An expert meeting of the ROLE OF RADIOSURGERY IN THE TREATMENT OF ONCOLOGICAL PATIENTS was held in Belgrade.
The initiators and organizers of the meeting are Atlas General Hospital and Radiochirurgia Zagreb. The two institutions cooperate with each other to diagnose and treat cancer using radiotherapy and radiosurgery.
The goal of cooperation between Croatian and Serbian experts is not only to exchange experiences but also to raise awareness among citizens about the importance of preventive examinations.
Professor Schwarz, what is the reason for your stay in Belgrade?
We came in Belgrade after invitation of our colleagues to show them our results, patients, new techniques.
The idea is to try to make a joint cooperation in the fight against malignant diseases, said Prof dr Schwarz Dragan.
What is it that you would say not only to doctors, but also to patient?
The thing we are constantly telling to our patients is prevention, prevention, prevention. Early detection of malignant disease increases chances for best results of treatment. In this way, we all have better results in treatment, and we need to encourage patients to go often to do preventative examinations.
What is radiosurgery and how important is for oncological patients?
That is non invasive method that is compared with classical surgical method where patient during one visit to hospital can get radiosurgery treatment. Whether we speak about brain, lung, liver, prostate or lymph nodes cancer or some other parenchymatous organ, after that procedure patient can go home. That is absolutely non invasive method that has extraordinary results and we demonstrated it:
- in lung cancer is 94 % successful
- in metastatic liver carcinomas is successful in 96%
This is a new method that is combined with immunotherapy, chemotherapy, classical surgery, hybrid procedures, so we use all the modalities of possible treatments for oncological patients.
For this type of treatment it is necessary to have a team-who is in it?
It is always multidisciplinary approach, we always have an oncologist, surgeon, radiation oncologist, radiologist, pathologist, engineer, physicist or other different specialties depending on the specific organ. If it is brain, then in team it is neuro oncologist, neurosurgeon, if lungs are issue, then it is thoracic surgeon, radiologist. So, we use all the sub specialties that cures oncological patients.
Radiochirurgie is the first private polyclinic from Zagreb that performs diagnostic and treatment of the carcinoma. They have cutting edge equipment for diagnostic and treatment of cancer using radiotherapy and radiosurgery. In this meeting we had large number of patients that were successfully treated.
Patient with multiple metastasis in the lungs, after our treatments they do not have disease recurrence more than 22 months and we follow their health condition further, says professor Schwarz.
What is the stage of disease that is still curable regarding lung cancer?
In the early stage if we discover lung cancer with ultra low dose of CT and see some node which is with pathological analysis confirmed as tumor, then we can use different methods: radiosurgery, classical surgery, if there are multiple nodes in both lungs, then we perform radiology procedures that are minimally invasive. If cancer is discovered on time there is better prognosis and better outcome, that is why we constantly speak – prevention.
You said previously that the patient can choose, but between what?
Patient can choose between treatments. He could opt for classical surgery, chemotherapy, or combined method, or can choose radiology procedures. We see patients that refuse the chemotherapy, or refuse operating treatments. Patient has right to choose for his own body and he could choose about the way and type of treatment. Some patients say that they don’t want anything, they refuse any treatment, at the end it is the patient will.
At the expert meeting, a constructive and useful discussion was held from concrete examples presented by colleagues from Zagreb.
Doctor Galun, what was the topic of the meeting today?
We had an opportunity today to hear about completely new method of the treatment with patients with malignancy. These are the patients that have malignant processes of the liver, pancreas, lungs and brain. Colleagues from Croatia introduced us a new method of radiology procedures that enables high dose of radiation therapy in strictly controlled conditions. These controlled conditions mean that radiation is sent exclusively to tumor tissues while the rest of the tissue (the part of the organ that is not affected by the tumor) practically without any significant radiation or spreading of the toxic effect on the environment, says dr Galun.
Where are we, comparing to this method?
I think we should be proud of the fact that Clinical Center of Serbia, especially thanks to the effort of Prof Dana Grujičić is enabled to our patients to have access to this method. You know that for years there is a Gamma knife, recently we have also an X knife, so or patient also have possibility to use modern methods of treatment. I am positive that the number of patient that will use this method will increase in the future.
Is there some lack of condition, equipment or professionalism?
I think that we should invest in human resources, I believe we have a great potential, only our human resources need additional education and exchange of experiences with experts from abroad. We should be optimistic and expect that in time that is in front of us an increasing number of the patients that would be able to handle this techniques and that large number of patients will be able to get this modern, sophisticated methods of treatment.
What will be your subject today at the meeting dr Galun, at this oncology meeting?
I will speak today about the application of transarterial chemoembolization in treatment of patients with non resectable liver tumors. Also, I will speak about methods of percutaneous thermal ablation also in patients with primary and metastatic liver tumors. These are patients that due to comorbidity can not be operated or are unfortunately patients that are no more eligible for operation because they have inoperable tumor (tumors that can not be removed surgically). Then some other modalities of treatment that enable better control of the disease and the most important thing is that the life of the patients is extended. These patient are usually with primary liver tumors or hepatocellular carcinomas and we can proudly say that around 300 patients were treated in the previous period with this method with positive outcome.
Dr Aleksandar Đorđević spoke at the meeting about the metastatic diseases of the skeleton but he also polemicized with the colleagues from the Radiohirurgije Zagreb.
Colleagues from Croatia have the opportunity to follow up patients who have been treated with a new radiotherapy method for several years, which has the intention of replacing the surgical treatment of malignancies in certain cases. It’s nice when we have new things to offer and we are optimistic, but experience has taught us that many beautiful things do not end up being as good as we initially imagined they would be, but that doesn’t mean we should be skeptical.
Collaboration with colleagues from Croatia brings an exchange of experiences for the benefit of patients
I think that cooperation is necessary because when one do not change professional surrounding (I do not think that one has to travel to the end world to see something new, these are mostly the things that are available to us now, we have information from all sides nowadays) we should be rational enough and accept information that are promising on a logical and theoretical basis.
Dr. Đorđević talked about bone metastases, which is a very difficult condition for the patient but also for family, friends and the surrounding
People who are in great pain and who are immobile are in dramatic situation, psychologically very difficult, emotionally and in all possible aspects a very difficult condition. If we can help (we cannot always), we should not give false hopes to people, technology is in that sense and rapid recognition of differential diagnoses can lead to minimizing that patient suffering. This is usually the terminal phase of the disease, the last few months, and I think it is very important for patients to live with dignity and not to remain in the memory of their loved ones as someone who burdens them.
Is there a space for surgery?
When my colleagues in Zagreb talked about radiotherapy as a replacement for surgery, it was mostly about organs, and when it comes to skeletal localization, I think surgery is still irreplaceable (when the real indications are in question).
Are you successfully helping people with bone tumors?
Mostly during their active phase. There are certain anatomical locations such as hip fractures – the femur region and this is the most common indication. Also localization on the spinal column where stabilization and orthopedic surgical treatment give a quick and functional recovery. In combination with oncology and radiation therapy, they also give remissions.
The eminent experts of Atlas General Hospital and Radiosurgery Zagreb sent a message to the public that it is most important that patients should go for preventive examinations, that is, screening for the early detection of the most common cancers such as lung, prostate, breast and colorectal cancers. With up-to-date diagnostics and the latest treatments, early detected cancer is successfully treated.