New technology allows radiotherapy to bid farewell to the era of "fuzzy bursts"

Recently, a special operation caused the radiotherapy technique to attract media attention
.

The team of Dong Jiahong, academician of the Chinese Academy of Engineering and dean of Beijing Tsinghua Chang Gung Memorial Hospital, together with relevant experts, implemented yttrium [90Y] resin microspheres for a patient with advanced liver cancer in Hainan Boao Super Hospital

"In the past 30 years, China's radiotherapy has developed rapidly, but the development of various regions is uneven, and there is a serious shortage of accelerators for radiotherapy.
According to the recommendation of the World Health Organization, the accelerators for radiotherapy are configured to be 2-4 units/ One million population
.

The current situation in China is that there are only 1.

Radiotherapy techniques are divided into two types: in vitro and in vivo

When it comes to radiotherapy, the public is no stranger to it.

It has a history of more than 120 years

Feng Xiaobin, deputy director of the Department of Hepatobiliary and Pancreatic Surgery at Beijing Tsinghua Chang Gung Memorial Hospital, said that the current clinical application of radiotherapy techniques can be divided into long-range radiation and short-range radiation, or external radiation and internal radiation
.

At this stage, external radiation technologies include proton therapy, neutron therapy, and photon therapy
.

With the development of medical technology, there has been also clinically intensity modulated, tomotherapy, TOMO, arcuate illumination, stereotactic radiotherapy, gamma knife, knife gyro, CyberKnife like

What is the difference between internal radiation therapy and external radiation therapy? Feng Xiaobin said that compared with external radiotherapy, the radiation dose of internal radiotherapy is higher, and the distance between the radiation source and the target area is shorter, so that the radiation accuracy is higher
.

In addition, in vivo radiotherapy achieves the maximum radiation dose to kill tumor tissues while avoiding damage to surrounding tissues and organs to the greatest extent

The above-mentioned yttrium [90Y] resin microsphere therapy belongs to internal radiation therapy
.

Cai Jianqiang, deputy director of the National Cancer Center and deputy dean of the Cancer Hospital of the Chinese Academy of Medical Sciences, said in an interview with a reporter from the Science and Technology Daily: "Yttrium [90Y] is a special radioactive source with high radiation energy, up to 2.

New radiotherapy technology has important clinical significance

"The clinical application prospects of internal radiotherapy and external radiotherapy are very broad, and the choice of disease treatment depends on the patient's condition, the size and scope of the tumor and other factors
.

" Feng Xiaobin said

At present, external radiotherapy can be used for the treatment of a variety of tumors, such as cervical cancer, lung cancer, breast cancer and liver cancer
.

In vivo radiotherapy also has abundant clinical applications
.

"For example, RDC targeted radiopharmaceuticals headed by 177Lu can be used for the treatment of neuroendocrine tumors, prostate cancer and kidney cancer; 166Ho and 90Y radioembolization can be used for the treatment of primary or metastatic liver cancer; 131I can be used for thyroid cancer or hyperthyroidism Treatment of other thyroid diseases; 223Ra can inhibit prostate cancer bone metastasis and reduce tumor recurrence; 125I seed implantation can play an effect on a variety of solid tumors, such as lung cancer, prostate cancer and liver cancer

"However, traditional external irradiation technology does not completely match the shape of the irradiation field with the shape of the tumor in the three-dimensional direction, so it will also irradiate the normal tissues around the tumor and cause damage to the normal tissues
.
" Feng Xiaobin said frankly
.

In order to reduce the damage to the surrounding normal tissues, new external radiotherapy techniques continue to appear
.
For example, stereotactic radiotherapy techniques, three-dimensional conformal radiation therapy, image guided radiation therapy technology
.

Li Yexiong also said that the new radiotherapy technology has important clinical significance
.
"On the one hand, it can increase the tumor radiation dose, improve the local tumor control rate and patient survival rate; on the other hand, it can reduce the normal tissue radiation dose, reduce the toxic side effects to normal tissues, and expand the application range of radiotherapy technology
.
"

"For example, intensity-modulated conformal radiotherapy can improve the survival rate of patients with head and neck tumors, reduce normal tissue deformities and long-term side effects, improve the quality of life of patients, and increase the long-term survival rate of patients; the application of spiral tomography and radial radiation therapy systems can Significantly reduce the risk of cardiovascular disease; proton radiotherapy technology can significantly reduce the risk of the second primary tumor; in the treatment of prostate cancer, heavy ion therapy can significantly reduce the risk of the second primary tumor
.
" Li Yexiong said
.

The popularization of new technology still needs to climb the hurdle

In the past 30 years, China's radiotherapy has developed rapidly
.
Li Yexiong introduced that China's radiotherapy centers have grown from 364 in 1986 to 1,463 in 2019, and the number of radiotherapy-related practitioners is also growing rapidly
.
In addition, driven by the development of computer technology and imaging technology, China's radiotherapy technology has developed rapidly, and heavy ion therapy, MRI simulation positioning, and MRI accelerators are gradually being used
.

"On the whole, China's radiotherapy technology is in line with international standards in both equipment and technology
.
" Feng Xiaobin said
.

According to experts, from the perspective of radiotherapy equipment, China's radiotherapy equipment is rapidly spreading, and many county-level hospitals already have more advanced radiotherapy equipment
.
"Beijing, Shanghai, Guangzhou and other domestically developed cities have radiotherapy equipment that are even more advanced than those in Western countries such as the United States
.
" Feng Xiaobin said
.

From a technical perspective, the level of radiotherapy in many large domestic hospitals has been in line with or even leading the international level.
For example, China's radiotherapy technology for nasopharyngeal cancer is far ahead in the world
.

From the perspective of concept, the concept of precision radiotherapy has also been formed in the field of radiotherapy in China
.

However, it should not be overlooked that the level of radiotherapy in China has developed unevenly in various regions, and the level of radiotherapy in hospitals in different regions is uneven
.

In addition, there is a serious shortage of accelerators for radiotherapy in China, especially the shortage of accelerators independently developed
.
Cai Jianqiang said: "On the whole, the level of radiotherapy in China is not much different from the international level
.
But at present, 80%-90% of radiotherapy accelerators in China are from abroad, which limits the use of advanced radiotherapy methods in
China.
Although China's independent research and development of radiotherapy Accelerator equipment has been gradually put into application, but has not yet reached the level of market promotion, so we must increase the independent research and development of medical accelerators
.
"

Li Yexiong believes that the application of new radiotherapy technologies is also facing great challenges
.
"The use of new radiotherapy techniques requires qualified doctors to accurately grasp the definition and dose of the target area, and qualified physicists to ensure the smooth progress of the treatment plan and the quality control of radiotherapy.
However, the radiotherapy department of the hospital Talents are relatively scarce
.
"

"It's worth noting that there is a certain cognitive bias in Chinese cancer patients about radiotherapy
.
" Feng Xiaobin said that in word of mouth, the public's impression of radiotherapy is negative
.

Feng Xiaobin believes that to promote the development of radiotherapy technology in China, it is necessary to combine the training of basic talents and the reform of the hospital's departmental model
.
"The construction of the talent team needs to start with school education, add interventional radiotherapy, recruit more medical physics and oncology students, and encourage students to go overseas to learn the use of advanced equipment, etc.

" Feng Xiaobin said
.
(Dai Xiaopei)