The New York Times recently reported on a couple of cases of radiation therapy gone terribly wrong. Since then, several radiation oncologists have come out urging us to keep our perspective and remember that these incidences, though devastating, are very rare (less than 1 in 22,000) and that radiation has, by far, done more good than bad in the treatment of cancer.
According the the National Cancer Institute, “more than half (about 60 percent) of people with cancer get radiation therapy.” Radiation kills aberrant cells, stops them from multiplying, shrinks tumors and can save lives. But, cancer is insidious and it is difficult to completely kill all the cancer cells without exposing some healthy tissue.
“Since the first description of radionecrosis by Fischer and Holfelder in 1930, injury to the brain and spinal cord is a feared complication, although irradiation is an essential treatment for many CNS (brain and spinal cord) tumors,” writes Dr. Steven R. Isaacson, from the Gamma Knife Center, in his chapter on Radiation Injury in the 12th edition of Merritt’s Neurology.
It is fair to say that balancing the benefits of the treatment with its known risks, has been a driving force in the development of radiation technology and treatment protocols since then. The introduction of the MRI in the 1970’s and the PET scan in the 1980’s allowed 3D imaging of tumors to better target radiation. Today, a fourth dimension has been added, time, using intensity-modulated radiation therapy (IMRT) allows for real-time adjustments for even more accuracy and less risk.
The New York Times reported uncommon errors, in particular with IMRT. Dr. Isaacson says,” IMRT is a type of radiation delivery that is most commonly employed as a fractionated therapy, that is, given everyday over the course of several weeks.”
For tumors of the brain specifically, the Gamma Knife is often used instead of IMRT. Unlike IMRT, the treatment is given in just one dose and according to Dr. Isaacson, “The Gamma Knife, although very complex itself, is not affected by most of these concerns.”
All of this technology is only as good as the people who run it, however. In a letter to patients, faculty, and staff at Columbia, Dr. K.S. Clifford Chao, Head of Radiation Oncology was reassuring:
At the New York Presbyterian Hospital, Columbia University Medical Center, and Weill Cornell Medical College, we have rigorous guidelines for the planning and delivery of all radiation treatments, including IMRT and seed implant. The plan generated by the computer is independently reviewed by two qualified medical physicists and approved by the attending physician prior to treatment. Before beginning the first irradiation, the plan is re-reviewed by a radiation therapy technologist and a medical physicist, and the dose delivery is monitored continuously throughout the treatment. Equipment is examined and maintained on a regularly scheduled basis.
This is something that is taken very seriously, Our faculty and staff are trained and inculcated with the core principle that the safety and welfare of the patient is always our prime concern. Our clinical expertise and quality control mechanisms assure that the most cutting-edge radiation treatments will be safely delivered.
It is important to keep all of this in perspective and to remember that while knowledge of the risks is crucial in making the right treatment choices, radiation can ease suffering and save lives. We don’t want people to throw the baby out with the bath water and not get the treatment they really need.
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