Dr. Nadya Nakova is a specialist in radiation therapy with over ten years of experience in treating oncological diseases. A graduate of the Medical University of Sofia, she continued her education with a second master’s degree in Health Management, a PhD at the Institute of Neurobiology at the Bulgarian Academy of Sciences (BAS), and teaches at Sofia University.
After many years of working at Tsaritsa Joanna University Hospital – ISUL, Dr. Nakova is now part of the high-tech Radiosurgery Center at St. Ivan Rilski University Hospital in Sofia, where she performs both cranial and extracranial radiosurgery.
Dr. Nakova sees patients at St. Ivan Rilski University Hospital and online via i-Health, offering second opinions, document reviews, and consultations related to radiotherapy, radiosurgery, and cancer treatment.
What inspired you to choose radiation therapy as your specialty?
Honestly, radiation therapy found me. When my mother was diagnosed with cancer, I started getting more involved—reading, talking with medical oncologists—and naturally found myself on the path of specialization. At first, I was skeptical, but over the years I fell in love with this dynamic, challenging, and constantly evolving field. Today, I can’t imagine doing anything else. I’m grateful to have had the chance to learn from some of the best doctors—both in Bulgaria and abroad.
How has your practice changed the most since the beginning of your career?
Like any new beginning, it was extremely difficult. The biggest challenge was proving myself to my colleagues and earning the trust of patients and their families. Today, I’m more confident because I’ve gained valuable experience over the years. I always try to follow one of the most important pieces of advice I received at the start of my journey: “Never stop fighting!”, shares Dr. Nakova.
How do you balance your clinical work with research and teaching?
Teaching at the university and working with future doctors gives me energy. I’m proud of my students’ success. I believe that young people need inspiration, support, and space to grow—not just dry lectures and formal exercises.
My PhD at the Bulgarian Academy of Sciences opened many doors for me, both in Bulgaria and abroad. I’ve had the privilege of meeting extraordinary scientists—people who are changing the world. I’m happy to be a small part of this community of bright and curious minds.
Fortunately, my clinical work is in a field that constantly evolves. Reading the latest scientific publications, attending international congresses, and discussing clinical cases with colleagues keep me professionally sharp and motivate me to keep moving forward.
What are the most common myths and fears patients have about radiation therapy?
Patients often perceive a diagnosis as a death sentence. The strongest emotions they experience are related to the fear of radiation therapy and its potential side effects. Unfortunately, there’s a lot of misleading information circulating online, which only heightens their fear and uncertainty.
How do you approach patients when radiation therapy is being proposed for the first time?
Introducing patients to the stages of planning, the techniques used, and the possible side effects brings clarity and a sense of security. When someone knows what to expect, fear gives way to confidence—they feel prepared and reassured that the therapy will proceed in the best possible way.
What, in your view, makes radiation therapy successful not only medically, but also from a human perspective?
Of course, the goal is always disease control—achieving remission. I never see the patient as just a diagnosis—for me, the person behind the disease is most important. I believe there are two invaluable gifts in life: our health and the time we have. Every battle won gives me fulfillment and inspires me to constantly improve, so I can offer my patients care on par with Europe’s top radiotherapy clinics.
What recent innovations in radiation therapy and radiosurgery have impressed you the most?
Radiosurgery has evolved at an incredible pace and is now an alternative to surgical treatment for some conditions. Today, we can irradiate a target with very high doses while minimizing risk to surrounding tissues—something that was once wishful thinking is now reality.
What is extracranial radiosurgery, and in which cases is it most commonly used?
Extracranial radiosurgery is radiosurgery performed on all parts of the body outside the skull. It is applied to primary tumors or metastases in the lungs, liver, adrenal glands, pancreas, lymph nodes, bones, and others, and is performed using a machine called a linear accelerator.
How have approaches to breast cancer treatment changed in recent years?
Radiation therapy and medical oncology are constantly evolving, and treatment protocols are changing. We now have techniques that track the phases of breathing, allowing irradiation of moving targets. This significantly reduces doses to the underlying lung and heart, which is especially important for patients who’ve had left-sided mastectomies and require post-operative radiation of the chest wall.
As the average age of breast cancer diagnosis decreases, we increasingly need to irradiate patients with breast reconstructions—implants or expanders—which requires precise planning to reduce the risk of contracture.
Organ-preserving therapies are gaining focus—when are they possible, and what role does radiation play?
Organ-preserving radiation therapy shows definitive results for patients with head and neck tumors. Preserving speech is extremely important for quality of life, especially for people with professions such as lawyers, doctors, teachers, and others.
Radiation therapy also plays a significant role in treating skin carcinomas on the face, which can have better cosmetic outcomes than plastic surgery. Brachytherapy allows prostate preservation and has the highest rate of erectile function preservation in patients with prostate cancer.
For which hematologic cancers does radiation therapy play a key role?
Radiation therapy is an essential part of the multidisciplinary approach to treating hematologic cancers such as Hodgkin’s and non-Hodgkin’s lymphomas. It plays a crucial role in treating primary lymphomas affecting the central nervous system.
You meet patients during a very difficult time in their lives—how do you cope with the emotional side of your profession?
I can’t remain indifferent to human suffering, which is why much of my clinical practice is dedicated to palliative radiation therapy—whether for bleeding control or pain relief. I don’t remember all my victories, but I never forget the patients who lost their battle. “I constantly ask myself—did I do everything I could?”, says Dr. Nakova.
What recharges and motivates you in your daily work?
My patients remind me every day that life is a gift and we must be grateful for the time we have—something very simple that we often take for granted. Working with people makes me a better person. I treat each new day as a new beginning.
What is the focus of your PhD research at the Bulgarian Academy of Sciences?
I’m working on evaluating the biological effects of natural and synthetic substances in neurocognitive diseases such as Alzheimer’s. This is another dream of mine—to help discover a mechanism not just to slow, but to stop the progression of Alzheimer’s disease. Few people know that this condition is one of the leading causes of death worldwide.
In your opinion, what needs to improve in the radiotherapy system in Bulgaria?
The patient pathway and access to medical services are often difficult. Bulgaria lacks effective screening programs for cancer prevention, and unfortunately, we lack sufficient health awareness. Medical checkups are frequently delayed, and persistent symptoms are ignored, which delays diagnosis.
What is your vision for the future of radiotherapy in Bulgaria?
I’m an eternal optimist. I’m glad that through European programs, Bulgaria now has access to expensive equipment that places us on par with leading centers abroad. The radiotherapy community in Bulgaria updates its treatment protocols annually to stay aligned with evidence-based global medicine.