IORT TECHNIQUE IS A GAME-CHANGER IN BREAST CANCER TREATMENT - The Daily Guardian
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IORT TECHNIQUE IS A GAME-CHANGER IN BREAST CANCER TREATMENT

Intraoperative radiotherapy is a treatment delivery technique that dates back to the early twentieth century and involves the use of orthovoltage energy, with limited applicability due to its energy properties.

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Breast cancer is an illness in which the cells of the breast multiply uncontrollably. There are various types of breast cancer. The type of breast cancer is determined by which cells in the breast become cancerous. Breast cancer can start in a variety of places in the breast.

Lobules, ducts, and connective tissue are the three primary components of a breast. The glands that generate milk are known as lobules. The ducts are tubes that transport milk from the breast to the nipple. Everything is held together by connective tissue, which is made up of fibrous and fatty tissue.

Breast cancer usually starts in the ducts or lobules. Breast cancer can spread to other parts of the body via blood and lymph vessels. Breast cancer is said to have metastasized when it spreads to other regions of the body.

Intraoperative radiotherapy (IORT) is a treatment delivery technique that dates back to the early twentieth century and involves the use of orthovoltage energy, with limited applicability due to its energy properties. The procedure was cumbersome. This was until the development of a mini-LINAC technology called Intrabeam that could be easily moved and used in the operating room. This has made IORT feasible and practicle. The technique of IORT called TARGETED INTRAOPERATIVE RADIO Therapy (TARGIT) has been used for breast cancer patients over the past few years.

During surgery, therapeutic levels of radiation are usually delivered to the tumour bed while the area is exposed. IORT is usually used in conjunction with external beam radiation, surgery, and chemotherapy in the multidisciplinary treatment of locally advanced and recurring cancer.

IORT can also be used in earlier-stage cancers like prostate and breast cancer, which has become more popular in recent years.

IORT has been demonstrated to be effective and practicable in the multidisciplinary management of a variety of solid tumours, but further research is needed to pinpoint the benefits. It is mostly used in selected breast cancer cases. However, IORT has been suggested to play a role in brain tumours and cerebral metastases, locally advanced and recurrent rectal cancer, skin cancer, retroperitoneal sarcoma, pancreatic cancer, and certain gynecologic and genitourinary malignancies based on single-institution experiences. If repeated EBRT is no longer possible, irradiation with IORT is the only radiotherapeutic option for local recurrences, aside from brachytherapy. In some instances the intraoperative radiation therapy is delivered after the surgery instead of during it. Your surgeon will have to reopen your incision if that is necessary. After the procedure, be sure to get enough rest, stay hydrated and eat nutritious meals. Some studies have shown that intraoperative radiation therapy is just as effective as external beam radiation therapy. Other studies have proven that women who have IORT are more likely to have local recurrence (the cancer returns in the same breast) than those who had whole breast EBRT. Patient selection for IORT is of vital importance and requires a multidisciplinary approach.

Accordingly, we set-up our criteria based on the consensus of a joint committee of surgical oncologists, pathologists and radiation oncologists.

For the first time, we categorized patients according to age and tumor size and accordingly older patients with larger tumor sizes were considered appropriate candidates for IORT in our series.

WHAT IS IORT?

Intraoperative radiation therapy (IORT) is a type of radiation treatment in which a high dose of radiation is delivered to a malignant tumour site during surgery after it has been removed. Recovery is normal after surgery, and no more external radiotherapy is required. In the case of selected low-risk breast cancer patients, this saves patients the time, effort, and side effects associated with 30–40 days of treatment.

IORT is a type of intensive radiation therapy that is given during surgery and is reported to be more precise, with fewer problems and a shorter treatment time. For early breast cancer, IORT helps radiate the tumour bed directly during a lumpectomy. Individuals over 50 with early-stage breast cancer that hasn’t spread might benefit the most from IORT.

With direct visualisation in the operating room, IORT provides the advantage of delivering a tumoricidal radiation dose in a single session while tailoring the therapy to the region of highest risk of disease recurrence. This results in a high relative biological effectiveness while minimising dosage to normal tissue through tumour bed devascularisation, elimination of inter-fraction tumour cell repopulation, and maybe a systemic immunological impact.

Furthermore, the elimination or decrease of outpatient treatment appointments, which typically last 5–6 weeks for standard postoperative radiation, provides practical benefits to the patient, such as increased quality of life, reduced side effects, and financial advantages. IORT is frequently used in conjunction with EBRT or chemotherapy and may be equally effective as standard radiation for some tumours, while also shielding healthy cells from the harmful effects of radiation.

WHY TREATMENT BY IORT IS DESIRABLE

IORT is a less time-consuming method. Instead of being administered in multiple doses over several weeks, IORT is given in a single dose.

When compared to EBRT, IORT has fewer side effects. The dose of radiation delivered by IORT is higher. IORT kills cancer cells while leaving healthy tissues alone. Because IORT eliminates microscopic illness promptly, it may lower the risk of cancer recurrence (EBRT might not start until a month later, giving the cancer time to return). IORT can also be repeated, but, EBRT cannot.

A NEW BENCHMARK

For decades, whole-breast radiation has been a routine and highly effective therapy option. Continuous research and advancements have resulted in a 70% reduction in five-year recurrence risk, saving and improving the lives of millions of women.

However, it comes with a slew of negative side effects, including exhaustion, scarring, and a five-to seven-week commitment to daily treatments, which is inconvenient and often unattainable for many women.

As a result, IORT is becoming a more appealing alternative for eligible people. When compared to whole-breast therapy, studies have revealed that IORT is extremely successful.

A longer-term study involving a larger number of patients, according to some observers, is needed to acquire a clearer picture of its effectiveness.

Patients are often keen on this procedure as it offers a significant improvement in convenience.

Using treatment technologies already in the RT arsenal, opportunities to enhance dose, improve accuracy, and optimise treatment for personalised treatment planning may improve results after IORT. The role of IORT will be defined by further improvement of patient selection for APBI in general and IORT in particular.

The author is director-department of Surgical Oncology & Robotic & Laparoscopic Surgery Fortis Hospitals, Bannerghatta Road, Bengaluru.

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Medically Speaking

PREVENTION: HOW TO KEEP YOUR HEART HEALTHY AT AGE 40

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PREVENTION: HOW TO KEEP YOUR HEART HEALTHY AT AGE 40

An individual becomes more concerned about their health as they reach a certain age. As the most vital organ of the body, the heart requires extreme care as its chances of developing cardiac diseases increase with age.
Among older people, heart disease is the leading cause of morbidity. To reduce the risk of CVD in middle age, it is recommended to maintain or increase physical activity. Dr AnbuPandian, Medical Advisor, Agatsa, shared some tips to keep the heart healthy at 40 with us.

Stay Active
The most effective way to prevent heart disease at 40 is to adopt a healthy lifestyle. If you work nine hours in an office job, take short breaks every two hours. Taking the stairs instead of the lift, walking short distances instead of using a vehicle or public transportation. Exercise, meditate, swim, play basketball, dance, and do yoga—whatever you love.

Exercise Regularly
Physical exercise has been shown to have a positive effect on heart health in comparison to sedentary lifestyles in various studies. A great quality of life is dependent on a healthy heart. Maintaining a regular exercise routine will keep the heart healthy for years to come.

Regular Heart Health Check-ups
A heart health check-up is essential at every stage of life, but becomes especially crucial after age 40. There are several factors that determine how often a person should get a check-up, including smoking, alcohol consumption, heart disease in the family, being overweight, and diabetes. Blood sugar and cholesterol levels should also be monitored closely. Heart diseases can be better treated if they are detected early. Once a person crosses the age of 40, a yearly checkup is mandatory. The physician may recommend more frequent check-ups if heart disease is detected.
As age increases, metabolism tends to decrease by 5 % every decade after 40. Hormonal imbalance and bone density are two other significant changes that the body registers while getting old. Increase the intake of fruits rich in Vitamin C. All citrus fruits, for that matter, have a bonus heart-healthy benefit. The best diet for preventing cardiac disease is one that is full of fruits and vegetables, whole grains, nuts, fish, poultry, and vegetable oils. Individuals who follow their dietary pattern have a 31% lower risk of heart disease than those who consume junk food.

Remote Monitoring Machines
Remote monitoring machines have been around for years but have gained significant prominence recently, thus resulting in high demand. Such devices are used on a daily basis to monitor diseases such as heart attacks, hypertension, and diabetes. These devices are very portable, user-friendly and capture patients’ health parameters via cables and sensors. These devices are cost-effective for patients because they reduce medical care costs and provide more timely intervention for chronic conditions. No one can slow down the ageing process. However, with proper care, one can be more fit, look younger, and lead a more energetic and active life. Life doesn’t end, but begins afresh again at 40!
The author is a Medical Advisor at Agatsa.

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Medically Speaking

Why heart attacks are on the rise among women

Even though heart ailments are on the rise among women, a lack of awareness has prevented many from getting timely treatment and diagnosis of the disease.

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Why heart attacks are on the rise among women

Heart diseases are no longer a “men’s problem” and women too are equally prone to them. According to a recent report published by the National Family Health Survey, it was found that the overall prevalence of undiagnosed hypertension in women of the age group 15–49 years is 18.69% in India, which busts the myths that heat conditions are most prevalent among men.
Several other international studies have also indicated that heart ailments are now a leading cause of death among women, resulting in ten times more fatalities than breast cancer. Even though heart ailments are on the rise among women, a lack of awareness has prevented many from getting timely treatment and diagnosis of the disease.
Why are heart diseases going undetected in women? While ensuring the well-being of their loved ones, women in India tend to ignore their own needs and often neglect their health. For instance, if a woman has mild chest pain, she would rather ignore the symptoms and focus on managing the work/household chores rather than visiting a doctor. The patriarchal setup of our society also expects women to keep the well-being of others at the forefront rather than taking care of themselves, which results in late diagnosis and is one of the primary causes of increasing heart ailments among women in the country.
As the symptoms of a heart attack are different in both men and women, many women often don’t know if they have already suffered one or two heart attacks in the past until eventually, they visit a doctor. While in men, a heart attack usually results in extreme and sudden chest pain and breaking out in cold sweats, whereas in women, the symptoms are usually mild and heart attacks can be frequent and smaller. The symptoms in women can range from jaw pain to fatigue to pain in the neck and back to sweating or just heartburn, indicating the need for them to undergo regular health check-ups and take proactive measures to ensure overall well-being.
Which age group is most susceptible to heart attacks and what are the major concerns?
Women of the age group 45–55 years are at a high risk of experiencing a heart attack due to low levels of estrogen post menopause, work and family-related stress, loneliness, and lack of physical activity. More women in this age group may go undiagnosed and have atypical symptoms compared to men.
The second most affected age group is 60 years of age, where the biological deterioration makes both men and women more susceptible to heart attacks. High cholesterol, blood pressure, obesity, smoking, sedentary lifestyle, and diabetes are also some of the main concerns that make women more prone to cardiovascular diseases.
How can women take care of themselves and keep heart attacks at bay?
There are several steps that women can take to prevent heart ailments, such as:

  1. Educate yourself and increase awareness about the risk factors that can lead to blockages.
  2. Avoid smoking or the use of tobacco.
  3. Engage in physical activities like yoga, dancing, running, and walking for 30–45 minutes every day to maintain heart health and overcome obesity.
  4. Avoid junk food, aerated drinks and adopt a balanced diet. Healthy heart diets that include complex carbohydrates, legumes, fruits, vegetables, and less sugar, salt, and fat can have a positive impact on heart health.
    Lastly, it is important to note that gender has nothing to do with heart attacks, and the condition affects both men and women equally. However, adopting a healthy lifestyle and undergoing regular health checkups can help you get the gift of good health.

The author is a Senior Consultant at Interventional
Cardiology, Aster CMI
Hospital, Bangalore.

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Medically Speaking

HEALTHY LIFESTYLE: Role of nutraceuticals in heart health

The never-ending work of the heart and the constant workload necessitate healthy dietary patterns and lifestyles.

Dr Anish Desai

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HEALTHY LIFESTYLE: Role of nutraceuticals in heart health

The growing evidence of cardiovascular diseases (CVDs) in both developing and developed nations over the last 20 years has made CVDs a global healthcare priority. As per the WHO, heart attacks and strokes account for 85% of all CVD deaths. It is responsible for an estimated 31% of all deaths worldwide, with 17.9 million deaths yearly. More than 75% of all cardiovascular events occur in low- and middle-income countries. CVDs are the leading cause of death worldwide, with more people dying from them each year than from any other cause.
Role of diet in the maintenance of a healthy heart:
The never-ending work of the heart and the constant workload necessitate healthy dietary patterns and lifestyles. One of the most important factors that can be changed to promote heart health is diet. An unhealthy diet high in saturated fat and carbohydrates is linked to abnormal blood lipid levels, which increases the risk of heart disease.

Use of
Nutraceuticals in heart health:
Nutraceuticals refer to substances that are either food or a component of nutrition that help in the prevention, protection, and/or treatment of chronic diseases. Nutraceuticals can maintain health, slow the progression of lifelong or chronic diseases, and slow aging. Nutraceuticals are considered superior to chemical medicines due to their lack of side effects and ease of access.
• Omega-3 fatty acids: They possess a beneficial effect on the heart as it helps in reducing the risk and advancement of cardiovascular disease. Clinical studies have found that omega-3 fatty acids lower serum triglyceride levels, increase fatty acid degradation, and clear plasma triglycerides. They also help to lower systolic and diastolic pressure in hypertension patients. Foods which are rich in omega-3-fatty acids are flax seed, mackerel, salmon fish, cod fish, etc.
• Coenzyme Q10 (CoQ10): Clinical data revealed that a high dose of CoQ10 helps maintain a healthy heart by reducing lipoprotein oxidation and forming atherosclerotic lesions. Foods such as oily fish (salmon, tuna), grape seed, soyabean, avocado, broccoli, peanuts, and soybeans contain a high amount of CoQ10 in them.
• Carotenoids: Carotenoids such as lycopene can reduce the risk of atherosclerosis by prohibiting endothelial dysfunction and lowering LDL levels. Tomato, red cabbage, beet root, papaya, and watermelon are good sources of carotenoids.
• Polyphenols: Polyphenols present in fruits and vegetables improve lipid metabolism, reduce blood pressure and delay the progression of heart diseases. Almonds, cherries, berries, black olives, cloves contain a high concentration of polyphenols.
• Use of micronutrients: Supplementation with micronutrients such as zinc, selenium, magnesium, selenium, vitamin C, and vitamin E exerts a protective effect on the heart by reducing endothelial cell damage, production of nitric oxide, and inhibiting LDL-c oxidation.
Due to the modern lifestyle, it is imperative to maintain a healthy heart. Regular consumption of nutraceuticals will help to prevent cardiovascular diseases and help to follow a healthy lifestyle.

The author is MD, Clinical Pharmacologist and
Nutra-ceutical Physician, Founder and CEO IntelliMed Healthcare Suctions.

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Health & Wellness

Kashmiri ASHA worker serves as inspiration by donating blood 28 times

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A 32-year-old woman named Bilqees Ara, an ASHA worker, has donated blood 28 times since 2012. She has served as an inspiration to others across the nation.

Bilqees, who is from the Handwara Tehsil in the Kupwara area of North Kashmir, stated that she understands the “importance of blood”.

She said that by donating a pint of blood, she not only saves a precious life but an entire family.

She began donating blood in 2012 and has since given 28 pints.

She expressed her gratitude and pride at being the saviour of so many patients in the Kashmir valley.

I’ve seen people cry helplessly as they try to get blood to save their loved ones, but I’m proud of myself because I’ve arranged blood for them as well. “I felt an inner joy after that,” she said.

In Kashmir, she is known as the “Blood Woman of Kashmir”.

She is a registered blood donor. Whenever a need arises, the officials at the Blood Bank at Handwara hospital call her and, within the shortest span of time, she makes herself available to donate blood.

Women should come forward and do this as there is nothing to be afraid of. This is to be done for society, she said. She also said that she wondered who else would do it if she refused.

If a person has blood and courage, why can’t he give it to someone else in a time of need? She asked.

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Health & Wellness

Covid facilities to reduce in Delhi amid drop in cases

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The Delhi government has closed 11 Covid care facilities because to a consistent reduction in cases. Two Covid Care Centers are operational at Ambedkar Nagar Hospital, which has 50 beds, and Balak Ram Hospital, which has 25 beds, according to a government report. Only five admissions were registered at Ambedkar Nagar Hospital over the past three months, while there were none at Balak Ram Hospital.

The number of patients has steadily decreased at the remaining CCCs as well, according to reports.

According to officials, the Delhi Disaster Management Authority on Thursday decided to scale back the medical staff and infrastructure that had been deployed for COVID management in a planned manner. The health department will now formulate an action plan in response to this decision.

“The deven CCCs were closed and dismantled by Delhi government and one by the Centre and three others with total 4000 bed capacity- Radha Saomi Satsang ,Chattarpur, Sawan Kirpal, Burari , and Sant Nirankari, Burari- were closed but not yet dismantled”, officials said.

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Medically Speaking

We Women Want: Focus on menstrual health

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We Women Want: Focus on menstrual health

This week on We Women Want, we talk about menstrual health and awareness with Madan Mohit Bharadwaj, founder of She Wings, an organisation that works to end period poverty by working with rural women, teens, the homeless, and low-income people. We also had She Wings employees Savita and Mamta, as well as Gurvani, Chief Communication Officer, and Shubhendra Rajawat, Chief Planning Officer of She Wings, to tell us stories from the ground. 

AWARENESS
A former journalist, Madan founded She Wings once he realised the lack of awareness and also the lack of basics such as sanitary pads amongst low-income women. The foundation is doing a lot of good work in that they not only distribute pads amongst the poor but also educate women on the basics of menstrual hygiene. She Wings volunteers and workers also spend time with the men folk trying to deal with the biases and social taboos against menstruation. 

IMPORTANCE
As Madan said, it is a natural cleansing process and not something to be shunned and ostracised. He also recalled how a woman died due to a septic infection from a rusted hook while she was using an old blouse as a sanitary pad. That is when he realised the dire emergency of the situation for something as basic as menstrual hygiene and sanitary pads.
Both the audience in the studio and the entire team at We Women Want were very appreciative of the work that the She Wings team is doing, and indeed, it is efforts such as these that should be applauded and celebrated on the show. The show was moderated by NewsX Senior Executive Editor, Priya Sahgal, and will be on air this weekend on the channel.
Catch fresh episodes of “We Women Want” every Saturday at 7:30 PM on NewsX. The programme will also be streamed live on major OTT platforms-Dailyhunt, Zee5, MX Player, ShemarooMe, Watcho, Mzaalo, Jio TV, Tata Play, and PayTm livestreams.

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