Top Hospitals in India for Radiation Therapy: International Patient Guide

Radiation therapy

Radiation therapy refers to the medical treatment of cancers using high-energy radiation, typically either X-rays, gamma rays or particle beams to kill cancer cells or otherwise impair them. The aim will be to prevent the development of tumors or to reduce tumors but with minimum damage to the surrounding healthy tissue.

The Way It Works

• Radiation, in turn, destroys the DNA located in cancer cells, and the cells cannot develop and reproduce.
• A healthy cell is normally more receptive to radiation as compared to cancer cells hence is more prone to die once exposed to treatment.
• Normal, healthy cells are more able to repair than cancer cells.

Radiation Therapy types

External Beam Radiation Therapy (EBRT)

• An outside-the-body machine (linear accelerator) guides an outside source of radiation.
• May be targeted with very high precision (e.g. IMRT, VMAT, proton treatment).

Brachytherapy (Internal Radiation Therapy)

• A radioactive medium is filled or used in tumor.
• Occurs frequently in prostate, cervical and breast cancer.

Systemic Radiation therapy

• Radioactive materials are injected into a bloodstream or given to the body.
• Example: thyroid cancer: radiation iodine.

The Reason It is used

• First line therapy to treat cancer.
• Catabolic administration (postoperative) to destroy the cancerous cells that are left.
• Palliative treatment to alleviate such symptoms as tumor pain or tumor blood.
• When used in conjunction with chemotherapy or immunotherapy to produce improved outcomes.

Best radiation therapy for cancer

There is no single universal best as to the radiation therapy that is best in treating cancer rather it all depends on the type of cancer, its location, stage and what the general health of someone is. The following is a comparison of the principal radiation therapy modalities and when each one is tentatively the best:

External Beam Radiation Therapy (EBRT) -Standard and Multipurpose

• Ideal in: Lots of solid tumors (breast, lung, prostate, brain, head & neck, rectal).

Advantages:

• Non-invasive.
• May be directed and be moulded to target tumor precisely.
• Deep tumors works.

Advanced forms:

• IMRT (Intensity-Modulated Radiation Therapy): Uses beam energy to avoid damaging healthy tissue, good on cases where there is a tumor near a sensitive organ.
• VMAT (Volumetric Modulated Arc Therapy): More rapid method of delivery than IMRT and comparable accuracy.
• SBRT (Stereotactic Body Radiation Therapy): The very high doses are given in 1 5 sessions and are used on small well-defined tumours (e.g. early lung cancer, brain metastases).
• Proton Therapy: instead of X-rays, protons are utilized- lowers the exposure of radiation to healthy tissue, particularly helpful in children or a tumor in close proximity to important organs.

Brachytherapy- Inside Accurate

• Optimum use in: Prostate, cervical, uterine, head/neck, some, and breast cancer.

Advantages:

• Radiation that is inserted directly into or close to tumor.
• Extremely local high dose, little impact on nearby tissue.
• Reduced in speed as compared to EBRT.

Types:

• HDR (High Dose Rate): Periods of a small duration, frequently as an outpatient.
• LDR (Low Dose Rate): Radioactive seeds are deposited which remain days or permanently put there.

Whole-body Targeting Systemic Radiation Therapy

• Most effective with: Cancers that are sensitive to radioactive medication Compatible with: Sometimes used together with drugs that treat cancers directly e.g. thyroid cancer, some lymphomas Can be used to treat metastases in bone.

Advantages:

• Attacks malignant cells all over the body.
• Frequently used in conjunction with alternative forms of treatment.
• Example will include radioactive iodine (I-131) in the treatment of cancer of the thyroid.

Stereotactic Radiosurgery (SRS) Pinpoint Brain & Spine Treatment

• Suitable in cases of: Brain tumors, arteriovenous malformations (AVMs), spinal tumors.

Advantages:

• A single- to low-dose session or two.
• Very accurate- avoids healthy brain tissue.

Techniques:

• Gamma Knife
• CyberKnife
• LINAC-based systems

Factors Affecting Radiation therapy cost

Radiation therapy cost may be very high or very low depending on medical, technical and logistical factors:

• Type of Radiation Therapy
• Cancer Type and Stage
• Number of Sessions (Fractions)
• Hospital & Technology Level
• Planning & Imaging Requirements
• Oncologist & Medical Team Expertise
• Location of Treatment
• Combination with Other Treatments
• Hospital Stay (if required)
• Supportive Care & Follow-ups

Radiation therapy treatment process

The following are steps involved in the radiation therapy treatment process so you would have the knowledge of what goes on during treatment processes.

Initial Consultation

• The people you see: Radiation oncologist.

What happens:

• History, biopsy, scans review.
• Physical examination.
• Whether radiation is appropriate or not.
• Description of type, timing, benefits most likely to occur, and adverse effects.
• Signing of a consent form.

Simulation & Treatment Planning

• This process will enable the tumor to be the target and leave healthy tissue intact.
• Scanning: CT scan, the MRI or PET may be used together with an accuracy.

Positioning:

• Special molds, or masks, or cushions keep you immobile.
• Lines (small tattoos or marks) drilled or painted to line up the beam.

Planning:

• A radiation oncologist and medical physicist create a plan that is personalized with 3D software.
• Determine beam angles, dose, and session (fraction) quantities.

Quality Checks

• Calibrated machines are precise in dosage.
• Before beginning treatment, use test imaging to check the treatment.

Radiation Delivery (Treatment Sessions)

• Frequency Typically 5x/week, 1-7 weeks (type of cancer & program).

Process:

• The patient reclines in the same intended atmosphere.
• Radiation therapists position the beams with the help of the marks or lasers.
• Machine releases radiation-you won?t notice it.
• Duration of session: 10 30 min (time of actual beam-on is just several minutes).
• During radiation, you will be alone in the room, however, staff is monitoring equipment by camera and sound.

Monitoring in Treatment

• For side effect, nutrition, and emotional support weekly consultations with the oncologist.
• Adjust the dose (when necessary).
• Blood tests or radiology at some instances.

Post-Treatment Follow-Up

• Follow up visit: This typically occurs 2-6 weeks after its completion.
• Long-term follow-up: 3 6 months initially, annual.
• Imaging (CT, MRI, PET) to monitor the treatment of the tumor.
• Any late side effect management.

Radiation therapy for breast cancer

Post-surgery Radiation therapy of breast cancer has become an important drug method in destroying any cancer cell that may remain in the breast, chest wall and lymph nodes close to breast. 

Breast Cancer Goals

• In Post-lumpectomy (breast-conserving surgery): Decrease the chance of recurrence of cancer in the same breast.
• Following mastectomy: Advised when the cancer appears large or it encroaches on skin/chest wall or when the cancer has metastasized to several lymph nodes.
• In the scenario of metastatic disease: Palliate or manage symptoms.

Types of key Breast Cancer Radiation 

• External Beam Radiation Therapy (EBRT): Outside Source of high intensive X-rays
• Whole-Breast Irradiation (WBI): The entire breast exposed to radiation
• Partial-Breast Irradiation (PBI): Just the part around the location although it is tumor is being policed
• Internal Brachytherapy: Radioactive seeds/catheters placed into breast
• Chest Wall Radiation Lymph Node Radiation: EBRT to chest wall and /or axilla

A Standard Treatment Procedure:

Consultation & Planning

• Choose pathology and imaging.
• Positioning and mapping CT simulation.

Treatment Schedule

• Normal: 5 days per week, 3-6 weeks.
• Hypofractionated (shorter): Greater dose per session in 3-4 weeks, can be used on many early-stage patients.

Delivery

• Patient is in supine position (removed face down -prone position).
• The heart intact in left-sided breast cancer with the use of breath-holding methods (Deep Inspiration Breath Hold) to shield it against radiation exposure.

Radiation therapy for prostate cancer

One of the primary therapies of prostate cancer is radiation therapy particularly in cases where the patients have a low-grade or men who are unable to (or would not like to) undergo surgery. It might be applicable in advanced cases to regulate the growth of tumor or symptom relief.

Prostate Cancer Goals

• Localized (early stage): Treat the cancer, but do not strip the prostate.
• Locally advanced: Spread control and minimise the size of tumors.
• Metastatic disease: Ease pain in bones or obstruction in urinary.
• After surgery (adjuvant or salvage): Kill the remaining cancer cells.

Prostate Cancer Major Radiation Types

• External Beam Radiation Therapy (EBRT): outer radiation-X-rays/protons
• IMRT (Intensity-Modulated RT): Beams of specific shape
• VMAT (Volumetric Modulated Arc Therapy): IMRT alternative with faster version
• SBRT (Stereotactic Body RT): High dose (very high) in 5 or less sessions
• Proton Therapy: X-rays replaced by Protons
• Internal radiation therapy by catheter (Brachytherapy): Prostate Given?
• The use of combination therapy: EBRT + brachytherapy

The Normal Process of Treatment:

Consultation & Planning

• Check biopsy, PSA, MRI.
• Make the choices whether to use hormone therapy (ADT) along, with radiation.

Simulation

• Mapping with the use of CT scan.
• Protection of rectum can be by rectal balloon or gel spacer.

Treatment Schedule

• Standard EBRT: 7-9 weeks with 5 days/week.
• Hypofractionated EBRT: 4-5weeks (greater dose per session).
• SBRT: 5 visits within 1-2 weeks.
• Brachytherapy: requires only 1 day (LDR) or several small sessions (HDR).

Radiation therapy hospitals

Artemis Hospital, Gurgaon

High-precision therapies offered by the centre include IMRT (Intensity-Modulated Radiation Therapy), IGRT (Image-Guided Radiation Therapy), and brachytherapy which aim at equitable treatment and reduced exposure to healthy tissue. Artemis Hospital is the first of its kind and is equipped with a state of art M6 CyberkNife system in North India, a frameless, non-invasive high precision radiosurgery system which is used to treat tumors located anywhere in the body with high precision and minimal number sessions (normally between 1-5), such as brain, lung, spine, pancreatic and prostate tumors.

Medanta-The Medicity, Gurgaon

Medanta, founded by Naresh Trehan in 2009, Gurugram and is one of the top super-specialty hospitals in India including one-stop cancer care, Medanta Cancer Institute. VMAT (Volumetric Modulated Arc Therapy) on Infinity linear accelerators. - to make radiation highly conformal and precise. IGRT (Image-Guided Radiation Therapy) a two-way radio with real time imaging. SBRT / SRS (Stereotactic Body Radiotherapy / Radiosurgery) - including frameless Elekta system said to treat lung and liver tumors treated in less than 20 minutes. CyberKnife VSI robotic radiosurgery, a high accuracy non-invasive technique to treat functional and tumors. Tomotherapy: they are best suited to large-field therapy such as in craniospinal or whole-body irradiation. Integrated Brachytherapy Unit- to provide the internal radiotherapy in cancer e.g. cervical or prostate.

Fortis Memorial Research Institute, Gurgaon

FMRI has a flagship facility named the Fortis Cancer Institute (FCI) that provides combined cancer services such as medical, surgical, and radiation and backed by genetic counseling, rehabilitation, nutrition, psychological support, and research projects. MR-Linac: An imaging and radiation therapy system that integrates MRI with a linear accelerator in real time to produce the highest precision possible and reduce side effects. Source: 6-slice CT Simulator IMRT, IGRT, VMAT, stereotactic radiotherapy (SRS/SBRT) and brachytherapy with Linear Accelerators (Elekta). Gamma Knife Esprit (the first in the South Asia) that was highly specific, non-invasive, working with brain tumors and functional disorders.

Max Hospital, Saket

Equipped with TrueBeam Linac with Exactrac, allowing high-precision Stereotactic Radiosurgery (SRS) and Stereotactic Radiotherapy (SRT), high dose precision radiation in only 110 sessions. Having one of the earlier adoption of Novalis Tx system in Northern India to enable its IMRT, IGRT, Radiosurgery, HIPEC, SRS/ SRT services. As well as Brachytherapy and SBRT (Stereotactic Body Radiation Therapy) to target tumors with as little exposure to normal tissue as possible. The Cancer Care center provided by the hospital is a coordinated treatment model whereby the radiation, surgical and medical oncology groups in the hospital work together to personalize the treatment of the patients.

Radiation Therapy Doctors

• Dr. S Jayalakshmi
• Dr. Tejinder Kataria
• Dr. Swarupa Mitra
• Dr. Charu Garg

Radiation therapy in India by GetWellGo

GetWellGo is a medical tourism firm involved in helping foreign patients to seek cost-effective, quality cancer care in India. It includes end to end coordination-hospital and doctor selection as well as travel. GetWellGo connects patients with top cancer care hospitals in India- Artemis, Medanta, FMRI (Fortis Memorial Research Institute), and Max hospital Saket all of which feature sophisticated radiation oncology offerings.

Why Choose GetWellGo for Radiation Therapy?

GetWellGo is regarded as a leading supplier of healthcare services. We help our foreign clients choose the best treatment locations that suit their needs both financially and medically.

We offer:

• Complete transparency
• Fair costs.
• 24 hour availability.
• Medical E-visas
• Online consultation from recognized Indian experts.
• Assistance in selecting India's top hospitals for Radiation Therapy.
• Expert radiation oncologists with a strong track record of success
• Assistance during and after the course of treatment.
• Language Support
• Travel and Accommodation Services
• Case manager assigned to every patient to provide seamless support in and out of the hospital like appointment booking
• Local SIM Cards
• Currency Exchange
• Arranging Patient’s local food