Types of Cancer
Brain Tumors
Malignant Brain tumor are offered radiotherapy based on the location, site, Operative status and Grade of the Tumor. Also a lot of importance is currently given to the molecular types and treatment is changed based on the molecular marker findings.
Benign conditions such as Acoustic Neuromas and Meningioma can be treated with Steriotactic Radiosurgery or with Steriotactic Radiotherapy based on the proximity to critical structures and size of the tumour.
Arterio-venous malformations are offered Steriotactic radio-surgery after considering the other alternative options such as coiling and surgery based on the location and recurrence/ residual following prior mentions alternative options.
Trigeminal Neuralgia and epilepsy can also be treated with Steriotactic Radio-surgery with Neurology Neurosurgery and Neuroradiology team combined guidance.
Head and Neck Cancers
Cancers of the head and neck region is very common in India due to high prevalence of tobacco use.
These cancers are treated based on the sub-site involved.
Oral cavity – Tongue, Cheek etc are offered surgery first, then based on the histo-pathology report offered further treatment for prevention of recurrence. Radiotherapy is used alone or in combination with low dose chemotherapy.
Nasopharynx– Though not a common cancer in India we do see them quite often and offered curative intent radiotherapy with chemotherapy. If the presenting extent of cancer is too high patient can be offered chemotherapy to reduce the bulk before starting radiotherapy.
Oropharynx and Hypopharynx
Throat, vocal cords and back of the tongue are usually offered Radiotherapy with chemotherapy to preserve the normal functionality. Surgery is preferred if the extent is too high or organ preservation may not be possible. Chemotherapy is given concurrently along with radiotherapy or sometimes before the radiotherapy to reduce the extent and make the patient amenable for RT
Soft tissue Sarcoma
Soft tissue sarcomas are offered radiotherapy as a preventive modality for recurrence after the primary surgery. If surgeon feels that it is difficult to get a negative margin due to local extensions there is an option to give radiotherapy before the surgery too. Few sites and types of sarcoma Radiotherapy is offered as a curative alternative for Surgery and have given comparable results.
Bone Tumors
Bone tumors are considered radio-resistant and usually not treated with radiotherapy but in few selected sub-sites and types, radiotherapy is offered as a local curative option due to inoperability and morbidity of the surgery at the site.
Extracorporial radiotherapy is an option to treat the cancerous bone with high dose of radiotherapy and use the same specimen as an implant.
Carcinoma Esophagus-
Cancer Oesophagus is a common cancer among Indian subjects and radiotherapy is an integral part of the cancer treatment. Radiotherapy in early cancer is curative as well as can be offered a prerequisite to dubulking the tumour prior to surgery. In cases where the burden of the tumour is more Radiotherapy along with chemotherapy concurrently is offered as a curative option.
Gynecological Cancers
Cancer of the Cervix is a common cancer in India and usually detected in the locally advanced stage. The current recommendation for early cancers is surgery followed by Radiotherapy in case of high risk features. In Stage II to III RT with CT is the standard of care. Brachytherapy is given after completion of 5-6 weeks of RT.
Cancer of endometrium is treated with Surgery in all the stages except metastatic disease and radiotherapy is given as vaginal Brachytherapy or external beam Based on the Stage, Age and other high risk features.
Skin Cancers
Skin cancers like Basal Cell Cancer and Squamous cell cancers can be treated with Radiotherapy alone or after surgery.
Benign conditions like Keloids can be treated with Brachytherapy after surgical excision to prevent recurrence of the keloid.
Lymphomas and Myeloma
Lymphomas are offered radiotherapy at different stages as either curative or as a salvage based on the stage of the disease and outcome following chemotherapy. Treatment is tailored as per the stage and outcome after discussion with Medical oncologist/ Hematologist
Multiple Myeloma can be treated with radiotherapy alone in very early localized stages but is usually detected at later stages and RT is given to lytic bone lesions that cause pain.
Lung Cancers
Lung cancers in early stages are treated with surgery and chemotherapy. When surgery is not possible Radiotherapy is offered as an option most likely as Steriotactic Body radiotherapy.
Locally advanced disease are treated with VMAT IMRT concurrently with Chemotherapy.
Pediatric cancers
Pediatric Tumors are difficult to treat as the intent would be to avoid radiotherapy as far as possible but in few cancers Radiotherapy is strongly indicated.
Based on the stage, Radiosensitivity and multiple factors RT is given for a variety of pediatric cancers like Rhabdomyosarcomas, Ewing’s sarcoma, wilm’s tumor, retinoblastomas etc.
Pediatric brain tumor too are offered radiotherapy in high grade lesion as inoperable and critically located benign tumors.