IMRT : Better and Safer

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IMRT means Intensity Modulated Radiotherapy. It is an advanced technique of radiotherapy treatment, which is better and safer than conventional radiotherapy. It is available at KCC Cancer Center. This center is the first private cancer hospital in Nepal to provide this treatment.

IMRT is based on the fact that not all organs around the tumor need the same dose of radiation.

Multiple research have shown that IMRT leads to safer treatment and clinically proven better results

What is the Difference ?

In old-generation Radiotherapy (2D/3D), the radiation dose is in equal intensity all over. Although the tumor isn’t missed, but it overdoses the organs around it – which is just a ‘collateral damage’. IMRT if used properly , easily minimizes the unwanted tissue damage by ‘modulating’ the radiation at different intensity for different targets.

In IMRT, dose of radiation for different volumes around the tumor is at different intensity. The tumor receives the desired dose of radiation. The organs near it, which do not have a tumor, receive very minimum dose of radiation. this ‘organ sparing’ pays back – the patients have minimal side effects and the tumor control is better.


Let’s discuss a scenario. This gentleman presented with a tumor just below his brain (nasopharynx), and had lymphnodes in his neck. These structures are very close of vital structures like eyes, brain, spinal cord and parotid glands.

IMRT Scenario. Tumor is near vital organs.
The tumor (Green) is very close to the brain (Pearly white). There is another cancerous lymph gland in the neck, near the spinal cord. Typical case which needs IMRT.

IMRT helps us save the brain and other important organs from radiation without compromising the dose on the tumor.

Radiation Oncologists work together with radiation physicists to design radiotherapy plans.Each volume is drawn with the help of special software and treatment is planned. We use  MIM Software’s radiation oncology solution for drawing contour of tumor and other organs, fusion of CT,MRI and PET Images as well as other clinical and research work.

It usually takes a few days after radiotherapy planning to start the treatment. Each treatment sessions take a few minutes only. Usually, sessions are 5 days a week, for 5 to 7 weeks. The duration depends on the cancer type and organ involved.

In conclusion, IMRT is the newer radiation technique, which is better and safe. We at KCC Cancer Hospital have been doing IMRT regularly.

Please contact us to discuss the options and the facilities available at our hospital. We would be happy to answer your queries.

तरकारी को बिषादीले कम उमेरमै क्यान्सर :डा आविश अधिकारी

हरेक वर्ष ३०  हजारको हाराहारीमा नेपाली लाई क्यान्सर रोग लागिरहेको  छ। यसरी भयावह रूपमा क्यान्सर रोग बढ्नुमा कुनै न कुनै रूपमा विषादीको पनि हात छ । विषादी भन्नाले सामान्यतया खेतीपाती मा प्रयोग हुने केमिकलहरु (insecticide र pesticide) लाई जनाउँछ। साथसाथै औद्योगिक र घरेलु  प्रयोजनमा पनि विषादीको प्रयोग गरिन्छ।

विषादीको सम्बन्ध विशेष गरी  लिम्फोमा (Lymphoma), रक्त क्यान्सर (Leukemia), फोक्सो(Lungs) र स्तन क्यान्सर(Breast), डिम्बाशयको (Ovarian) क्यान्सरसँग जोडिएको छ । क्यान्सर बाहेक अरू दीर्घ रोगहरूसँग पनि यसको सम्बन्ध छ।

World Health Organization

विशेष गरी बालबालिका र कम उमेरका व्यक्तिलाई विषादीको कारणले हुने क्यान्सरको जोखिम बढी छ । खेतमा काम गर्ने किसान र उनीहरूको परिवारलाई विषादीबाट हुने जोखिम पनि सामान्य मानिसभन्दा निकै बढी हुन्छ । खेतबारीमा अत्याधिक विषादीको प्रयोग गर्दा निकै लामो समयपछि पनि त्यसको अंश माटो र खानेकुरामा रहिरहन्छ । यसको नकारात्मक असर प्राय गरी दीर्घकालीन हुने हुनाले निकै वर्षपछि सम्म पनि देखिन्छ।

विषादीबाट बच्ने सबैभन्दा राम्रो उपाय आफैं घर करेसा कौसीमा तरकारी उत्पादन गर्ने अथवा अर्ग्यानिक तरकारी फलफुलको प्रयोग हुनसक्छ ।  

हाल विश्व स्वास्थ्य सङ्गठन (WHO)  र अन्तर्राष्ट्रिय क्यान्सर अनुसन्धान एजेन्सी (IARC) ले तीन प्रकारका केमिकल लाई Group 1 carcinogen अर्थात् प्रमाणित रूपमा क्यान्सर गराउने भनेर वर्गीकृत गरेको छ। यो समूहमा Arsenic, lindane र ethylene oxide पर्दछन्। अरू छ वटा विषादीलाई Group 2A र सात  वटा लाई Group 2B मा राखिएको छ । सरकारले पनि विषादीको जोखिमबारे जन चेतना कार्यक्रम, विषादी परीक्षण तथा कडा नियमन गरेमा यसको जोखिम घटाउन सकिन्छ ।

समयमै उपचार गराए जस्तोसुकै क्यान्सरको पनि नेपालमै सफल उपचार हुन्छ

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नेपालमा पछिल्लो समय क्यान्सरका बिरामी बढिरहेका छन् । नेपालमा क्यान्सरका बिरामीको यकिन तथ्यांक छैन, तर विभिन्न अस्पतालमा उपचारका लागि आएका बिरामीको तथ्यांक हेर्दा पुरुषमा फोक्सोको क्यान्सर बढी देखिने गरेको छ भने दोस्रोमा मुखको क्यान्सर देखिन्छ । महिलामा हेर्दा पाठेघरको क्यान्सर बढी देखिने गरेको छ ।


What is LINAC (linear accelerator) ?

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And why it is better than cobalt.

Medical Linear Accelerator (LINAC) is a machine used for delivering radiotherapy in cancer treatment. It delivers high-energy x-rays to the region of the patient’s tumor. This treatment can be designed in such a way that it destroys the cancer cells while sparing the surrounding normal tissue.

The LINAC is used to treat cancer of almost all body sites, either by using conventional techniques, Intensity-Modulated Radiation Therapy (IMRT), Image Guided Radiation Therapy (IGRT), Stereotactic Radiosurgery (SRS) and Stereotactic Body Radio Therapy (SBRT).

The Linear Accelerator (LINAC) at our center is one of the best machines available for high precision radiation therapy. With facilities of Three-Dimentional Radiation Planning, Intensity modulation of the radiation beam,VMAT , and electron beams, the machine is very suitable for many different types of cancers.

Advantages of a Linear Accelerator over the Cobalt machine ?

2D – vs – 3D Radiotherapy

Linear Accelerators work on a different mechanism and also these days come with 3-Dimentional Planning System making them more precise, thus tumors can be treated precisely without much toxicity to surrounding tissue. Multileaf collimators (MLC) are computerized thin blocks that are attached to LINAC treatment head, that shapes the radiation beam according to geometry of tumor.

In Cobalt machine, 2-Dimentional planning is done imagining the tumor to be in the center of the drawn rectangle, which can be readily missed.


Cobalt machines work with a Cobalt-60 radioactive source, and can be very dangerous if it gets leaked or lost. Whereas Linear Accelerators do not have radioactive isotopes. It works with x-rays and the radiation is only ‘on’ when the machine is on. Because of this, personnel safety is also maintained.

No need of Source Change

Cobalt-60 is an radioactive isotope and has to be changed every 5 to 10 years because it gets depleted with time. In LINAC, there is no radioactive source so there is no concern of source change.


Burden of cancer patients needing radiotherapy is increasing day by day. Usually Cobalt machine can treat around 40-50 patients daily. Each treatment would take about 10-15 minutes. The advantage of LINAC is that the treatment time significantly decreases to less than 5 minutes, thus decreasing the patient’s time in the radiation bunker significantly.

Clinically Better

Because of high energy x-ray, the penetration of the LINAC is more as compared to Cobalt thus treating deep seated tumors can be done with confidence, sparing the overlying skin and the other normal tissue.

Is LINAC necessary?

LINAC is very necessary if cancer treatment has to be done properly. There are a few cobalt machines in Nepal and most of the developed countries have replaced it with LINACs many years back.

Radiotherapy is under-utilized around the world and varies widely among countries. Published peer-review literature has suggested that more than half of all cancer patients should have radiotherapy included as part of their treatment regimen. In under-developed or developing economies, radiotherapy is provided to no more than 25% of cancer patients.

IAEA recommends that each radiotherapy machine should treat on average up to 500 patients per year. It is also suggested that with current cancer incidence in the Low and Mid-Income countries, from 1–3 radiotherapy machines per one million population would be needed. That would mean in Nepal, we need atleast 30 Linear Accelerators.

Saving the Heart in Breast Cancer Radiotherapy with DIBH

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Many breast cancer patients require radiation therapy during their treatment. Inside the chest wall, where radiotherapy is given, lies the heart and the lungs. 

During conventional radiotherapy, both the heart and the lungs receive a fraction of the radiation that was planned for the chest wall only. Scientists have proven that a few of those patients would have issues with their heart after many years when their left chest wall is treated with radiotherapy conventionally.

We at Kathmandu Cancer Center are using a technique called the DIBH – deep inspiration breath holding technique, where the patient takes a deep breath and holds during some seconds when radiation is given. This way, the heart moves away from the chest wall reducing significantly the  dose the heart receives.

New radiotherpy helps reduce memory problem in brain cancers.

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Hippocampus Sparing Radiotherapy

Hippocampus are small parts of the brain that are responsible for memories. Conventional radiotherapy to the brain is given without sparing the hippocampus. With our 3D imaging and inverse planning software, we have been doing hippocampus sparing radiotherapy to the brain in selected patients of brain tumors and brain metastasis. 

Hippocampal sparing radiotherapy is gaining positive responses world wide and we are glad to be able to deliver the same treatment for our patients. 

Keeping Your Hair in Radiotherapy.

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Scalp Sparing VMAT.
Hair-loss is a common side effect in patient who receive radiotherapy in brain. But now ,these patients can avoid typical hair-loss (alopecia) when treated with newer radiation techniques

In many cancers, radiotherapy to the brain is necessary. Be it brain tumors, or cancers from other organs growing in the brain as metastasis – radiotherapy to the brain is warranted.

With conventional radiotherapy, there are high chances that there will be hairfall – usually patchy, affecting the areas of the entry of the radiation beams.

With this newer technique where radiotherapy is planned in such a way that a certain part of scalp only doesn’t receive the high dose of radiotherapy. With this technique of volumetric arc therapy (VMAT) sparing the scalp, there is very minimal hair loss.

Talk to your doctor about this hair-saving technique and if this is suitable for you.

Students visit kathmandu cancer center.

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Students from Ambition Academy visited us today. We showed them around. There were a few who were really keen about the science behind the radiotherapy.

Students were eager to see how patients are managed .Some of them showed keen interest in the physics aspect of radiotherapy. When we asked them what they liked about cancer hospital, most of them talked about treatment planning system. Doctors creating model of patients in computer before treatment was very interesting for them.

We hope we could inspire some to get into wonderful field of radiotherapy. 

नि:शुल्क गाडीको उपलव्धता सम्बन्धमा

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काठमाडौं क्यान्सर सेन्टरले बिरामीहरूकोलागी अस्पतालबाट जगातीसम्म र जगाती देखि अस्पताल सम्म निशुल्क गाडीको व्यवस्था गरेको छ । 

जगाती मुख्य सडकमा रहेको चोक हो, जहाँबाट उपत्यकाका विभिन्न ठाउँका सार्वजनिक गाडीहरू पाइन्छन् । यसले गर्दा बिरामीहरूलाई अस्पताल आउन र जान निकै सजिलो हुन्छ ।

यहाँलाई यो सुविधा चाहिएको भए ९८१८२२६२३७ मा फोन गर्न सक्नुहुनेछ । यो सुविधा बिहान ७ बजे देखि बेलुका ६ बजे सम्म मात्र उपलव्ध हुनेछ ।

टोटल बडी रेडिएसन

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४ बर्षका एक बालकमा आज हामीले टोटल बडी रेडियोथेरापी गरेका छौं । उनलाई अप्लास्टिक एनिमिया भन्ने रोग लागेको र त्यसको लागी बोन म्यारो ट्रान्स्प्लान्ट गर्ने योजना छ । यसरी टोटल बडी रेडिएसन गर्दा बिरामीको बोन म्यारो ट्रान्स्प्लान्ट सफल हुने सम्भावना बढ्छ । 

अहिले सम्म हामीले दस जना बिरामीको यो उपचार गरेका छौं र धेरै जनामा यो उपचार सफल भएको छ। अहिलेको समयमा नेपालमा यो उपचार हाम्रो अस्पतालमा मात्र हुने गरेको छ ।

KCC starts brachytherapy

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KATHMANDU: Kathmandu Cancer Center, a hospital in Bhaktapur established with the joint efforts of cancer specialists in the country, has started Brachytherapy services from today.

Previously, the hospital used the Linear Accelerator from Elekta, which treated cancer patients with external beam radiation, besides chemotherapy.

With the introduction of Brachytherapy (or Internal Radiation Therapy), doctors can treat a focused part of the body more quickly with a higher total dose of radiation as compared to the conventional external beam radiation therapy.

Brachytherapy is used for the treatment of cancers throughout the body, including cancers of the cervix, breast, oesophagus cancer, among others.

The precision of 3D-reconstruction based Brachytherapy to destroy the cancer cells only, sparing the tissue nearby leading to lesser side effects.

The cost of treatment has been heavily subsidised, the technology being established with the support from an American organisation – Radiating Hope.