TECH UP THE CHALLENGE

Precision technology is revolutionising cancer care

- NIRMAL JOVIAL

In September 2023, Ravi (name changed), a 67-year-old from Bengaluru, developed symptoms of jaundice. Further investigations brought more alarming news: he had an aggressive form of pancreatic cancer with a poor prognosis. A PET scan revealed that the malignant lesion had advanced, complicating treatment.

To treat his jaundice, doctors performed a stenting procedure. Ravi then underwent eight cycles of neoadjuvant systemic chemotherapy to shrink the tumour. This was followed by 27 sessions of external beam radiation therapy (EBRT).

Typically, cancer treatment involves three main approaches: surgery, chemotherapy and radiotherapy, sometimes combined with immunotherapy. Surgery aims to remove all visible cancer. However, microscopic cancer cells that are too small to detect may remain in the area around the surgery site. If left untreated, these cells can grow back, causing the cancer to recur. To address this, radiotherapy is given after surgery to target these residual cells.

In Ravi's case, despite the treatments he underwent, a followup PET CT scan showed the disease affecting nearby critical blood vessels. Surgery was seen as an inadequate option as it could still leave behind some cancer cells. Pancreatic cancer near major blood vessels is hard to remove completely, increasing the chances of the cancer coming back. Conventional radiation doses, limited to 50-54 Gy, are often not strong enough to treat cancer near vital structures fully.

Conventional radiotherapy has other limitations, too. It involves delivering radiation from outside the body, which means it must pass through healthy tissues-such as skin, fat, intestines or kidneys-before reaching the target area. This can harm normal tissues and still may not reach the intended location with precision, as pinpointing the exact spot of residual cancer deep inside the body can be challenging.