Because radiotherapy is a powerful, long-term treatment, its use is typically targeted carefully to ensure that its benefits are maximised and are proportionate to the significance and severity of the condition they are intended to treat.

This means that radiotherapy is primarily used to treat cancer, but it can sometimes be used to treat non-malignant conditions when it is suitable to do so, and there is a proven evidence base that it can be used to significantly help.

One particularly interesting example of how radiotherapy can be used to help treat conditions other than cancer is heterotopic ossification, one of several non-malignant conditions alongside osteoarthritis, chronic pain and Ledderhose disease that radiotherapy can help treat.

How is this the case? What causes heterotopic ossification in the first case? Can radiotherapy always be used? And what are the alternatives if it cannot?

What Is Heterotopic Ossification?

An inflammatory disease that can cause serious pain and decreased range of motion, heterotopic ossification (HO) is the growth of bone where it should not be, almost always replacing soft tissue or muscles.

It is sometimes mistaken for bone spurs, fragments or chips, in part because both HO most commonly emerge as a result of a traumatic injury, a response to surgery or have no cause at all.

It can vary in severity from a barely noticeable lump to a significant growth that restricts your range of motion, often requiring surgery to remove.

What is known in all cases, however, is that anyone who has experienced HO bone growth is at risk of it happening again, meaning that treatment is needed not only to remove the bone but also to prevent it from regrowing.

What Causes Heterotopic Ossification?

There are two different types of heterotypic ossification, which vary not only in root cause but also in severity.

The most common is nongenetic heterotopic ossification, which is caused by a traumatic injury that your body rebuilds too effectively.

They often occur following an accident which affects your joints, your head, your neck, your pelvis or anywhere else you are most likely to be injured, but they can also emerge as a response to the trauma inherent to surgery.

Sometimes it can grow for no reason at all, which can sometimes cause concern as the ossification is confused for cancer growth before it is tested and is ultimately benign.

Bone growth due to injury or surgery is not uncommon, happening in a third of people who have hip replacement surgery or treatment for a major tibia or fibula fracture in the leg. Most of these will not be noticeable, however.

Alternatively, HO can also be genetic in origin, most notably found with the very rare disorder fibrodysplasia ossificans progressiva (FOP), which causes bones to progressively form in connective tissue whenever it flares up.

Can Radiotherapy Always Help To Treat Heterotopic Ossification?

If bone growth caused by heterotopic ossification is causing problems, there are treatments that can help to cure it or prevent further bone growth, discomfort and pain.

Radiotherapy is not required for every case of heterotopic ossification. Many mild cases can be managed conservatively, and some areas of heterotopic ossification cause few or no symptoms.

Radiotherapy is most commonly considered for patients at higher risk of recurrence, particularly following orthopaedic surgery such as hip replacement or previous surgical removal of heterotopic bone.

It is primarily used as a preventive treatment, particularly before surgery. A single dose of radiation is applied on the morning of the operation to stop the bone from growing in soft tissue and potentially causing damage to joint mobility.

It can also be used in the days following surgery, where the goal is to minimise the growth of bone in the wrong parts of your body.

As a result, it is typically used as an adjunctive therapy in combination with other treatments to ensure the best possible recovery.

What Treatments Are Used To Treat Heterotopic Ossification?

Alongside other preventative measures such as physiotherapy, bisphosphonates or ibuprofen, the main treatment to remove heterotopic ossification entirely is surgery.

As there is a risk that this surgery can also cause HO to form again, it is typically only used in cases where the bone growth has caused chronic pain or significant restrictions in movement, with radiotherapy used to reduce the chance of bone regrowth.

You typically need to wait until the bone has completely grown before it can be surgically removed, otherwise it will simply grow back and require further surgery.

This is particularly the case with genetically caused heterotopic ossification, such as that caused by FOP.

Radiotherapy can help to minimise bone growth by stopping bone cells from growing and dividing. As it is a very quick treatment that is accessible at many hospitals or nearby clinics, it has become best practice in order to assist with mobility.

Leukaemia is a very particular category of cancer, as it is found not in one location in the body, but in the blood and bone marrow. It exists in various forms, not all of which are treated using radiotherapy.

This means that our radiotherapy centre can treat some forms of leukaemia this way, while we will provide other treatments, such as chemotherapy, for other types.

Most cancers are specific to a certain area and are labelled as such, examples being lung cancer, pancreatic cancer, brain cancer and so on, although the specific forms will have their own names; for instance, brain tumours may be astrocytomas or oligodendrogliomas.

These cancers may, of course, spread through a process called metastasis, progressing from primary cancers located in one area of the body to secondary cancers, where cancerous cells will migrate and manifest elsewhere.

What Are The Different Types Of Leukaemia?

By contrast, as a blood and bone marrow cancer, leukaemia by its very nature is found all over the body, wherever there are bones or blood vessels, but it does come in different forms. Common types include:

• Chronic lymphocytic leukaemia (CLL)
• Chronic myeloid leukaemia (CML)
• Chronic myelomonocytic leukaemia (CMML)
• Acute myeloid leukaemia (AML)
• Acute lymphocytic leukaemia (ALL)
• Acute promyelocytic leukaemia (APL)
• Hairy cell leukaemia (where abnormal white blood cells look hairy under a microscope)

All of them arise from mutations in the marrow, where both red and white blood cells are made. Each type of leukaemia affects different blood cells.

For example, AML is characterised by the rapid production of abnormal myeloid cells in the bone marrow, which interferes with the production of healthy blood cells, including white blood cells, red blood cells and platelets.

Acute forms of leukaemia involve fast-progressing cancer, while chronic types see slower progression.

In most cases, treatment is carried out using chemotherapy. However, radiotherapy is often used to treat types like ALL, AML and CLL. It is not used for CML and some other, less common forms of leukaemia.

What Types Of Radiotherapy Are Used To Treat Leukaemia?

Different kinds of radiotherapy can be used in each case. For example, in the case of ALL, cranial radiotherapy may be used to prevent leukaemia cells from reaching the brain.

This is used because most forms of chemotherapy do not reach the brain, although there are means of delivering chemotherapy that can do this.

External beam radiotherapy can be used for total body irradiation treatment for some forms of leukaemia, which can be a precursor to a stem cell or bone marrow transplant.

In the case of AML, whole body irradiation is often used ahead of stem cell treatment or a bone marrow transplant. Unlike other kinds of cancer, leukaemia cannot be removed by surgery in the way that a tumour may be excised.

Other reasons for using radiotherapy against AML include tackling a lump that has formed inside the bone marrow, sometimes known as a myeloid sarcoma, as well as for treatment on the brain and spinal cord if AML spreads there, although this is rare.

These types of radiotherapy differ from the stereotactic radiosurgery used for other forms of cancer, such as brain tumours or cancers located close to other sensitive organs.

In those cases, the purpose of using very precise radiation is to direct powerful beams at very specific locations. This maximises the impact on the cancer while minimising exposure for sensitive tissue nearby.

Full-body radiation does not work in the same way. In this case, the dose is lower to prevent serious harm to healthy tissue, while covering a wide area due to the fact that leukaemia will be present throughout the blood and marrow.

How Can You Prepare For Leukaemia Treatment?

If you have been diagnosed with leukaemia, our oncologists will talk you through the treatment options and processes. It may be that you will have chemotherapy, radiotherapy, or a combination of both.

As with any cancer treatment, we will seek to provide personalised care that will help you as an individual. This includes helping you with preparation, personal and moral support, practical issues and aftercare, as well as the treatment itself.

Among the factors determining your treatment will be:

• The type of leukaemia
• How early it has been diagnosed
• Your age
• Your general health
• Your medical history
• Genetic factors that may make certain therapies more or less effective

Part of the wider treatment programme will be help and advice for dealing with the side-effects of radiotherapy and chemotherapy, which can both include symptoms such as nausea, hair loss and tiredness.

Whatever your diagnosis, we can provide the best private radiotherapy care for you, using the best expertise and the latest equipment, ensuring that we can deliver a tailored treatment plan to maximise the chances of giving you the best possible outcome.

Learn more about our advanced radiotherapy and neurosurgical treatments for leukaemia on the Amethyst Group website.

What makes a cancer treatment so impactful is not just the effects of the disease itself or the need for treatment, but how much it can affect your life.

This is particularly true if you are travelling internationally for specialist treatment, and many people notice that their personal, social and professional lives will change over the course of treatment.

To what extent it affects you depends significantly on your diagnosis, your overall health and your individual circumstances. Some people find work helps connect them to the other critical parts of their life, whilst in other cases it is simply not possible.

It is a complex debate, and one to discuss with your cancer care team, but here are some of the biggest factors that may affect your decision to keep up with your work and social life during radiotherapy treatment.

When Is Working During Radiotherapy Possible?

Unlike surgery, where you must spend a considerable amount of time off to allow scars to heal and to rehabilitate, and unlike chemotherapy, where there are aspects of the treatment that can affect your ability to share a workplace with others, some radiotherapy courses will allow you to keep working.

In some cases, you can work as normal, whilst in other cases you may need additional accommodations to ensure you can attend appointments, work from home or have flexible hours to work around your fluctuating energy levels.

Ultimately, you are the best judge of how you feel, and if your workplace is willing to accommodate that and allow you to be flexible with how you do your work, it should be possible to work during your treatment.

In general, jobs that will allow you to work during radiotherapy:

• Will primarily consist of duties that do not require heavy lifting or other manual labour.
• Will have flexible working hours.
• Will allow you to work from home or in a quiet space.
• Allows you to defer or alter your job duties, prioritising ones you can do easily and allowing others to help you with jobs that are more difficult whilst receiving treatment.
• Will offer adaptations and reasonable adjustments to help you continue to work.

Depending on where you are working and where you are receiving treatment, there may be certain legal protections for people undergoing radiotherapy treatment and carers for those undergoing cancer treatment more broadly.

The main exception to this is if you are receiving brachytherapy; whilst the radiation fades over time, you may be warned to avoid close contact with people, particularly children and pregnant women.

What Makes Working During Radiotherapy Treatment More Difficult?

It must be noted that whilst many employers can and will be flexible to ensure that you can return to work when you are able, this does not mean you are obligated or required to.

Some people will feel like they can navigate radiotherapy more easily than others, and certain job roles are easier to do whilst managing side effects and fatigue.

At a basic level, you will need to take some time off for each appointment you have, and given that some radiotherapy courses are every weekday, it could mean starting later or working reduced hours.

Depending on how you feel after each session, you may need time to recover, and that can sometimes mean that work could get in the way of the healing process. It can sometimes be better to take a work break and recover faster than to try to keep working and affect your treatment.

Another aspect is where you are receiving treatment. If you opt for treatment in another country, then you will need to ensure that you can work remotely and factor different time zones into your work schedule.

Finally, there are mental health considerations to think about; cancer treatment can provide a lot to think about, and if you are worried about your treatment and your performance at work, it can create stress and burnout that can be counterproductive.

Should You Keep Working During Your Radiotherapy Treatment?

Everyone is in a unique situation when it comes to their cancer diagnosis and radiotherapy schedule, and your treatment and job must work around you.

Some people find it really helpful to continue to work; they want to keep connected to their colleagues and work friends, enjoy what they do, benefit from the structure that having a job provides and feel well enough on most days to be comfortable staying in post.

However, if you do not feel that way or your job cannot be done safely whilst you are managing side effects, support is often available if you need it, if you need to take long-term sick leave whilst undergoing your treatment and during your recovery.

Our private radiotherapy services offer the best treatments available, using the finest expertise, the most modern equipment and cutting-edge techniques, which combine with comprehensive aftercare to seek the best possible outcomes and provide strong support.

A key part of this process is providing individualised care. It is important that each patient receives treatment tailored to their needs, for several reasons:

• Their own age, general health and other circumstances, such as genetic factors, will vary
• Each cancer diagnosis will have its own characteristics, such as differing tumour sizes and locations
• Some cases will be diagnosed at an early stage and some will be later, when the disease may have progressed to a late stage and metastasis may have taken place
• Patients will be involved in the process and their needs and wishes will be taken into account

Apart from this, there is the important aspect of care for each individual as a person, appreciating that undergoing radiotherapy, chemotherapy, or other cancer treatments can be challenging for them and their loved ones in various ways.

The most important thing is to ensure the course of treatment is tailored to individual circumstances, which can be established by initial diagnostics.

What Is The Important New Development Involving PET Scans?

This does not just involve diagnosing a cancer, but establishing facts such as the precise location, size and extent of the disease and whether it has spread through metastasis from its original site to elsewhere in the body.

When planning and then delivering treatment, we use the best methods and devices available, but anyone with even a fleeting knowledge of treatments such as radiotherapy will be aware of the great advances in treatments and the resulting improved medical outcomes.

New developments in technology and medical understanding continue to offer advances and the next one may include the use of PET scans to enable the process of tailoring radiotherapy treatments for brain tumours to be taken to a new level.

According to Physics World, this possibility has emerged with the development of a new form of PET scanner, which uses a multiplex array to display images of more than one radiotracer at a time.

The publication stated that this could enable biologically individualised radiotherapy treatments to be carried out, improving patient outcomes by dealing with the problem of tumour heterogeneity, which involves variations in characteristics within tumours.

Such heterogeneity can pose a problem as some parts are more resistant to radiation than others, but existing scans, with just one screen, can only judge overall resistance, which could then, incorrectly, be assumed to be uniform across the tumour.

With multiple screens, this problem could be resolved, as different scans at different angles can be examined simultaneously, showing which parts of a tumour have higher resistance and where it is lower. This will aid the targeting of radiation in subsequent sessions.

How Can Better Scans Enhance Stereotactic Radiotherapy?

This will help maximise the precision with which the best radiotherapy technology can operate. Stereotactic radiotherapy is designed to do this, with very precise beams of high-intensity radiation.

A prime benefit of this, underlying the invention of the technique and the Gamma Knife tool for delivering it by Swedish neurosurgeon Lars Leksell in the 1960s, is to carry out radiotherapy on the brain and minimise radiation exposure to healthy tissue.

The capacity to focus radiation in this way marked a major advance, but better scanning enables this precision to be taken to even higher levels. Not only can the radiation be delivered more accurately and powerfully, but the targeting can be more accurate.

How Do 3D Scans Improve Radiotherapy?

Multiplex PET scans could add a new scanning advance to those that have already helped to improve radiotherapy. Among these are 3D scans, which enable a clearer picture of tumours and other areas with cancerous cells to be developed.

This is particularly useful when treating tumours with various forms of external beam radiation, as it enables effective targeting to fire beams of radiation at tumours from different angles.

Once again, the fact that there are systems capable of delivering radiotherapy in this way means that modern treatments can maximise the potential for both targeting and delivering radiation from different angles, enabling optimal dosages to be given in the right places.

The use of PET scans may be the next development in scanning technology, but there have already been huge enhancements in this area.

Where once diagnostics depended on biopsies and some guesswork and radiotherapy was relatively imprecise, great strides have been made.

These developments make it increasingly possible to provide tailored treatments, making the way we can respond to your condition truly individual, using the increasing volume and accuracy of scan data and other diagnostic information to plan your programme.

Learn more about our advanced radiotherapy and neurosurgical treatments for brain tumours on the Amethyst Group website.

Everyone who has been diagnosed with cancer has a different treatment plan and journey to take, and in some cases, it can take you to an international radiotherapy centre to receive personalised care in the heart of Vienna.

If your treatment plan takes you to us, whether due to our particular specialities in oncology or through a second opinion, then we will help you through the complicated elements of organising travel, accommodation, long-term stays and ensuring that friends and family can come visit you whilst you have treatment.

One aspect of treatment that can often lead to more questions if you travel abroad is what happens once your treatment course ends.

What should you do after your last radiotherapy appointment? How should you expect to feel following treatment? And given that you may need to travel long distances back, when is the best time to return home?

These answers will vary depending on your particular treatment plan and the advice provided by both your primary doctor and ourselves. However, here is some advice and guidance for what you can expect at the end of your radiotherapy treatment.

How Long Does A Course Of Radiotherapy Take?

Radiotherapy treatments are broken up into dozens of smaller sessions, with schedules that can vary significantly from multiple times per day to once every weekday, three times a week or weekly.

As the sessions are relatively short, there is a lot of flexibility to ensure that anyone being treated has time to recover and rest in between appointments.

A typical course of radiation therapy is between six and eight weeks, assuming regular doses of radiation every weekday. There are alternatives which allow for more rest time. Alternatively, high-dose radiation treatments attempt to condense the process and shorten your treatment duration.

The exact time depends on:

• • Cancer type.
  • Location in the body.
  • Any other treatments you are receiving.
  • Your overall health.

Each individual session is between 30 minutes and an hour, but the rest periods in between are so important that they should be considered part of the treatment.

A side benefit to taking radiotherapy abroad is that when you are away from home, you have a great impetus to rest and avoid too much stress and strain on your body, rather than focusing on work and other commitments.

What Happens After Your Last Radiotherapy Session?

The final dose of radiation is not the end of treatment, and you should not plan to pack your bags and take the first flight out of Vienna.

Your last appointment will not only involve the final dose but also establish what the next steps of treatment are likely to be.

The symptoms of radiotherapy tend to linger for a short time after the final session. This is normal as the radiation works to kill off the cancer cells. It will take some time before you return to a new normal.

There will often be a follow-up session with your cancer team before you return home, to ensure that you are ready to travel, that there are no lingering effects that are causing concern, and to help arrange follow-up support with your primary doctor.

It can be a difficult time filled with complex emotions, but there is support available, and you do not have to face this alone.

When Can You Go Home After Your Final Radiotherapy Follow-Up?

You will receive one or several followr-up appointments, but where these will take place and when will depend on your recovery following the final radiotherapy session.

You must be deemed fit to fly, which may involve discussions about the right time to travel, when it is safe to do so or if the airline should be made aware of any conditions that would complicate your ability to fly or mean that you require additional equipment such as supplemental oxygen.

Depending on your treatment, you may be at greater risk of infection, although this is less likely for people who have undergone radiation without chemotherapy or other drug treatments which affect the immune system.

In most cases, once the effects of the last session of radiotherapy ease up, you can start to make arrangements for your return trip home. Ask your cancer team for advice on what you need to think about during travel, which medicines you need to take with you and what you should do if you have issues.

Usually, this takes a few weeks, but make sure to contact your cancer team if you have any concerns before you leave Austria, and make sure you receive contact information for who to get in touch with once you return home.