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Madrid, November 17, 2021.- Only one year after the discovery of radium by Marie Curie in 1898, it had already begun to be used in the treatment of cancer. After more than one hundred years of advances, radiation oncology, whose commemorative day was celebrated this month, has become one of the most accurate, safe methodologies; hence its importance in the treatment of prostate cancer. “Technology has allowed us to increase the survival rate of patients and to shorten the duration of the radiation treatment. Before, we treated patients in 35-40 sessions and we can now do it in just 5 sessions”, points out Dr. Natalia Carballo, head of the Radiotherapy Service at MD Anderson Cancer Center Madrid.

According to data from the Spanish Society of Radiation Oncology (SEOR), in Spain 35,126 new cases of prostate cancer were diagnosed in 2020, with this tumor being the most common tumor in men and the third cause of cancer mortality, with more than 5,000 deaths yearly2. “The prostate is surrounded by two very important structures: the rectum and the bladder. Only with very precise technologies can we prevent patients from having rectal and urinary sequelae for life”, explains Dr. Carballo. This precision is made possible by the ability of advanced radiotherapies to administer the maximum dose, limiting it to the volume and shape of the tumor to be treated.

In this way, dispersion of the dose is avoided, ensuring that the areas adjacent to the cancerous lesion are not affected by the treatment and, therefore, preventing the side effects, according to the specialist. "The radiotherapy of the 21st century not only seeks to cure, but to heal without generating side effects," she says, adding: "This is what we are achieving with the equipment we have at our disposal". Furthermore, More recently, the treatment has been applied in metastatic patients.

In addition, the new technologies used have imaging resources, like integrated CT scanning, which the position of the internal organs to be seen, thus refining the process. In the specific case of the prostate, this approach is essential to knowing how full the bladder and rectum are, which in turn determines the position of the prostate.

Lack of knowledge and lack of access to the specialty

Despite its importance, this is a little recognized an area of specialization, not only at a general level but even within the world of medicine. In fact, according to SEOR1, medical students are not especially drawn to choosing the specialty for their MIR (specialization) residencies. This could be a result of the fact that it is offered in only a few leading hospitals in Spain, where there are only 65 places available, says Dr. Carballo, adding that patients also suffer from this lack of knowledge. “One of the great handicaps we have when patients come to us is that they unfortunately think 'they are going to radiate me' or 'they are going to harm me'. There is always a negative, outdated view of this specialty”, she regrets.

Furthermore, the European Society of Radiotherapy and Oncology (ESTRO) recently showed in one of its HERO1 studies that Spain is a country in which cancer patients have poorer access to radiation oncology services, mainly due to the lack of treatment units, which require a large investment in technology, the setting up of areas within the hospital and training for the health personnel staffing the department.

“Radiation therapy is essential in the multidisciplinary treatment of cancer. Up to 80% of patients will require radiotherapy treatment at some point in the overall treatment process”, emphasizes Dr. Carballo, who states that the treatment carried out in Madrid also includes the expertise of her colleagues from MD Anderson Cancer Center in Houston, "since data from all the treatments fall within a shared program and are studied globally".

Dissemination and investment: two necessary boosts for radiation oncology

To deal with this social perception, the work of the Radiotherapy Service at MD Anderson Madrid has focused on promoting these two areas - the dissemination of knowledge through various communication channels and the promotion of the modernization of Spanish radiotherapy centers. “We are a technological, advanced specialty, but little known. We have to try to be didactic and publish as much as we can”.

In fact, in October, Dr. Carballo received an award at the Ist Virtual Congress of the SEOR for her leadership in the creation and implementation of the ESTRO Madrid 21 Legacy project, a pioneer in the world, to bring cancer radiotherapy closer to the public. The project has involved developing the website, which offers information about what radiotherapy is, why it is important, what the benefits of this technique are for the survival and quality of life of cancer patients or how to care for the skin during the process, in addition to patient testimonials and an audiovisual campaign called ‘Invisibles’.