armonk, NY: IBM Corp) software was used for analysis and
the level of significance was set at P < 0.05. Descriptive statistics
and survival analysis were applied. Survival analysis and curves
were done via the Kaplan–Meier method. Survival curves were
analyzed due to the T stage. Logrank test was used for the analysis
of T stage survival curves.
Total treated patients number is 89. 15 patients (17%)
were treated with tomotherapy and 74 (83%) were delivered
radiotherapy with linac. Mean age of population was 57 (12-83)
years. 48 (54%) of all were females whereas males were 41 (46%).
Mean KPS (Karnofsky Performance Score) was 90 (70-100). 2
patients were in stage 1 (2%), 25 (28%) were in stage 2, 35 (39%)
wee in stage 3 and remaining 23 (26%) were in stage 4. 4 (5%) of
all were benign. 83 (93%) of patient population were treated with
conventional fractionation and 6 (7%) of all were treated with
SBRT (Stereotactic Body Radiotherapy). 16 (18%) patients were
delivered palliative doses and 73 (82%) of all were given curative
doses. The diagnosis of patients was seem to be a wide range of
different type of cancers. 24 patients (27%) were breast cancer,
5 (6%) of all were prostate cancer, 15 (17%) patients were lung
Head and neck cancer patients were 6 (7%) of all. 4 (4%)
of all group were lymphoma whereas 2 (2%) patients were
gynecological cancer. Gastrointestinal cancer patients were 12
(13%) of all. 3 (3%) of all population were skin cancer. Central
nervous system cancer were in 3 (3%) patients whereas 2 (2%)
of all were pediatric tumors. Benign patiens were 4 (4%) and
CUP (carcinoma of unknown primary) patient was just 1 (1%). 8
remaining (11%) of all were diagnosed with other type of cancers.
According to the data of International Atomic Energy
Association, there are 8403 centers delivering radiotherapy.
15276 mv therapy and only 107 light ion therapy are used in
these centers. The number of kv therapy devices are 740. 3380
brachytherapy devices are used for treatment. In Turkey, there
are 137 centers for radiotherapy. 281 mv therapy devices are used
here and no light ion devices are there in our country. The number
of brachytherapy devices are 31.
RT is a treatment approach that delivers energy to kill
malignant tumor cells in the targeted area. What RT do is to
damage the DNA of cancer cell by ionizing the atoms making
the DNA chain. An optimal balance must be achieved between
probability of a radiation-induced complication in a normal
tissue and the probability of tumor control. The therapeutic ratio
is achieved by minimizing the dose to normal tissues or organs
while maximizing the dose to the target. At the same time, the
total dose of radiation is often divided (fractionated) into smaller
daily doses to allow normal tissues to repair the radiation damage
External beam radiation therapy (EBRT) is the most common
RT approach which delivers the radiation from a source outside
the patient . Electrons are accelerated to high energy and
are allowed to either exit the machine as an electron beam or
to strike a target that produces X-rays (also known as photons),
which are directed at the tumor in linear accelerators. Photons
are the most widely used radiation mode due to their ability to
penetrate deeply and reach internal organs whereas electrons
are specifically used for superficial targets such as the skin
and breast to minimize radiation to deeper tissues and organs.
Treatment planning include definition of tumor target, patient
immobilization, imaging, delineation of the target volumes and
critical organs, consideration of dose and schedule, set-up and
Intensity-modulated radiation therapy (IMRT) is an ultimate
form of 3- dimensional conformal radiotherapy (3D-CRT) that
shapes the intensity of radiation in different parts of a single
radiation beam while the treatment is delivered . Image Guided
Radiotherapy (IGRT) is real-time imaging of the treatment target
and normal tissues during each treatment allows for minimization
of additional margins and the reduction of irradiated volumes
which decreasing missing a target. Particle therapy is a special
form of EBRT, with protons being often used . Proton radiation
reduces the dose to normal tissues by allowing for more precise
dose delivery because of the unique physical specialities of heavy
particles . Neutron RT is believed to have an advantage in the
treatment of certain tumors such as recurrent or inoperable
salivary gland malignancies or incompletely resected sarcomas of
soft tissue, cartilage and bone [7,8].
Stereotactic radiation therapy techniques administer the
calculated dose of radiation in one or a very limited number of
treatment fractions. Stereotactic techniques often utilize photons
that are delivered by a linear accelerator or by a cobalt-60
source. Stereotactic radiosurgery (SRS) refers to a single-fraction
treatment of intracranial or spinal targets whereas stereotactic
body radiation therapy (SBRT) meaning multifractional (typically
two to five fractions) treatment of intracranial, spinal, or
extracranial sites such as prostate, liver, pancreas, head and neck
and lung [9,10].
Total body irradiation (TBI) is widely used as a component
of preparative cytoreductive regimens for hematopoietic cell
transplantation. Brachytherapy is a form of RT in which a radiation
source is located inside or close to the area requiring treatment.
The radiation emitted is usually active over only a relatively short
distance. Brachytherapy can be delivered with either high dose
rate (HDR) or a low dose rate (LDR) system [11,12]. Intraoperative
radiation therapy (IORT) that single-fraction treatment used is
the delivery method of radiation at the time of surgery and dose is
limited by critical structures .