Ledderhose Disease - Ledderhose's disease on the bottom of a foot

What Is Ledderhose Disease And How Can Radiotherapy Help?

Radiotherapy treatment is often thought of as synonymous with a cancer diagnosis. 

However, the uses for the treatment are much broader and radiotherapy can, in fact, be used for selected benign conditions, as well, including certain musculoskeletal disorders.

Among the conditions that radiotherapy can be applied to is Ledderhose disease. Predominantly impacting middle-aged to elderly men of Northwestern European origin, its prevalence is approximately 1-1.75 cases in every 100,000 of the population worldwide. 

What is Ledderhose disease?

Although often associated with Dupuytren’s disease, which affects the hands in a similar way, Ledderhose disease affects the structure of one or both feet. 

Ledderhose disease, also known as plantar fibromatosis, is a benign form of abnormal cell growth that manifests as hard lumps on the sole. They are made of fibroblasts and myofibroblasts, with dense collagen fibres that create a fibrous stroma.

The lumps, or nodules, are formed within the fascia, and it usually affects the plantar fascia or arch of the foot, although the lumps can grow on toes as well. 

The onset of the condition is often gradual, with nodules potentially presenting as the initial symptom. Some patients experience little or no pain and symptoms can vary. Pain does not necessarily precede the appearance of nodules.

The plantar fascia is a tendon-like connective tissue along the sole. It is used in foot strikes when walking and running, so if that tissue is damaged, it can be very debilitating for the patient. 

Although exact causes of Ledderhose disease are not confirmed, it is thought that a combination of genetic factors, age and injury to the foot can increase the likelihood of it occurring. Diabetes, smoking and alcohol misuse may also be factors.

What happens if Ledderhose disease is left untreated?

While the disease does have a variable course, with nodules potentially remaining stable for prolonged periods, lumps can also cause pain, tenderness and functional limitations.

Weight-bearing can be difficult, wearing certain shoes can become painful, and the quality of life can be severely impacted in some cases.

What treatments are there for Ledderhose disease?

Both conservative and surgical treatments are possible for Ledderhose disease.

A very conservative treatment for a mild case would potentially be a combination of non-steroidal anti-inflammatory medications, physiotherapy and stretching. This may be insufficient for some patients with persistent symptoms or progressive disease, however. 

Surgical interventions to remove the lumps can leave scarring that makes it uncomfortable to walk. Recurrence following surgery is a recognised concern, but outcomes do vary. 

Given that the plantar fascia is essential for shock absorption when running and walking, as well as supporting the arch of the foot and contributing to energy storage during movement, surgery does have the potential for complications, including wound-healing problems, painful scarring and recurrence.

Radiotherapy is a non-invasive way of potentially reducing pain and limiting disease progression, but note that complete elimination of nodules isn’t guaranteed. 

How is radiotherapy used to treat Ledderhose disease?

As an alternative to surgery, radiotherapy is a far less invasive treatment for plantar fibromatosis. 

It works in a similar way to radiation treatments for cancer, using the same fundamental principle of ionising radiation. However, the treatment objectives, doses and protocols differ for benign conditions. Radiotherapy isn’t necessarily preferable to surgery for every patient. 

During a course of treatment, radiation is targeted directly at the cells in the lumps. It’s thought this can drive changes in cellular proliferation and inflammatory signalling associated with fibrotic tissue formation.

Because it is so precisely targeted and delivered by specialist radiation oncologists, the treatment reduces exposure and damage to the healthy cells surrounding the lumps. 

The treatment for Ledderhose disease is typically low-dose radiotherapy, with typical protocols set as daily treatment for five days, followed by a six to 12-week break, then a further five-day treatment plan.

What are the benefits of radiotherapy treatment for Ledderhose disease?

Non-invasive

Radiotherapy treatments for Ledderhose disease are non-invasive, which means there is less risk of post-operative infections, reactions to anaesthetics or damage to the plantar fascia. It is a relatively quick procedure, with symptom relief developing over weeks or months.

Few side effects

Side effects are usually mild and located around the site of the treatment. Temporary side effects can include redness, itching or dry skin and texture changes to the nodules, as well as burning sensations and a temporary increase in pain. 

Side effects do vary between individuals and longer-term tissue changes are also possible. 

No scarring

Unlike having surgery to remove the lumps, radiotherapy is non-invasive and works by shrinking them. There is no guarantee that nodules will shrink, however, and time will still be required in order for symptoms to improve. 

X-ray of the pelvic bones of a woman - Heterotopic ossification

How Can Radiotherapy Help Tackle Heterotopic Ossification?

Radiotherapy has a range of applications, successful at treating both cancer and other more benign conditions, such as heterotopic ossifications.

What Is Heterotopic Ossification?

Heterotopic ossification is a condition that leads to the emergence of bone tissue in soft tissues, which sometimes leads to pain, swelling and tenderness. This can happen for different reasons, including:

  • After an injury, especially bone fractures and traumatic brain injuries
  • After surgery
  • The result of a genetic condition, although this is rare
  • Sometimes no clear cause can be identified

In some instances the bone formations can cause a problem, because they are large and can restrict movement, especially if close to a joint, for example. The most severe cases are often genetic cases because of the locations they commonly affect.

How Is Heterotopic Ossification Treated?

Whether the cause is genetic or not, if you have been diagnosed with heterotopic ossifications and they are causing discomfort, there are various ways they can be treated. 

Potential treatments include:

  • Medication such as corticosteroids to reduce swelling and inflammation
  • Physiotherapy
  • In some post-injury cases, rest, ice and stretching exercises can help
  • Surgery

The last of these can often be followed up by low-dose radiotherapy to prevent the bone formations from returning, which is the role that we can play.

In the 1950s, scientists discovered the role that cells called osteogenic progenitors play in bone repair. Normally, they play a positive role in helping to repair bone damage.

However, if, as in the case of heterotopic ossification, the bone is growing in the wrong place, it can be beneficial to disrupt these cells. This can be achieved using low doses of radiation.

When this is used in the aftermath of surgery, it can work as a means of preventing fresh bone growth, providing lasting relief.

Evidence and optimal treatment parameters remain variable, however, including dose and timing.

Who Can Benefit From Radiotherapy For Heterotopic Ossification?

How much relief is provided will depend on the circumstances underlying the condition. In many cases, this low-dose radiation treatment after surgery or following a trauma can reduce the risk of reformation or recurrence, although this isn’t guaranteed.

Radiotherapy may be beneficial in instances where a recurrence is likely, such as:

  • A history of heterotopic ossification
  • Ankylosing spondylitis
  • Osteoarthritis

It is primarily used for prophylaxis and to prevent initial or recurrent heterotopic ossification, rather than to treat the established condition itself. Surgical excision is generally the treatment for symptomatic established heterotopic ossification.

In the minority of cases where the problem is genetic, the issue may be recurrent. That could require future courses of radiotherapy to bring future relief, alongside other treatments.

Not everyone will be recommended low-dose radiotherapy after surgery to prevent heterotopic ossification. In some cases, it will not be necessary.

Does Low-Dose Radiotherapy Produce Many Side Effects?

Having low-dose radiotherapy is different from the kinds of high doses required for cancer treatments.

In the latter case, the high dose is needed to disrupt the DNA of cancer cells to break them down and prevent replication, helping to shrink tumours and, in the aftermath of surgery to remove cancerous tissue, to prevent recurrence.

For heterotopic ossification, however, low-dose radiotherapy is associated with comparatively few side effects.

This is for the same reason that everyone can be exposed to low doses of radiation in everyday life, from background radiation to electronic devices, without suffering any harm.

The body has a certain tolerance of radiation levels that high dose radiation will exceed, whereas low dose radiation will not reach this threshold. 

Cancer treatment radiotherapy - Patient Radiation therapy mask

What Are The Different Kinds Of Radiotherapy Used For?

Some people might imagine that radiotherapy is just one kind of treatment, or that it is only used to treat cancers that cannot be surgically removed. In fact, radiotherapy comes in different forms and may be used to treat various conditions.

The use of radiotherapy dates back to the turn of the 20th century, when it became understood that radiation could have some beneficial effect for cancer patients.

Over time, however, greater understanding of radiation, advances in technology, improvements in diagnostics and developments in other treatments that can be used in conjunction with radiotherapy have vastly increased the ways it can be used effectively.

What Are The Different Types Of Radiotherapy?

At our radiotherapy centre, we offer some of the most advanced radiotherapy treatments.

The main types of radiotherapy are:

  • External, as delivered by a linear accelerator machine
  • Stereotactic, which is also external and involves high-precision targeting
  • Internal radiotherapy, where radioactive material is injected into an area of the body

The use of external radiotherapy using a linear accelerator machine may target one particular area, such as the breast or prostate.

It can also be used for full-body doses and localised radiotherapy, which are used for treating secondary cancer when it has spread to multiple sites.

Stereotactic radiotherapy is a means of delivering radiotherapy that is even more precise, directing intense beams of radiation into very small areas. It involves highly precise delivery of high doses to small, well-defined targets, often over a limited number of treatment sessions.

It is used for attacking small cancerous targets such as tumours, while leaving the surrounding healthy tissue largely untouched to minimise side effects. The aim is to minimise radiation exposure to surrounding healthy tissue, but some normal tissue will inevitably receive radiation.

The term stereotactic radiotherapy was coined by Lars Leksell, the Swedish neuroscientist who invented the Gamma Knife device in the 1960s. More advanced versions of this have subsequently been developed.

Internal radiotherapy comes in two forms, both of which involve the administering of a radioactive substance into the body.

Brachytherapy delivers specifically targeted doses, such as adjacent to a tumour. Systemic radiotherapy, meanwhile, injects a substance into the bloodstream that can target cancerous cells.

How Is Radiotherapy Used Alongside Other Treatments?

The ways radiotherapy can be used also vary:

  • It can be used in conjunction with surgery
  • It can be used in combination with other non-surgical treatments such as chemotherapy
  • It can be used on its own

The choice of how to use radiotherapy may depend on various factors. For example, where it is used alongside surgery, the initial step will be to surgically excise a tumour or other cancerous tissue and then use it to treat any remaining cancer cells.

This particular use of radiation is known as adjuvant radiotherapy and it can also be used when apparently all of the cancerous tissue has been excised, to help prevent a recurrence.

In some cases, sections of tumours cannot be surgically removed, so the radiation will be used to shrink those surviving parts.

Radiotherapy can be used as a sole treatment for a range of cancers and clinical situations, not only when surgery is impossible.

On occasion, the use of radiotherapy and chemotherapy together can help to fight cancer more effectively than each method on its own, as they will attack it in different ways.

What Is Low-Dose Radiotherapy Used For?

The last consideration is the variations in the dosage of radiation given.

Radiation dose varies according to the cancer, treatment intent, target, fractionation and treatment technique. It needs to be powerful enough to damage the DNA of cancer cells to stop them from replicating.

However, low-dose radiotherapy can be used to treat some non-cancerous conditions. We offer this as a means of treating problems such as joint pain and osteoarthritis.

This is designed to reduce the inflammatory response to reduce pain, but note that even low-dose radiotherapy has potential risks and side effects.

cancer treatment radiotherapy - female volunteers participating in breast cancer awareness

The Differences Between Primary And Secondary Cancers

The appropriate course of treatment for cancer will depend on the origin of the disease and whether it has spread, which will help your cancer care team select the most effective patient pathway and planning processes.

Everything from cancer origin, type, location, extent, any previous treatments and the individual patient’s overall health are all taken into account, with radiotherapy not automatically indicated for every primary or secondary cancer.

Primary cancers originate at a specific site, while a secondary tumour represents cancer that has spread from one site to another (known as metastasis).

To understand why, it is important to understand the differences between primary and secondary cancer treatment, how this differs from the staging system used to classify certain types of cancer, and how your cancer team will manage treatment.

What Is Primary Cancer?

A primary cancer is a cancer that originates in the tissue or organ where it first develops. The term ‘primary’ can also be used in diagnostic reports and clinical discussions when it is necessary to distinguish the origin from metastatic disease.

What Is Secondary Cancer?

A secondary cancer is a cancer that has spread from its original site to another part of the body, commonly through the blood or lymphatic system.

For example, if the breast cancer tumour from the example above spread to the liver, it would not be considered a liver cancer, but breast cancer that has metastasised to the liver or liver metastases from breast cancer. 

The metastatic cells retain the characteristics of the original breast cancer.

This is a vitally important distinction, as identifying the primary cancer helps clinicians select an appropriate treatment strategy.

Are Second Cancers The Same As Secondary Cancers?

No, a second cancer (or second primary cancer) is a new primary cancer that has emerged in the body, rather than a metastasis from the original cancer.

This can be confusing at times, as it is possible to have, for example, a secondary breast cancer that has spread to another part of the body, as well as a second breast cancer that has emerged as a lump in the other breast.

Can You Have A Secondary Tumour Without A Primary Tumour?

Metastatic cancer can be diagnosed even when the primary site cannot be found or identified, rather than it being absent.

This is typically known as a cancer of unknown primary (CUP), referring to confirmed cancer in which the primary site remains unidentified after appropriate diagnostic evaluation.

According to Cancer Research UK, two per cent of cancer diagnoses each year in the UK involve a CUP, with 60 per cent of cases occurring in people aged 74 or older.

Primary tumours may go unidentified because:

  • The secondary cancer has grown quickly
  • Very small cancers may not cause symptoms or appear on scans
  • Your immune system may have successfully attacked the original cancer, while the secondary cancer continues to grow

Is Secondary Cancer Always More Serious Than Primary Cancer?

The term ‘secondary cancer’ generally refers to metastatic cancer, which is different to advanced cancer and Stage IV diseases.

Prognosis will vary according to the cancer type, the extent of the spread, tumour biology and patient response to treatment.

Treatment may control metastatic cancer, relieve symptoms and sometimes achieve long-term remission. Curative treatment may be possible in selected cases, depending on the cancer type and extent of the disease.

Is Secondary Cancer The Same As Advanced Cancer?

Advanced cancer can include locally advanced disease without distant metastasis, while secondary cancer refers to metastatic spread.

Advanced cancer may require treatment aimed at cure, disease control or symptom management, depending on the individual diagnosis.

Some locally advanced cancers remain confined to the original region, while selected patients with limited metastatic disease may be eligible for potentially curative treatment.

radiotherapy centre - daughter and her mother with breast cancer

What Does Daily Life Feel Like During A Course Of Radiotherapy?

Understanding what life may be like while undergoing a course of radiotherapy is key so you can prepare as effectively as possible, putting support systems in place so you can focus on your own health and wellbeing.

Radiotherapy is generally non-invasive, with fewer associated side-effects than some other cancer treatments, but support is still very important, especially if you are an international patient being treated in a different country.

People who have never had radiotherapy treatment before, whether for a benign condition or as part of cancer care, often ask what daily life feels like, and whilst everyone’s journey is unique, here is what you should expect.

What Does An Average Day Feel Like During Radiotherapy Treatment?

Treatment schedules vary significantly, from as few as five sessions to 30 or more, depending on the treatment. Typical radiotherapy sessions take approximately ten minutes but, again, this can vary between individuals.

Is It Normal To Feel More Tired As Radiotherapy Progresses?

Every day may feel different. Energy levels can fluctuate when undergoing radiotherapy, and by the end of treatment you may find yourself feeling more tired than usual.

Part of this is due to the cancer itself, but it can also be the result of your body exerting itself in order to fix the damage caused by both the cancer and radiotherapy.

Pain is also inherently tiring to deal with, as are the anxiety and stress of treatment, which is often compounded by a lack of sleep.

Finally, if you have to travel significant distances every day for radiotherapy appointments, that can also take its toll.

Many patients feel progressively more tired as the treatment progresses, and if you plan to keep working during treatment, it is important to keep in mind that you may not have the same energy every day.

This fatigue may linger for a number of weeks after your last session, but discuss your symptoms with your healthcare team if you have any undue concerns.

Can You Work During Cancer Treatment?

If you are having cancer treatment, particularly if you intend to travel abroad, discussing matters with your employer will ensure that they can put a support plan in place.

Even if you are physically capable of working, it may be advisable to focus mental and physical energy on recovery. The appropriate approach will vary considerably between patients and treatments.

When Can You Get Back To Normal Following Cancer Treatment?

It typically takes at least two weeks following your last radiotherapy session for the fatigue and physical effects of the treatment dissipate.

Discuss travel plans with your treating physician and medical team about travelling abroad. 

They will be able to give you advice and assistance regarding their policies for people travelling whilst undergoing or recovering from cancer treatment.

Breast cancer treatment Vienna - womans hands holding pink breast cancer awareness ribbon

How Is Radiotherapy Used In Treating Breast Cancer?

Breast cancer is one of the most common cancers, with different patient-centred treatment approaches available, based on a wide range of factors.

According to some of the most recent data from the European Cancer Information System for the EU, published in 2023:

  • 374,800 women and 4,400 men were diagnosed with breast cancer in the EU
  • This accounted for 29.4 per cent of cancers diagnosed in women
  • The estimated cumulative risk for women of developing breast cancer by age 74 is one in 11
  • Austria has one of the lower incidences of the disease in the EU, with the highest rates found in France, Finland, Denmark, the Netherlands, Belgium and Luxembourg

Why Should Breast Cancer Treatment Be Personalised?

If you come for breast cancer treatment in Vienna, an initial assessment of your circumstances is carried out before a course of treatment is agreed upon, tailored specifically to suit you.

Factors accounted for when devising personalised oncology plans include:

  • Age
  • General health
  • Genetics
  • Stage of diagnosis
  • Whether metastasis (secondary cancer) has occurred
  • Tumour characteristics, such as hormone receptor status, HER2 status, tumour size, grade, lymph node involvement and surgical margins

When Is Radiotherapy Used In Breast Cancer Treatment?

The role of radiotherapy in treating breast cancer varies on an individual basis, taking into account tumour size, cancer stage and so on.

It is often used to complement surgery, which can take two forms. The first of these is a lumpectomy, when a section of cancerous tissue is surgically removed from the breast. A second and more radical form of surgery is mastectomy, when the entire breast is removed.

In these cases, radiotherapy is used as an adjuvant, reducing the risk of local or regional recurrence by treating potential microscopic disease.

This can be the course of action after lumpectomy and mastectomy procedures, although this is not always necessary in the latter case, as the total removal of the breast can often excise all cancerous tissue.

Other treatments may include hormonal therapy or chemotherapy, which are also used to combat any remaining cells.

How Is Radiotherapy Administered To Breast Cancer Patients?

Radiation is commonly delivered using external beam therapy. This will involve lying down on a bed while a machine directs precise beams of X-ray radiation at the affected area. This can include the breast, chest wall or lymph nodes.

The number of treatments will vary, as will the extent of radiation exposure. For instance, partial-breast radiotherapy can be used after a lumpectomy in certain cases where eligibility is assured, with factors including:

  • Age
  • Tumour size
  • Histology
  • Surgical margins
  • Lymph node status
  • Tumour biology

Hypofractionated regimens can deliver a higher dose of radiation per session over fewer sessions, with side-effects dependent on the treatment technique, dose, target volume and the individual patient.

Common side-effects of radiotherapy include skin reactions, fatigue and breast swelling or discomfort, but severity varies between individuals.

However, further radiation therapy is sometimes needed due to metastasis, or secondary cancer, although metastatic disease isn’t necessarily treated with radiotherapy to every affected site.

Radiotherapy is commonly used for symptom relief or local control, and may be used in selected other circumstances alongside systemic treatments.

Metastatic risk depends on tumour biology, disease stage and other clinical factors, including genetic predisposition and hormone receptor status. This can be one of the key factors determining the kind of treatment that we will provide.

What Follows Radiotherapy For Breast Cancer?

Individualised treatment will also focus on aftercare, helping you deal with any potential side-effects from radiotherapy (although none may be present), as well as chemotherapy if that is involved.

Breast cancer can be a very challenging condition and every patient’s experience of it is different. But we can provide you with a tailored programme of treatment and support to prioritise the best possible outcomes.

Dupuytren’s Disease - Dupuytren’s Disease

How Can Low-Dose Radiotherapy Ease Dupuytren’s Disease?

Dupuytren’s disease is a condition that people from northern Europe are particularly susceptible to, but our radiotherapy centre can offer treatment that can help slow progression in selected patients with early-stage active disease.

Dupuytren’s Disease affects the connective tissue of the palm of the hand and may lead to Dupuytren contracture, in which the affected fingers bend towards the palm.

The condition manifests in a thickening and fibrosis of the palmar fascia, which prevents fingers from straightening and causes a shortening of the cords that pull the fingers inwards towards the palm.

Other symptoms include:

  • Difficulty placing the palm and fingers flat on a surface, which can develop as the disease progresses
  • Pits or dimples in the skin of the palm, which can cause discomfort (although this is not a defining symptom)
  • Small lumps can form on your palm, which can remain stable, enlarge or develop into cords over time
  • Hand function may become impaired, particularly when finger contractures restrict movement

What Causes Dupuytren’s Disease?

Dupuytren’s Disease has a strong genetic component and is more common in people of northern European ancestry, but it can affect people from any background.

Recognised risk factors for the disease include:

  • Age
  • Male sex
  • A family history of the condition
  • Diabetes
  • Smoking and heavy alcohol consumption
  • Epilepsy

Can Dupuytren’s Disease Be Cured?

No treatment guarantees permanent eradication and the disease can recur or progress after treatment. However, treatments can improve contractures and function, with some patients living with a stable condition that never requires intervention.

When it comes to treating the condition, the first issue to note is that this is not a curable condition and some people do not seek any treatment at all. 

However, others will seek to reduce the effects and slow its progress. Stable or mild disease may be monitored, while treatment may be considered if the disease progresses or affects hand function.

For those who do seek treatment, approaches will depend on disease stage, recent progression, existing contracture, functional limitations, overall health and patient preferences.

Treatment selection depends on the individual’s disease characteristics and clinical assessment.

How Does Radiotherapy Help To Treat Dupuytren’s Disease?

Radiotherapy can help by directing low levels of radiation at the affected areas of the palmar fascia. Low-dose radiotherapy may help slow disease progression in selected patients with early, active Dupuytren disease, particularly before significant contracture develops.

Treatment is generally well tolerated in published studies, but side effects can occur and long-term safety data remain limited.

Protocols commonly involve multiple fractions, sometimes delivered in two courses separated by a break. Further radiotherapy for later progression requires individual assessment and its benefits and risks should be considered carefully.

Radiotherapy may bring some benefits on its own, or it may be used in combination with other medical interventions that can curb the progression of the condition:

  • Surgery is an option for functionally significant contractures, with the procedure determined by the patient’s condition
  • A steroid injection can ease the pain in a lump, a treatment that may need repeating.
  • Enzyme injections can help to break down hard tissue
  • Needle aponeurotomy, which involves a needle being used to break apart tight tissue while the area is numbed with a local anaesthetic.

How Can Your Treatment Be Planned?

Radiotherapy is a non-invasive option that may be considered in selected patients with early, active disease, while surgery and other interventions are generally used to address established contractures. Evidence and recommendations will vary on a case by case basis.

Treatment planning is based on clinical assessment, which may involve collaboration with a hand specialist. The team can discuss treatment options and assess whether radiotherapy is appropriate, including the potential benefits and risks of further treatment where relevant.

external radiotherapy - Medical Concept with Selective Focus

How Many Radiotherapy Courses Can You Have In The Same Area?

A cancer diagnosis often means that oncologists will work quickly to ensure you have the right treatment for your condition, but can the best course of treatment involve multiple courses of external radiotherapy?

As there are so many different types of cancer, many of which have different symptoms for different people, your treatment plan and course of treatment may vary from someone else with the same type of cancer.

In general, a dose of radiotherapy is split and applied in a series of smaller doses in a process called fractionation. By the end of a course, you will have received the full dose of radiation in as safe and monitored a manner as possible, with room to change course depending on how the cancer reacts.

Usually, when you complete a course of radiation, you will not have another dose in the same area of the body. But why might you need another course? What happens if you do? And when is a second dose of radiation impossible in the same area?

Why Might You Need Repeat Radiotherapy?

Most people who go to a radiotherapy clinic only have one course of radiation, either because it helps to destroy enough cancer cells to send it into remission or because another course of treatment is necessary.

A repeat radiotherapy course or re-irradiation is where another course of radiation targets the same or an overlapping area in the body.

Whilst almost never considered previously, the advent of more advanced radiotherapy machines, diagnostic devices and the ability to be more accurate than ever before has made repeat radiotherapy far safer and more effective in the right circumstances.

They are often undertaken when radiotherapy is still the best course of action as opposed to chemotherapy or surgery.

What Factors Can Affect Suitability For Repeat Radiotherapy?

Repeat radiotherapy is usually considered on a case-by-case basis, but there are certain factors that can affect your suitability more than others. Here are some of the most significant factors:

Initial Dose

If you initially received a relatively low dose of radiation for your initial course of treatment, you are more likely to be referred for re-irradiation.

The total dose of radiation you have received will also be a factor, and will often decide if any further doses are safe for you.

Time Since Initial Treatment

The longer it has been since your last course of radiation, the more likely it is that your body has recovered from the effects of radiation, and as a result, it makes it safer to undertake a second dose of radiation.

It is important to wait as long as possible to allow healthy tissue to recover.

Rate Of Recovery

As well as the overall time, the speed at which you feel better, your body tissues recover, and your overall health will all play a role in determining if radiotherapy is the right choice for you.

Type Of Cancer

Certain types of cancers, such as breast, prostate, and head and neck cancers, can be more suitable for re-irradiation, depending on the circumstances.

What Happens If You Undergo Repeat Radiation?

Your cancer team will very carefully track how much radiation you have received from previous treatments, and will carefully plan your future radiotherapy care around these safe limits.

They will also let you know about what to expect, how the new course of treatment is similar or different to the old one, and how they will monitor and check up on you to ensure that the treatment is working for you and is safe to continue.

They will also encourage you to ask as many questions as you like about treatment or seek out a second opinion if you are uncertain that repeat radiation is the best option for you.

When Is Repeat Radiation Impossible?

Not every type of cancer is suited to repeat doses, as different parts of the body are more tolerant of radiation than others and are easier to provide consistent, accurate doses.

As noted above, prostate, breast, and head and neck cancers can often be suitable candidates for repeat radiation, but other types of cancers need to be treated in alternative ways if radiotherapy was ineffective.

These include liver cancer, lung cancer, and cancers which affect the spinal cord, all of which are serial organs where radiation damage can have effects which can cause harm to the entire organ.

As with any other cancer treatment, the benefits and risks will be carefully weighed against each other before any treatment plan is offered to you.

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Melinda – Patient Testimony

Breast cancer patient treated at Amethyst Radiotherapy Austria for Brain Metastases in August 2022.

At 41, Melinda was diagnosed with stage IV breast cancer and began a years-long journey through multiple rounds of treatment and recurrence.

After her initial diagnosis, she underwent chemotherapy, targeted therapy, and a mastectomy, and was declared cancer-free in early 2020. A recurrence in 2021, presenting as lung and pleura tumors, was later confirmed as a metastasis of her breast cancer, but she again responded well to intensive treatment and recovered.

Up until then, her lung metastases had responded well to treatment, and follow-up scans showed no signs of disease progression — until July 2022, when she developed persistent headaches while on vacation in Croatia with her family, followed by balance problems and an unsteady gait. After returning home, her condition rapidly worsened with severe dizziness, visual disturbances, and vomiting. She was admitted to hospital, where scans confirmed metastatic disease in the brain and thyroid.

She started medication to reduce brain swelling and was told that whole-brain radiation therapy was her only option, with doctors recommending WBRT treatment. However, she refused WBRT after learning about its potential long-term cognitive side effects.

While still in hospital, a friend told Melinda about Amethyst Radiotherapy in Vienna and its VMAT treatment option, which could better preserve brain function. That night, she emailed the clinic.

The next morning, she received a call from an Amethyst specialist in Hungarian, who explained that VMAT could treat her condition while sparing healthy brain tissue and protecting cognitive function. Melinda recalls thinking it sounded “too good to be true.”

After speaking with the Amethyst team, Melinda felt confident she had found the right place for treatment of her brain metastases, where communication was quick, accurate, and smooth.

After her conversation with the specialist, the radiation oncologist called her directly – and within the week she was scheduled for an in-person consultation with radiation oncologist, Dr. Kuczer.

In Vienna, she was assessed by Dr. Kuczer, and her treatment plan was prepared within a week. Just two weeks after first contacting Amethyst, she began the first of ten sessions of VMAT radiotherapy.

At the start of treatment, Melinda was in a wheelchair and extremely weak due to brain metastases, with severe fatigue and loss of coordination requiring assistance to attend sessions.

She describes this period as the most frightening part of her cancer journey, as it was her third recurrence and involved her brain. While waiting for treatment at Amethyst, she was largely bedbound and recalls that it felt like her last hope.

“I was kind of dying. I couldn’t do my typical daily stuff – I couldn’t help my kids, my husband. I was just lying on the bed and waiting for the treatment.”

She says she was initially nervous about treatment and possible side effects, but her experience was very positive. She particularly highlights the kindness and support of the staff, who were attentive and always willing to answer her questions and concerns.

“I think Amethyst is fantastic in communication.” (…) “They have modern treatment, high-tech technology, and everybody is so kind. You can ask anything, anytime.”

Throughout treatment, Melinda experienced significant improvements in mobility and coordination. By the end of her treatment course, she no longer required a wheelchair. Follow-up imaging showed an excellence response to treatment.

Melinda at Turkenschanz Park, Vienna, during her treatment.

She says she has been recommending Amethyst for years, as people often ask how she recovered from her condition. Despite having aggressive brain metastases and being wheelchair-bound, she is now fully mobile and living normally.

Today, Melinda is in excellent health and lives an active life, continuing to work as a risk IT advisor and raising her children, now 14 and 17 years old. In her free time, she loves to watch movies, do Zumba, and spend time with her family. She continues to advocate for cancer survivors by sharing her story and is active amongst many charities in Budapest. Melinda runs a blog, which she started at the beginning of her cancer diagnosis in 2019, and published a book in 2025, Még A Rák Sem Bír Velem. She is currently writing her second book.

Melinda raising awareness for breast cancer through her personal story.

“I always wanted to help people in my experience,” says Melinda, when asked what inspired her to start documenting her cancer journey.

Today, Melinda continues to stress the importance of early detection and not ignoring symptoms. Despite going through very dark periods during her illness, she encourages others to stay positive, sharing her message through her book, blog, and speaking engagements.

“Don’t waste your time, because the time is your life.”

Melinda promoting her book Még A Rák Sem Bír Velem (“Not Even Cancer Can Handle Me”)

Breast cancer treatment Austria - Word 'Care' from wooden block

How Can Breast Cancer Radiotherapy Be Personalised?

Breast Cancer is one of the most common cancers and cases are rising across the world. However, treatments are also advancing and this includes the development of more personalised courses of radiotherapy.

The disease is the second most frequent cancer worldwide and the most common to affect mainly women, although in rare cases men can suffer from it.

According to data published by the World Cancer Research Fund in 2022, the countries with the highest numbers of breast cancer cases were:

  • China (357,161)
  • The United States (274,375)
  • India (192,020)
  • The European country with the highest number was Russia, with 78,839, followed by Germany on 74,016
  • The global recorded total was 2,296,840

Why Are Breast Cancer Rates Higher In Western Countries?

What may be noticed from these figures is that they do not fully correlate with population figures. China and India have the largest populations in the world and the rate per 100,000 women is 33 and 26.6 respectively, whereas in the US it is 95.9.

Indeed, the figures for the ten most affected countries showed that leading economies are among those with the highest rates of cases. France topped the list at 105.4 per 100,000, while the UK was on 94.

These higher rates in Western countries partly reflect greater life expectancy, with breast cancer, like many other cancers, most likely to affect women aged over 70.

In addition, there is some evidence that breastfeeding lowers cancer risk, which means countries with lower birth rates in which more women do not have children are likely to have higher incidences of the disease.

Other factors can include smoking, high alcohol consumption and the consumption of processed food, the latter being a much bigger issue in the West than elsewhere.

Why is Personalised Breast Cancer Treatment Important?

Despite this, it remains true that patients seeking breast cancer treatment in Austria will be quite a diverse group, consisting of Austrians, those from other European countries and sometimes from further afield, while ages and other characteristics will vary as well.

This highlights the importance of applying personalised and tailored care, which treats everybody as an individual and deals with more than just medical needs, especially for international patients, who we can support with help such as accommodation and visas.

Nonetheless, the medical treatment itself will also be personalised, with radiotherapy being delivered in a way that is best suited for each patient.

Writing on this subject for Outlook India, oncologist Dr Abhilasha Maan noted that while breast cancer treatment has advanced and brought major improvements in patient care, the use of tailored treatment will still “play a key role in improving outcomes”.

How Can Tailored Radiotherapy Benefit Breast Cancer Patients?

This included radiotherapy, she noted, which has a growing role to play in improving patient outcomes with ever more advanced and precise treatment. Examples of this include:

  • Better local control through the use of radiotherapy to target any remaining cells after cancerous tissue has been removed by surgery
  • Making breast conserving surgery easier by reducing recurrence rates
  • More precision through advanced techniques that can deliver radiation exactly where it is needed while sparing other organs from exposure
  • Radiation can be scheduled in a personalised way to take into account factors such as tumour types, genetic markers and lymph nodes
  • Where courses of radiotherapy can be shorter, patients benefit from reduced toxicity and side-effects as well as greater convenience.

These are benefits that can be offered to patients now, but there will be better to come in the future with further developments, including in radiotherapy.

Dr Maan stated: “The integration of AI, genomics, robotic surgery and adaptive radiotherapy into clinical practice is the future of breast cancer management”.

This means that more early diagnosis (something AI contributes to), better understanding of genetic factors and more precise use of targeted radiotherapy will not only mean better outcomes, but shorter treatment times and less chance of ‘overtreatment’.

When it comes to radiotherapy, this is important, as it means the side-effects, which can be very significant and wide-ranging, will be kept to a minimum.

If you need breast cancer treatment, various factors will determine what treatment course you need. This ranges from how advanced the cancer is at diagnosis to genetic factors, the location of the cancer, your age and your general health.

This is why we will never have a simple ‘standard’ way of treating patients, be it for breast cancer or anything else. We will always tailor it to the needs of the patient.

At the same time, we have always sought to use the most advanced methods of treatment as they arise, because these have shown demonstrable benefits in improving patient outcomes.