Kathmandu, March 17 A senior radiation oncologist from the United States has stood against the proton beam therapy treatment, saying such radiation therapy could add more complications for cancer patients. During an interaction with practicing senior neurologists in Kathmandu hospitals, Dr Ashwatha Narayana, director of Radiation Oncology at the Yale New Heaven health system, said that proton beam therapy could be useful in a very few cases but it should be avoided in most cases of central nervous system tumour. “The uniformity of tumour response to single dose radiotherapy regardless of tumour type support a mechanism of response different from that regulating fractionated radiotherapy,” he said. Sharing his experiences on techniques of stereo-tactic radio-surgery and stereo-tactic body radiotherapy for malignant and non-malignant lesions of brain and spine, Narayana, who is one of the highly rated radiation oncology specialists in the US, said high-dose or single-fraction radiation provided excellent tumour control while high dose radiation could be given safely if normal tissue dose and volume could be minimised. “Sophisticated image guided technologies are able to provide high precision radiation in which local control is an important and meaningful clinical goal,” the Castle Connolly top doctor further added. According to him, tumours appear to respond with similar sensitivities to single-dose radiotherapy regardless of tumour type, stage or other phenotypic features. “There is a new generation of cancer care systems making the treatment times shorter and less invasive as well as more comfortable for patients,” the visiting doctor said, adding that the versatility enables doctors to treat a wide variety of patients using a single machine. During the interaction organised by Bhaktapur Cancel Hospital in association with Nepal Cancer Relief Society, Dr Basanta Raj Pant, chairman of the Annapurna Neurological Institute, explained the current scenario of brain tumour management in Nepal. “Patients often come late with large tumour and major deficit while almost all have financial issues,” he said. Saying that patients’ understanding of the disease is very poor, the expert neurologist claimed that some of the relatives didn’t want the doctors to tell the patient about the disease. In Nepal there is a need to have a national cancer registry system, Dr Pant noted adding that we needed to individualise brain tumour management so that it become more cost effective. “We need to learn how to say ‘no’ to cases which have clear-cut worst prognosis,” he said. According to him, surgery on high grade tumour depends on multiple factors so the decision is mainly taken on informed consent basis. “We need to incorporate eastern medicines in cancer care in a more scientific way,” he added. During the programme, Dr Ujjwal Chalise, radiation oncologist at Bhaktapur Cancer Hospital, said that BCH had been using modern radiotherapy technologies in the management of CNS tumours. Dr Suraj Thulung, head of the department of Neurosurgery at Upendra Devkota Memorial National Institute of Neurological and Allied Sciences and Professor Mohan Raj Sharma, Chairperson of Nepalese Neuro Surgeon Society, also shared their experiences of treatment of cancer patients.