Radiation Therapy: A powerful weapon against cancer, explained by Dr Sarthak Moharir

Last Updated on September 11, 2023 by Aditi Gangal

Sarthak Moharir, Radiation Oncologist

Do you know that cancer is a silent killer? A report by the World Health Organization says that one Indian out of 10 develops cancer in their lifetime. A lot of us often believe that it is an untreatable condition. However, it is not the reality. Medical science has improved enough to invent treatments that are much safer than chemotherapy and can kill cancer cells at an early stage to improve the chance of survival. One such treatment is radiation therapy. In an interview, THIP Media spoke to Radiation Oncologist Dr Sarthak Moharir to discuss the basics of radiation therapy. He is currently working at HCG Cancer Centre, Vadodara, Gujarat.

How does radiation therapy work against cancer?

Dr Sarthak Moharir: Radiation therapy is nothing but X-rays, the same X-rays that we use to take a CT scan or a chest X-ray. In the hospital, we just increase the energy of these X-rays to 1000 times and use it to treat the cancer. This X-ray damages the DNA. In this process, the cancer cells die.

When does a cancer patient need radiation therapy?

Dr Sarthak Moharir: About 90% of the patients who come to my hospital need radiation therapy at one or the other time. Radiation therapy largely deals with solid tumours, excluding the tumours of the blood. So, depending on the time of radiation therapy, there can be many indications.

For example, some patients might require neoadjuvant radiation. In these cases, we give the radiation before the surgery, so that we can downstage the tumour and the surgeon can take it out easily. Or it can be in a radical setting, for example in cancers of the uterine, cervix or cancer of the vocal cord or cancer of the prostate, where radiation is the only modality of treatment that you need to cure the cancer. Or it can be in an adjuvant setting, which means that the surgeon has operated on the tumour. In such cases, the histopathology report may tell us that the tumour is at a slightly higher stage. Therefore, the patient will need adjuvant radiation to bring down the risk of recurrence of the disease.

Also, in stage four cancer patients, patients who have symptomatic painful metastasis in, for example, the bones or metastasis to the brain, the radiation will play a palliative role. We give radiation to ease the pain and suffering of the patient.

What types of cancers are treated with radiation therapy?

Dr Sarthak Moharir: We treat a large variety of cancers and tumours. In my practice currently, the bulk of my treatment patients include breast, head and neck, which is a large burden of cancer patients in India. Apart from that, we also treat a lot of prostate cancer cases. We treat cancers of the uterine cervix. Apart from that, we also treat cancer of the endometrium that has been operated on and requires radiation.

We also treat a lot of laryngeal cancers, cancers of the vocal cord and cancers of the brain. Another procedure that we do is stereotactic radiosurgery. We do it when the surgeon cannot reach the tumour with the knife. We use radiation in the form of a digital or an X-ray knife to take the tumour out.

What are the side effects of radiation therapy?

Dr Sarthak Moharir: The side effects vary according to the location of the radiation. One of the biggest myths associated with radiation is that radiation will burn off your skin, it will make you lose your hair and things like that. The current radiation therapy, especially in 2022-23, is a highly focused radiation. It affects only the area where we want to target it, and it spares the surrounding organs as well as the rest of the body.

So, depending on the site where the radiation has been given, the side effects can vary. For example, if the radiation is being given to the head and neck region, there will be blackening of the skin. There will be some ulcers or mucositis in the mouth and the neck in the throat. Apart from that, the patient can experience dryness of the mouth, intolerance to spices and sticky, slimy saliva. The blackening of the skin is a common side effect of radiation therapy for any cancer. If the radiation is being given to the pelvic area, for example, for radiation for cancer of the uterine, cervix or prostate, the patient might experience some burning in the urine or some burning sensation while the patient defecates.

Apart from that, a very small percentage of patients might experience diarrhoea with pelvic radiation. Breast cancer treatment is straightforward. There’s just blackening of the skin. The patient might experience some difficulty in swallowing. All these side effects that I’ve mentioned till now, don’t last forever. The blackening of the skin, the burning of the urine, and burning during the defecation, and the ulcers in the mouth and the neck. These take approximately three to four weeks to completely go away.

The side effects that I mentioned, for example, the sticky and slimy mucus and the inability to taste food or intolerance to spices, these side effects take about they improve at a rate of about 15% to 30% in a year. So these are the side effects that take a little longer time to go, but they do eventually go away.

What is the special diet given during radiation therapy?

Dr Sarthak Moharir: This is an interesting question. I don’t ask my patients to go on any special diets because, during radiation and cancer treatment in general, the patients already have a very low appetite and are not in their best condition. So, I tell them to have whatever they want, avoiding spicy foods, especially ground spices.

A similar view has been shared by Dr Manish Singhal, Oncologist at the Apollo Hospital, New Delhi. He informs that it is vital to focus less on whether the diet is vegetarian or non-vegetarian and more on its overall composition. Maintaining a well-balanced diet is of paramount importance. Diets that are high in calories and have a high glycemic index, potentially leading to obesity, carry a greater risk as they can promote tumor development. Such diets cause rapid spikes in blood sugar levels, triggering the body to produce elevated levels of insulin. While occasional indulgences are acceptable, it is essential to maintain equilibrium and ensure that items meant for occasional consumption, like sugary beverages, do not become regular components of one’s diet.

How much does radiation therapy cost in India?

Dr Sarthak Moharir: The price of radiation therapy can change according to where you’re living and where you are seeking treatment. A very good thing about recent times is that the government of India has launched something called the Ayushman Bharat. And then states have their state insurance schemes because of which a lot of people can get that treatment done for free.

So basically, for some patients in some centres, radiation treatment can be completely free. But if you are talking about, say, a corporate centre or a corporate hospital in a tier two or one city, the cost of radiation therapy can be anywhere between 1.5 to 2 lakh rupees for the entire treatment course. This does not include the price of medicine that the patient may require during radiation.

What are the best hospitals for radiation therapy in India?

Dr. Sarthak Moharir: There are several hospitals in India. I am currently working out of HCG Hospital in Baroda. It is a chain of hospitals across India, which has a huge footprint in Gujarat and the southern states of India. Apart from that, there are other hospitals like Tata Medical Centre in Calcutta and Tata Memorial Hospital in Mumbai. People consider TMH, Mumbai the Mecca of oncology. And closer to where I work, there is the GCRI. Shout out to all these hospitals because they are doing incredible, incredible job at treating the cancer burden in India. Incredibly good quality research is also coming out of these places. So I’m very proud of all my colleagues who are working in these places and giving us the best treatment possible.

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