Hope to the Hopeless

File Photo of SMHS hospital

Most cancer patients requiring sophisticated radiotherapy treatment like SBRT, SRS, IGRT, VMAT etc., go to outside institutions, in other parts of country, like Tata Memorial Hospital, AIIMS New Delhi, Rajiv Gandhi Cancer Hospital, Fortis, and Apollo, where these sophisticated radiotherapy treatments are in use for last few years.  But all this is available at exorbitant rates, usually in the range of Rs 3 to 5 lacs. Besides, patients and attendants need to stay there for at least 2 months thus putting expenditure at too high a level for middle class family patients to afford. Resulting in compromise in treatment options and ever crisis for the patient, family and treating doctor, be it Surgical Oncologist, Radiation Oncologist, Medical Oncologist or any other domain of medicine/surgery dealing with cancer patients. Most of the time Kashmiri patients reschedule treatment at outside institutions because of quite different geographical conditions, thus a patient who should have received treatment in summer would delay till winter to accommodate the quite different weather conditions outside the valley. Even after receiving too costly treatment most cancer patients feel dissatisfied because of the communication gap between patient and treating physician.

Sensing this never ending crisis faced by cancer patients, the department, at SMHS, took the challenging initiative of providing sophisticated radiotherapy treatment options at the doorstep. Success in this challenging initiative has made our esteem go heaven high both academically and technically giving a solace to all those helping hands which delivered their bit at odd times, adding yet another feather in the ever glowing crown of Government Medical College, Srinagar in particular, and the Department of Health and Medical Education, in general.

Department of Radiation Oncology, SMHS Hospital, has the privilege of being the first ever Radiotherapy Centre in the state of Jammu & Kashmir. Being one of the first few Radiotherapy Centers developed in India this radiotherapy centre was established in the year 1979 with commissioning of a Tele Cobalt Unit “Janus”. Department provided Radiotherapy and Chemotherapy treatment services to patients till 1989 when the installed Janus Unit became defunct and Bhabha Atomic Research Centre Mumbai stopped delivery of radiotherapy treatment because of lack of equipment, requisite manpower, and Radiation Safety Officer. Since then this department suffered the brunt of turmoil to remain defunct from 1989 till 2005 when the process of revival of Radiotherapy treatment services was initiated. During this period SKIMS took charge of cancer treatment at all levels like well developed medical, surgical, radiation Oncology departments and nuclear medicine and clinical hematology.

NCCP Grant: National Cancer Control Program sanctioned Rs 3 Crores during 2005-06 for revival of defunct radiotherapy department through creation of Oncology Wing at Government Medical College Srinagar. With this grant and parallel funding from State Government our department commissioned a Tele Cobalt Equinox-80, Flexitron HDR Brachytherapy Unit, C T Simulator and Xio-Computerized Treatment Planning System. Thousands of cancer patients received life saving radiotherapy treatment till September 2014 floods which destroyed all equipments rendering department defunct once again.

Prime Minister Grant in Aid: Thanks to Honorable Prime Minister for coming forward with instant help in the form of replacement of flood damaged radiotherapy equipment and thus we received C T Simulator and Microseletron HDR Brachytherapy system, imported from Germany and the Netherlands respectively. Both these equipment stand installed and commissioned in line with AERB approvals. A brand new Equinox Cobalt unit is in use for radiotherapy treatment besides state of the art sophisticated radiotherapy treatment equipment TrueBeam Linear Accelerator is commissioned and in use for treatment of cancer.

Parallel Grants from State Government: With help from the government we procured TrueBeam Linear Accelerator”. It is worth mentioning that Tata Memorial Cancer Hospital Mumbai, commissioned this equipment in April 2017. With commissioning of this sophisticated high end equipment our department stands number 2 institution in India in commissioning this latest equipment.

Manpower: Besides providing parallel grants for purchase of equipment and construction of separate buildings for Radiation Oncology “cancer centre” Jammu and Kashmir Government has been kind enough to sanction creation of 82 new posts in 2010. Of these more than 70% stand recruited with the rest of posts referred to SSRB/PSC. It is worth mentioning that all these posts are not to be referred to PSC and SSRB because approximately 30% posts are lined with seniority and promotion of various cadres. Separate Departments of Medical Oncology and Surgical Oncology are created under Super Specialty Institute at Shreen Bagh. With all these developments the department of radiation oncology has grown as hope for hopeless cancer patients.

Expansion of Services: Only within 4 years of starting radiotherapy treatment the department experienced a shortage of beds for admission to ward services. Keeping in view that approximately 90% cancer patients need admission at any time during treatment our Government took a well timed decision of expansion of the department of radiation oncology by raising the second floor through vertical extension on existing radiation oncology block. Civil work is in progress, expected to get completed in 2to 3 months. This initiative will increase bed strength to 60 besides providing facilities for Critical Care (6 beds), small ICCU of 4 beds, seminar hall, library, and faculty rooms.

When Dreams Come True: These achievements are gained through persistent, dedicated and sincere team work at the department with the support and encouragement by worthy Principal/Dean Prof Samia Rashid. As a result of her administrative support, SMHS Hospital has been able to rewrite history on 22nd June 2020 when Dr Mushood Nabi (Associate Professor) along with all faculty members, Medical Physics team and Radiotherapy Technologist team took the biggest successful challenge in executing first VMAT treatment at SMHS Hospital. Mr. Dawood (name changed) a 64 year old male, suffering from prostate cancer is the first patient of valley being offered this treatment in any Government Medical College/ Institution. Oncologists will definitely appreciate this development. Most cancer patients and their educated attendants know about various forms of radiotherapy treatment and usually discuss with staff on availability of this and that of each protocol being prescribed for patients. They can understand the value of what it means to get a VMAT at SMHS Hospital.

The main advantages of Volumetric Modulated Arc Therapy (VMAT) are precision and speed. Volumetric Modulated Arc Therapy (VMAT) focuses the radiation on the tumor while protecting healthy tissues. Each Volumetric Modulated Arc Therapy (VMAT) treatment is completed in less than 2 minutes. Faster treatments improve the accuracy of radiation delivery, in addition to improving patient convenience and quality of life. Volumetric Modulated Arc Therapy (VMAT) uses photons generated by a Linear Accelerator; very small beams with varying intensities are aimed at a tumor and then rotated 360 degrees around the patient. This results in attacking the target in a complete three-dimensional manner. Volumetric Modulated Arc Therapy (VMAT) treatment involves three basic steps: diagnosis, treatment planning, and delivery. As part of the diagnosis, the medical team generates three-dimensional diagnostic images (usually CT and/or PET) of the patient’s anatomy and then uses these images to specify the dose of radiation needed to treat the tumor. Volumetric Modulated Arc Therapy (VMAT) beams can be as small as 2.5 x 5 millimeters. That’s the size of a pencil tip!

The idea is to deliver the maximum dose of radiation to the cancerous tumor while reducing the amount of healthy tissue affected. During the course of a single 360 rotation by our linear accelerator, a complete treatment is delivered.

Availability of Volumetric Modulated Arc Therapy (VMAT), IMRT, SBRT, SRS and IGRT keeps the department of Radiation Oncology SMHS Hospital on the cutting edge of cancer treatment in north India. After the equipment was installed and tested in late 2018, we have not been able to use Volumetric Modulated Arc Therapy (VMAT) for the treatment purpose because of last year’s internet problems, which now thankfully stand restored to equipment based satisfaction needs. At our Cancer Center, first priority is patient care. That’s why we continue to offer our patients the most advanced technologies available in the treatment of their disease. Volumetric Modulated Arc Therapy (VMAT) technology represents another step in the fulfillment of our ongoing mission.

Prof Sanaullah Kuchay, Head of Department Radiation Oncology, SMHS hospital, GMC Srinagar