Facing a battle against cancer can be one of the most daunting prospects anyone can be confronted with. It is not just the reality of our mortality – since we will all die eventually – but the uncertainty of outcome, both for you and your loved ones.

At the same time, a cancer diagnosis can bring out the fighter in many people. The best attitude anyone can have is not a fatalistic one, but a determination to do what not takes to beat the disease, or at least to extend life as long as possible. This is often the attitude of those who are always determined to make the most out of every single day life brings.

However, there will be inevitable compromises. Radiotherapy centre visits will be regular events and therefore will mean there are many days when you don’t have the freedom to go about your normal business or pursue your preferred activities.

Also, the treatment is likely to bring a range of side effects, which can include symptoms like fatigue, hair loss, nausea, skin changes and – for those whose treatment focuses on the abdomen – stomach trouble, and urinary problems like incontinence. For those with cancers in the pelvic areas, the consequences can include sexual dysfunction and infertility.

This will inevitably mean that while you want to continue life as normally as possible, it will never be exactly normal. Some things will change.

Why Your Diet Must Change

While these are the consequences of treatment, there are also some aspects of your lifestyle you need to alter yourself, including your diet.

This is because the effects of radiotherapy on your body can make you vulnerable to certain problems that can arise when you consume food, either making bad things worse or simply making normal things into a problem. At the same time, however, there are foods that can help you cope better with the treatment and are therefore an ally in your cancer battle.

Firstly, there are the foods you should cut out of your diet. For example, if you like fish you can still enjoy this when it is cooked well, but you must avoid raw fish and shellfish, such as sushi, clams or oysters. Smoked salmon, soft-boiled eggs, soft cheese and cheese made with unpasteurised milk should also be avoided.

The reason is that all these can contain a lot of bacteria. That might normally just mean a small bout of tummy trouble, although you can get worse food poisoning. But when you undergo radiotherapy, your immune system will be weakened and that means any bacteria you ingest could be much more harmful to you.

In the same way, you should avoid other risky food choices such as unpeeled fruit and vegetables, while any impact of radiotherapy on your gut, causing stomach upsets and diarrhoea, will be made worse by spicy food such as curries.

If you have treatment around the chest, throat or mouth, avoid sharp-edged or crunchy food, while acidic fruits like citrus or tomatoes can actually cause burns or cuts. Alcohol does this too, so sadly you should avoid that as well. Avoid Saturated fats too. These are bad for you anyway but are hard to digest, which will make any gastric symptoms worse.

What You Should Eat

However, there are also foods you can and should eat that will do you a lot of good, as these can help you suffer fewer and less unpleasant side effects and recover from the therapy faster and more easily. This means you should be eating lots of nutrient-rich products.

While highly acidic fruits may bring problems, others are very good for you, offering lots of fibre and vitamins. Grains, vegetables and lean meats are also very good in providing healthy proteins.  

Carefully choosing the ingredients in your meals is an important step, but it is not the only issue. It is likely your appetite will be affected by your treatment and this effect may vary, so you should monitor this. But in most cases, your appetite will be reduced, so the wisest approach is to make your meals smaller but more frequent.

By doing this, you generally will not eat less, while avoiding getting bloated by consuming a big meal. At the same time, if your appetite is greatly reduced, the quality of the proteins and nutrition you get will help to compensate for a smaller intake.

Planning For Healthy Eating

To ensure you eat well, you need to plan ahead. That means discussing these matters with your doctor to ensure you are eating all the right things and eliminating others, but it also means making sure you are correctly stocked up with the right kinds of food at home.

Because radiotherapy will compromise your immune system, especially if used alongside chemotherapy, you may find you go out less and therefore eating out is something you may not do. This may not be a bad thing, for if you do eat out you will have to be very careful about what you choose.

What To Drink

Alcohol has already been mentioned here as something to avoid. Among its harmful effects is that it is a diuretic, reducing your water when you need to stay hydrated. It is very important to make sure you drink a lot, not least as this will help flush any toxins out of your body sooner, limiting their effect at a time when your immune system is weaker.

Water is the obvious thing to consume, but there are also lots of other healthy alternatives. Because you need to avoid acidic and sugary foods, you should not consume soft drinks, or cordials with high sugar content.

Taking these steps may mean you forego some of your favourite foods and drinks, but it will be worth it because it will make it easier to cope with radiotherapy, reduce additional problems, lower health risks at a time when you are vulnerable and may also establish some good habits.

The last of these factors may be worth thinking about after successful treatment. It might be tempting to celebrate the ‘all clear’ with a hearty meal and a few glasses of wine, but in the longer run, eating and drinking healthily will help you achieve the long, healthy life your radiotherapy treatment may have done so much to increase your chances of enjoying.

People entering the radiotherapy centre today for precise treatment for brain lesions and tumours know that the treatment they are set to receive involves no incisions, leaves only the marks of the metal guide frame and will generally give them the opportunity to go home afterwards.

This is all possible thanks to stereotactic radiosurgery, which is itself made possible thanks to the Gamma Knife method and its inventor Lars Leksell.

Instead of a single focused beam of radiation, the Gamma Knife uses hundreds of beams that converge onto a single point, maximising the effect but minimising any damage to surrounding tissue.

Professor Leksell was a perfectionist, famously noting that no tool is “too refined” when it comes to treating the human brain and working tirelessly to perfect his methods for the rest of his working life.

However, whilst his methods and theory were exceedingly precise, his motivation for pursuing radiosurgery was far simpler; he sought out a more beautiful form of surgery.

Bloodless Surgery

Were it not for a car accident, Professor Leksell would have become a lawyer or literary critic. 

However, the passion of the doctors who treated him and the fascination he had for their methods led him to pursue medicine at the age of 20.

Initially, he struggled to find a focus for his ambitions, until he saw the work of Herbert Olivecrona, the head of neurosurgery at the Seraphim Hospital, Stockholm and the man who would ultimately train him.

However, whilst he had a great appreciation for Professor Olivecroner, he had a deep, multifaceted aversion to neurosurgery as it existed at this point in history.

Whilst neurosurgery had existed since the 1870s, it was still a procedure that relied a lot on somewhat invasive surgery without the aid of CT scans to aid in treatment planning.

It also required exceptionally lengthy recovery times; the modern average time in hospital for a craniotomy is over two weeks.

Professor Leksell had an aversion to blood and to the strong smells found in the operating theatre, and with the traumatic nature of invasive surgery he wanted to see if there was another, more refined, elegant way to perform brain surgery.

His son, Dr Dan Leksell, later claimed that his father wanted surgery to be beautiful.

The first step of this process was the development of a precise, sharp set of double-action forceps still known in operating theatres today as Leksells.  

The second was to redevelop a surgical process that had lain dormant for decades.

A New Stereotactic Frame

Stereotaxy, or the navigation of the brain through a precise set of coordinates, was first devised by Victor Horsley and Robert Clark, who in 1908 used an apparatus that relied on Cartesian coordinates to precisely map animal brains. It is believed to have never been used on humans.

By the end of the Second World War, interest had resumed in the concept of stereotactic neurosurgery, with Ernest Spiegel and Henry Wycis adapting the Horsley-Clark frame in combination with more advanced medical imaging to work with human beings.

Professor Leksell, already curious about the potential for the stereotactic method and having visited the latter at Temple University, Philadelphia, modified the concept of the stereotactic frame to use polar coordinates instead, which was more flexible and considerably easier to use.

However, he was not interested in using it to improve the accuracy and minimise the invasion of conventional surgery but instead used it to develop an entirely non-invasive process.

He also devised a method to adapt X-ray images into the target coordinates for his frame through the use of concentric circles, although unlike many of his other inventions surgeons found it too difficult to rely on. He also innovated the use of ultrasound in neurosurgery.

As well as improving this accuracy, he proposed that a series of small radioactive beams focused to a point would provide the power to destroy a lesion without damaging the surrounding tissue.

As a perfectionist, he kept working on making the frame and the beam more powerful, smaller and easier to use.

His original radiosurgery device, using a synchrocyclotron, was not precise enough for Professor Leksell, given his principle that no tool was too precise for the brain. It was also too awkward and complex for any other surgeon to use consistently.

Its relatively complete form was the Gamma Knife, which allowed for far more precision and versatility, ultimately becoming increasingly used for diseases that previously required the use of invasive neurosurgery.

Professor Leksell continued to practise until 1974 when he was 67. He passed away peacefully at the age of 78 in 1986 in the Swiss Alps.

When someone opts for treatment at a radiotherapy centre, they might be surprised at the sheer diversity of the range of treatments on offer, many of which are bespoke and targeted at treating particular types of cancer located in specific parts of the body.

As well as this, despite being a cancer treatment type that is over a century old, it is also constantly evolving, with methodologies and technologies developing at an exceptional pace in order to help treat a wide variety of cases, improving efficacy without leading to overly intense treatments.

To that end, whilst you can categorise radiotherapy treatments in a lot of different ways, from the isotope used, the part of the body they target and the intent of the treatment, every radiotherapy treatment can be grouped into one of two separate categories.

Both are used to treat different types of tumours in varying parts of the body and are vital parts of a radiotherapist’s toolkit, particularly since they are often used in tandem with each other and alongside other treatments such as surgery and chemotherapy.

What Is External Radiotherapy?

When most people think of radiotherapy, particularly when it comes to treatments for brain cancer, they are most likely thinking of a form of external beam radiotherapy.

External radiotherapy is when a machine is used to aim targeted high-energy beams of radiation shaped and targeted to destroy cancerous tissue as well as other types of malignant growths and tissues.

This can take a wide variety of forms depending on the type of treatment required. For example, stereotactic radiosurgery treatments such as Gamma Knife use a wide number of different radiation beams that converge on a particular point, delivering a precise, strong dose of radiation.

This is achieved using a dedicated frame and is used because any treatments on the brain need to be as precise as possible and avoid unnecessary tissue damage.

By contrast, there are some external radiotherapy treatments that are not targeted at all, such as total body irradiation, used to treat cancers that affect entire systems such as myeloma (plasma cancer), leukaemia (cancer of the white blood cells), lymphoma and as part of bone marrow transplants.

It is typically used for curative purposes, where the radiotherapy is intense enough to kill the cancer cells and avoid potential regrowth of cells, which is the reason why radiotherapy is typically intensive.

It can also be used in combination with surgical treatments, often used after the excising of a tumour to kill any remaining cancer cells, or alongside chemotherapy to enhance the effects of both treatments.

In other cases it is used as a palliative treatment; if after close examination removing the cancer entirely is not an option, then radiotherapy is typically used at lower doses to help relieve pain and reduce symptoms, which varies considerably depending on the treatment itself.

What Is Internal Radiotherapy?

By contrast, whilst external radiotherapy treatments tend to be noninvasive outpatient procedures (although some are done during surgery or require overnight stays), internal radiotherapy involves placing radioactive material inside the body to treat certain types of cancer.

There are a few ways this can be achieved, but typically it takes the form of either radionuclide therapy or brachytherapy, depending on what type of radioactive material is used.

Radionuclide therapy, sometimes known as radioisotope therapy, is the consumption or injection of a radioactive liquid that flows through certain parts of the body, destroying cancer cells.

For example, the most common type of radionuclide therapy, Iodine-131, is taken as a capsule that is absorbed by the thyroid gland, treating certain types of thyroid cancer in the process.

Alternatively, radium-223 is used to treat prostate cancer that has spread to the bone, and lutetium, which is used to treat certain types of cancer that afflict the neuroendocrine system.

On the other hand, brachytherapy is typically a solid radioactive source that is precisely positioned either in or close to the tumour, emitting radiation only to tissue close to its source.

It is typically used to treat cervical and prostate cancers, as well as cancers of the gullet, the skin and the womb.

It is typically applied via surgery, but can also be applied using applicator tubes, which launch pellets of radioactive material into the target area. 

Alternatively, in some specific types of liver cancer treatment, radioactive beads can be injected into the target area in a process known as selective internal radiotherapy treatment (SIRT).

Depending on the treatment the source of radiation is either absorbed by the body directly or is removed with a subsequent operation.

The use of radiotherapy dates from the end of the 19th century, but a host of technological and medical advancements over the years have increased its effectiveness in fighting cancer and extending life, while ameliorating the side effects.

However, some things remain constant. No matter what advancements have occurred in radiotherapy, chemotherapy or invasive surgery, it remains the case that any treatment has a better chance of success the sooner the cancer is diagnosed. Sadly, for many people, the diagnosis comes too late.

A New Test Brings New Hope

For that reason, patients coming to our radiotherapy centre in Vienna for treatment of brain tumours could soon enjoy a much higher rate of survival and recovery, after a new test was found to produce an earlier diagnosis.

Researchers in London, UK, have developed a new blood test that can lead to earlier diagnosis of glioblastomas, the most common potentially deadly brain tumour to affect adults.

A study at the Brain Tumour Centre of Excellence, a partnership between Imperial College London and the UK’s National Health Service, found that the test could detect tumours using what it calls the TriNetra-Glip blood test.

When a patient develops a tumour, some cells can break free from the tumour and circulate in the blood. The test has shown that these can be spotted, isolated, stained and then identified under microscopic investigation. The research was published in the International Journal of Cancer.

By doing this, diagnosis can happen sooner and it is believed that cancer patients could start to benefit from this test as soon as two years from now.

Research leader Dr Nelofer Syed said: “Through this technology, a diagnosis of inaccessible tumours can become possible through a risk-free and patient-friendly blood test.”

She added: “We believe this could be a world first as there are currently no non-invasive or non-radiological tests for this type of tumour.”

How This Can Help Patients

The implications of this development are clear; with earlier detection for more patients, the number of people who may come to a radiotherapy facility, either here in Vienna or anywhere else, is likely to rise, since there will be more people for whom the early diagnosis means it is not too late for such treatment to make a crucial difference.

As such, the overall demand for radiotherapy may rise in two ways. Apart from the higher number of people for whom it may make a difference in the first instance, there will also be those who survive their cancer the first time and go into remission, only to develop new tumours later.

However, even in that second case, early diagnosis could help again, ensuring that if a patient needs to be treated again, they could once more benefit from an early intervention that increases the chances of them winning their battle with the tumour.

New tests that can produce an earlier diagnosis would be of little use, however, if the radiotherapy itself was ineffective. That is why it still matters that tools such as the gamma knife and other innovations have come to be used more frequently, while more concentrated beams of radiation not only kill tumours more effectively, but minimise side effects.

It is also important to note that many other medical developments can work in combination with radiotherapy.

New Hope For Lung Cancer Sufferers

A good example of this is chemotherapy, with research published in the journal JAMA Oncology this month by UCLA in the United States showing how this can work on a kind of lung cancer.

Researchers found that using high doses of radiation while deploying stereotactic ablative radiotherapy alongside chemotherapy is both a safe and effective treatment for locally advanced non-small cell lung cancer that cannot be treated with invasive surgery.

Describing the development as moving into “uncharted territory”, lead author of the study Dr Trudy Wu said: “Our field has been moving towards hypofractionation across many disease sites; however, it is particularly challenging in locally advanced lung cancer.”

This is “due to the close vicinity of tumour to sensitive structures such as the airways and oesophagus,” she added.

Explaining the role of chemotherapy in combination with radiotherapy in such treatment, she said the use of a “novel adaptive boost technique personalised to an individual’s treatment response after the first two-thirds of radiation treatment” brings about the provision of “a tighter conformal radiation boost plan and reduction of healthy tissue receiving radiation”.

With new discoveries like these emerging all the time, the prospects for cancer sufferers are getting better. Advances in radiotherapy can progress side by side with earlier diagnosis and better treatment combinations to produce improved outcomes for many patients, giving years of life to those who might previously have had little hope.