About Us – IGRG's Mission
Excellence of care for elderly cancer patients
The IGRG is founded in 2012 through the collaborative effort of 15 radiotherapy institutions in the US and Europe. We are determined to provide elderly cancer patients with the best radiotherapy techniques to improve their chance for cure and having a better quality of life.
As treatment of elderly cancer patients is often complex, we recognize the necessity to have a scientific advisory board to assess the special need of elderly patients and to make recommendations on the design of future clinical trials to improve the patient quality of life.
We also seek the input of elderly cancer patient survivors and their family as they went through the ordeal of cancer treatment together.
Together, we will make the difference to provide elderly cancer patients with the best possible care and to design future prospective studies that may improve their quality of life.
Letter of the Chair
To our patients and members
From the desk of the Chair of the International Geriatric Radiotherapy Group (IGRG)
February 3, 2013
Allow me to introduce myself. My medical career has now spanned 46 years, of which the first 20 as a professor in teaching and research, the next 20 as a radiation oncology professor treating patients at universities, and the last 6 in smaller clinics in several USA states
My background spans basic science research and administration, clinical research and administration as well as many of the clinical off-shoots of traditional photon/electron radiotherapy, e.g. brachytherapy, hyperthermic ultrasound and microwave treatment techniques, as well as familiarity with proton-, photo- and nuclear therapy modes. Now at the mature age of 77 I consider myself competent to chair this group and help it get started.
The dual background in Swedish and US health care systems has provided me with an international mindset for some of the cultural differences that IGRG needs to embrace to be heard and believed in a global health care forum. Examples are entry into the discipline as patients, need for more efficient treatment regimens, better outcome data from treatments, collaboration with other surgery, chemotherapy, social institutions as an intimate communication with primary health care providers.
My role in IGRG should be to facilitate member participation in research data compilation and publishing endeavors, but also to provide a communication link to professional associations with similar agendas in order to allow our insights to mesh with the global community of health care providers.
It is a pleasure and challenge to accept this position in the group. The future offers many opportunities to improve health care for a patient group that is not only increasing in numbers but also faces social challenges. Among the different oncologic disciplines, the radiation oncologist often provides a crucial element of curative as well as palliative help to the elderly patient, at a time of her/his life when continued quality of life is both questioned and of premium importance. We want to accomplish this is well as to help make the process affordable for everybody without exception.
Cancer treatments with subatomic particles have become more successful since being introduced in the early 20th century. Many technical and biologic advances have contributed to this radiotherapy discipline. It is now considered to be an essential tool not only to eradicate cancer cells from the body but also to spare normal organs from the damaging effects of radiation.
The concept is comparable to our unwillingness to get sunburns but also to want vitamin D benefits from modest sun exposure. The underlying reason is that ‘too little is inefficient, just the right amount is beneficial, and too much is harmful’ (= the hormesis effect. that is operational in most of our medications as well as for effects from many chemicals).
It is now evident that radiotherapy is standard treatment in many curative and palliative treatments for cancer. Some cancers are still difficult to cure, but advances in radiotherapy have helped to improve outcomes, e.g. for lung, colon and brain cancers.
All patient ages have benefited from these advances but the reason for the founding of the IGRG ( lnternational Geriatric Radiotherapy Group) is that its members believe this older age group deserves special attention when it comes to need for radiotherapy.
The populations of civilized countries enjoy longer lifespans at the same time cancer is more common with higher ages. For some time our group has come to believe that the geriatric population of patients, as compared to younger patients, has become more health care challenged by not being offered radiotherapy. The reasons for this inequality are, in our opinion, responsible physician’s ‘educated guesses’ on patient lifespan and vulnerability to radiotherapy complications as well as society’s concerns for the social impact of a long treatment period on the elderlies’ quality of life.
Politically, there is no argument that age alone should not influence the right to evidence based radiotherapy, since biologic age must trump chronologic age. Society’s responsibility to provide means for health care delivery is a continuing challenge in many countries and need for better infrastructure is imperative. Housing patients at treatment facilities has been a recent and important advance in that respect.
A known fact is that children receiving radiotherapy have side effects and complications at lower doses than adults. Our group is of the opinion that elderly tend to have fewer side effects than younger patients. This concept is not yet universally embraced.
A known fact is that children receiving radiotherapy have side effects and complications at lower doses than adults. Our group is of the opinion that elderly tend to have fewer side effects than younger patients. This concept is not yet universally embraced.
We believe, and want to provide evidence for, that by research efforts, that the turn-over rate in elderly’s bodies is slower not only than in children but also slower than in adults. Although evidence for the association between cell turn-over rates is still sparse, the comparison with children’s and adults tolerance levels combined with our clinical experience provides indications for that the elderly can tolerate radiotherapy at least the same and often better than younger adults.
Some recently published research agrees with this hypothesis. Research on turn-over rates in nail and skin cells so far provide ample indications. Ingenious atomic (carbon-14) research methods may provide additional evidence in the future. If verified, it may even be possible to use additional doses of radiotherapy if this hypothetical concept can be verified for organs in general, and thus increase the probability for improving cure rates when normal organs are spared.
Therefore, our group wants to increase knowledge about radiotherapy for elderly, not only for patients but also for our colleagues and society decision makers. We aim to provide objective data that makes radiotherapy less an art and more a science. Our diversity of membership spans both countries and continents, allowing an international breadth of knowledge to penetrate the health care community.
Ulf L. Karlsson M.D., Ph.D.
Marshfield Clinic, Wl 54449, USA
Why Us?
We have been collaborating across the borders to investigate the feasibility of IMRT and IGRT to spare the normal organs in cancers of various anatomic sites.
We have been successful to demonstrate that these new radiotherapy techniques can significantly decrease radiation dose to radio-sensitive organs without compromising cure rate.
Our preliminary experience with elderly head and neck cancer patients undergoing chemotherapy and radiation for cure suggested that elderly patients tolerated treatment as well as younger patients.
This international collaborative effort between academic and private radiation oncology institutions may one day demonstrate that chronological age should not be the main factor to deny elderly cancer patients a chance for cure.
References
Nguyen NP, Vock J, Chi A, et al. Impact of intensity-modulated and image-guided radiotherapy on elderly patients undergoing chemoradiation for locally advanced head and neck cancer. Strahlenther Onkol. 2012;188(8):677-683. doi:10.1007/s00066-012-0125-0
Nguyen NP, Vos P, Vinh-Hung V, et al. Feasibility of image-guided radiotherapy based on helical tomotherapy to reduce contralateral parotid dose in head and neck cancer. BMC Cancer. 2012;12:175. Published 2012 May 11. doi:10.1186/1471-2407-12-175
Nguyen NP, Chi A, Betz M, et al. Feasibility of intensity-modulated and image-guided radiotherapy for functional organ preservation in locally advanced laryngeal cancer. PLoS One. 2012;7(8):e42729. doi:10.1371/journal.pone.0042729
Nguyen NP, Vock J, Chi A, et al. Effectiveness of intensity-modulated and image-guided radiotherapy to spare the mandible from excessive radiation. Oral Oncol. 2012;48(7):653-657. doi:10.1016/j.oraloncology.2012.01.016
Nguyen NP, Ceizyk M, Almeida F, et al. Effectiveness of image-guided radiotherapy for locally advanced rectal cancer. Ann Surg Oncol. 2011;18(2):380-385. doi:10.1245/s10434-010-1329-0
Nguyen NP, Krafft SP, Vinh-Hung V, et al. Feasibility of tomotherapy to reduce normal lung and cardiac toxicity for distal esophageal cancer compared to three-dimensional radiotherapy. Radiother Oncol. 2011;101(3):438-442. doi:10.1016/j.radonc.2011.07.015
Chi A, Jang SY, Welsh JS, et al. Feasibility of helical tomotherapy in stereotactic body radiation therapy for centrally located early stage non‒small-cell lung cancer or lung metastases. Int J Radiat Oncol Biol Phys. 2011;81(3):856-862. doi:10.1016/j.ijrobp.2010.11.051
Affiliated Organization
International Institute of Anticancer Research (IIAR)
We have a long-term collaboration with the International Institute of Anticancer Research (IIAR), an international organization devoted to cancer research under the leadership of Dr. John G. Delinassios.
Our two organizations share the same goal to improve patient quality of life and finding a cure for cancer patients. We often conduct joint meetings under the auspices of the IIAR. We look forward for a fruitful collaboration with the IIAR for the fight against cancer.
Advanced Technology & Patient Informations
New radiotherapy treatment modalities such as intensity-modulated radiotherapy (IMRT) and image-guided radiotherapy (IGRT) allow for sparing of the normal organs and decrease radiation treatment toxicities.
Intensity-modulated radiotherapy (IMRT)
Conventional radiotherapy technique uses multiple beams of radiation with the same intensity to treat the tumor leading to excessive high radiation dose of the normal tissues in the beam path.
Intensity-modulated radiotherapy (IMRT) is able to modulate the beam intensity through multiple small beams (beamlets) within the radiation beam such as when the radiation goes through the normal tissues, its intensity decreases and when it hit the cancer, its intensity increases.
Such physical properties allow IMRT to conform the radiation dose to the cancer delivering a high radiation dose to improve the chance for cure while sparing the adjacent normal tissues.The tumor is usually treated with a safety margin to decrease the chance of missing the tumor because of patient movement during treatment and the difficulty to reproduce the same treatment position every day.
Image-guided radiotherapy (IGRT)
Image-guided radiotherapy (IGRT) is a special technique of radiation delivery that combines the normal sparing property of IMRT with daily imaging before each radiation treatmen. Imaging of the tumor during treatment allows us to precisely target the tumor and decrease the volume of normal tissue in the safety margin.
IMRT and IGRT allows elderly cancer patients to tolerate radiation treatment better
As a result, IGRT allows further sparing of normal tissues and possibly escalating radiation dose to the cancer to kill it completely in some cancer that may be more resistant to radiation such as cancer of the kidney.
As the cancer shrinks during the treatment, we can re-plan the treatment to spare more normal tissues from radiation. The normal tissue sparing of IMRT and IGRT allows elderly cancer patients to tolerate radiation treatment better especially when radiotherapy is combined with chemotherapy to increase the patient chance for cure.
Complications may be minimized with IMRT and IGRT
Complications following head and neck cancer radiation such as hearing loss, damage to the jaw bone, swallowing difficulty requiring a feeding tube or resulting in aspiration of food into the lungs, hoarse voice, and dry mouth may be minimized with IMRT and IGRT.
Damage to the lungs, heart, small bowels, and bones may also be reduced following radiation of the chest and abdomen with these new radiotherapy techniques. All other normal organs close to the tumor may be spared from serious toxicity giving the patient a chance for better quality of life.
Two figures will be added in this section to illustrate the ability of IGRT to spare the normal tissues (lung) and tumor shrinkage during treatment (head and neck cancer)
Patient Informations
The diagnosis of cancer is devastating to elderly cancer patients and their family
The diagnosis of cancer is devastating to elderly cancer patients and their family. Most often, elderly cancer patient are discriminated because of the perception that they may not tolerate the treatment. Elderly cancer patients are often denied curative treatment and excluded from clinical trials.
The myth of poor tolerance to treatment
Yet, the myth of poor tolerance to treatment is not supported by clinical data. Radiotherapy is often recommended for elderly cancer patients. However, because of the fear treatment toxicity, a palliative course is often preferred even when cure is possible.
New radiotherapy treatment techniques allow cure without added toxicity
New radiotherapy treatment techniques such as intensity-modulated radiotherapy (IMRT) and image-guided radiotherapy (IGRT) deliver radiotherapy with precision, allowing cure without added toxicity because of the sparing of normal organs from excessive radiation.
We believe that IMRT and IGRT will provide the breakthrough for better quality of life in elderly cancer patients and dispel the myth of poor tolerance to curative treatment.