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.

radiotherapy centre- Woman in pink T- shirt with Pink Ribbon

How Likely Is It For Breast Cancer To Recur After Treatment?

While receiving a breast cancer diagnosis can be scary, treatments for this form of cancer have developed considerably over the years. In addition, national screening programmes mean that breast cancer can often be caught early, which significantly improves outcomes.

In fact, the findings in this area are encouraging. According to national cancer data, women whose breast cancer is diagnosed at an early stage have an excellent outlook, with five-year survival rates of around 96 per cent.

A study presented at the 15th European Breast Cancer Conference in 2026 found very low rates of local recurrence among patients receiving modern, individualised treatment, including appropriately selected radiotherapy.

However, recurrence risk varies depending on the type and stage of breast cancer, as well as the treatments received.

This research also highlighted the positive impact that radiotherapy has on both treating breast cancer in the first instance and on helping to prevent recurrence of the disease over the longer term.

In particular, this study highlighted how radiotherapy can reduce breast cancer recurrence when the patient has had surgery to remove the tumour, rather than a full mastectomy.

The key is in tailoring the radiotherapy treatment to suit each patient, based on how their surgery has gone and based on how well their chemotherapy treatment prior to surgery has worked to shrink the tumour.

The need for radiotherapy depends on several factors, including the type of surgery, lymph node involvement, tumour characteristics and individual recurrence risk.”#

How can I find out what my risk level is?

If you have received a breast cancer diagnosis, or are undergoing treatment at present, you can ask your oncologist to explain your risk level to you.

In the study we’ve cited here, low-risk patients were those who had a full mastectomy, rather than just removing the tumour, and who showed no signs of cancer in their lymph nodes.

Intermediate-risk patients were those who had cancer in one to three of their lymph nodes, while high-risk patients had cancer in four or more of their lymph nodes. If you are unsure of what risk level you are at, it is best to speak to the medical professionals who are treating you.

What happens if you need radiotherapy for breast cancer?

When you visit your radiotherapy centre, trained clinicians will explain the process to you so that you know what to expect from your treatments.

Each person is different and that means you will receive a highly tailored, precise treatment plan that is created using a specially designed computer system.

Your treatment plan is usually created using a dedicated CT planning scan, sometimes alongside MRI or PET imaging where appropriate.

Your oncologist will then review this plan and explain it to you, as well as helping you to prepare for your first radiotherapy treatments.

The reason radiotherapy for breast cancer has proven so effective is its highly targeted nature. The precision modern radiotherapy machines offer enable us to target the tissues most at risk, while minimising radiation exposure to surrounding healthy tissue..

As a result, we can deliver targeted radiation therapy to the tissues around the site of your tumour without targeting your lymph nodes if that is most appropriate. Alternatively, we can precisely target your lymph nodes if cancer is present here.

We use advanced radiotherapy techniques at our facility to ensure we can optimise the dose of radiation delivered to your tumour.

This helps minimise radiation to healthy tissues while delivering the prescribed dose to the treatment area.

Can you have radiotherapy for breast cancer more than once?

You may need a second course of radiotherapy for breast cancer in some situations, but this will depend on your personal circumstances and how the disease progresses in your body.

This is often referred to as reirradiation in medical literature. It specifically refers to a second course of treatment, rather than requiring multiple doses of radiation therapy during one course.

In fact, most radiotherapy for breast cancer will be delivered in several doses over multiple sessions to get the greatest benefits. However, should your breast cancer recur, it is possible that you may be advised to undergo a course of radiotherapy for a second time.

Do you always need radiotherapy to treat breast cancer?

Not all cases of breast cancer require radiotherapy. In some cases, surgery and chemotherapy will be sufficient in the first instance.

Should your cancer recur, however, radiotherapy is often one of the treatments recommended to help remove the tumour. As with all medical conditions, the best course of action will depend on your specific circumstances.

If you are unsure of what treatment is most appropriate for you after having received a breast cancer diagnosis, it is advisable to speak to your doctors and specialists in this field who can help you understand the most suitable treatment options for you.

Can Radiotherapy Be Used For Treating Secondary Cancers?

Thanks to advances in cancer treatment, more people are living longer after a cancer diagnosis.

However, some cancers can spread to other parts of the body, leading to secondary (metastatic) cancer, which may require additional treatment, including radiotherapy

Some cancers, including breast, prostate, lung and bowel cancer, can spread to other parts of the body.

What is a secondary cancer?

Secondary cancer can occur when the primary cancer has spread from the original site to a different location. When cancer has spread to another part of the body, it is classed as stage IV.

It happens when cancer cells separate from the first cluster and migrate, forming what are called metastases.

Cancerous cells do this by moving through the bloodstream and lymphatic system, a process called metastasis.

Secondary cancers are treated according to the type of primary cancer from which they originated, although the treatment approach may differ depending on where the cancer has spread and how extensive it is.

Also called metastatic cancer, secondary cancers can spread and develop in multiple places in the body. These can include:

  • Secondary brain cancer and leptomeningeal metastases
  • Secondary liver cancer
  • Secondary lung cancer
  • Secondary bone cancer

Secondary cancers can sometimes develop months or years after successful treatment of the original tumour, even when no cancer is detectable at the original site.

Treatments for secondary cancers can include chemotherapy, hormone therapy and radiotherapy. Treatment plans are highly specific to the individual case and the progression and location of the metastases.

How can radiotherapy be used for metastatic cancers?

Relief from symptoms

If the cancer has spread too far, it may be that radiotherapy is used for palliative measures. For example, if there is pain from a bone tumour, radiotherapy can be used to reduce the size and relieve symptoms.

Reducing pressure

When a tumour is pressing on a nerve, organ or vessel, it can severely impact how your body functions. Using radiotherapy can shrink the cell clusters. This will relieve pressure and hopefully allow a more normal function.

For secondary brain cancer, symptoms often include sickness, headaches and issues with speech and vision. Reducing the pressure caused by tumours in the skull, it reduces symptoms.

Controlling growth

When a diagnosis is at Stage IV, often there is no way to remove all the cancerous cells that have spread. In these cases, radiotherapy and other treatments can be used to slow down the growth of cells.

By doing this, it can improve the prognosis, giving the patient extra time to spend with their family or a better quality of life.

Destroying the metastases

In some cases, when cells have migrated to only a few specific locations, precise radiotherapy treatment can be used to destroy the secondary cancer cells completely.

What type of radiotherapy is used for secondary cancers?

The treatment plan will be tailored to each patient, but there are commonalities between treatments. Certain types of radiotherapy are more suited to metastasised cancers, and radiotherapy is a highly specialised area of medicine.

External beam radiotherapy

External beam radiotherapy is targeted therapy aimed directly at the cancerous cells, destroying their DNA and preventing them from replicating. A beam of X-rays or protons is directed at the affected area while avoiding the healthy cells.

Stereotactic radiotherapy

Sometimes called stereotactic ablative radiotherapy (SABR), stereotactic radiotherapy involves a very precise and very intense dose of radiation to a small area. It is a type of external beam radiotherapy, although it is far more focused.

Usually used on oligometastases in organs in the torso, such as lungs or liver, it can also be used on tumours in bones. It can also be used for small tumours in the brain where surgery to remove them would do more damage.

The machine used to deliver this type of treatment is a gamma knife. Although not an actual knife, it is stereotactic radiosurgery involving multiple beams all aimed at the same location.

Whole brain radiotherapy

Unlike gamma knife treatment, whole brain therapy is less precise and is used when the metastases are spread throughout the brain. Its purpose is to relieve symptoms and slow growth rather than cure.

Internal radiotherapy

Internal radiotherapy can be split into two types: brachytherapy and radionuclide. Both use radiation to damage or destroy cancer cells.

Brachytherapy involves the implantation of radioactive substances in the body for a short period. These seeds, wires or ribbons emit radiation that limits the growth of cancer cells, and are removed after treatment is completed.

Radionuclide therapy involves radioactive liquids administered to the patient, which then flow through the bloodstream and destroy cancerous cells.

Both types of radiotherapy impact the whole body and are often used to treat widespread metastases.

To discuss your treatment with us, get in touch with our team for a personalised plan.

radiotherapy centre - magnetic resonance therapy

When Should You Seek Specialist Medical Treatments Abroad?

A diagnosis of cancer can often change one’s relationship with time. The early stages of testing and treatment planning can often be hectic and overwhelming, but there is also a natural desire to start treatment as soon as possible to maximise your options.

There can be delays, either to allow for second opinions or due to the availability of certain types of specialist treatments which could be particularly helpful in your situation.

At that point, there are usually various options available, but one decision a growing number of people are making is to seek medical treatment from specialists abroad.

Our international radiotherapy centre is designed to make your medical care in Austria as simple and stress-free as possible. We offer detailed treatment plans, itineraries, help with transport and accommodation, and help you navigate the process of arranging your stay in Vienna.

When is it the best choice for your health? What should you consider before buying any tickets? Is it always an option? And what do you need to know before you fly out for treatment?

Why Do People Consider Medical Treatments Abroad?

Travelling abroad for medical treatment, often defined under the broad banner of “medical tourism”, happens for all sorts of different reasons, even discounting the mental and physical benefits of travelling abroad and seeing the sights in between appointments.

Whilst every patient that we see at our centre has their own story, we have found that many of the reasons for seeking medical care abroad can be grouped into one of three categories.

Second Opinions

One of the biggest reasons for seeking medical care abroad is to access the specialist expertise necessary for an effective second opinion.

In many medical fields, especially oncology, doctors will specialise in specific elements of practice, which means that both their diagnostic and treatment approaches can vary from practitioner to practitioner.

If an initial treatment plan suggests that surgery or a lengthy course of chemotherapy would be the only options, a second opinion may find that a targeted radiotherapy course could be considered as an alternative treatment option in some cases..

In particular, some rare conditions such as rarer types of cancer may require a second opinion from an oncologist with experience treating it.

Faster Care

In some regions, patients may face longer waiting times or have limited access to certain specialist treatments, prompting them to explore treatment options elsewhere.

In some cases, domestic private cancer care can be more expensive than travelling, particularly for other residents of the European Union, and this can make a trip to Austria the best way to access the care you need as soon as possible.

More Options

Not every area has the same access to treatment options, and this can affect the recommendations an oncologist and cancer care team can offer.

For example, if highly accurate high-dose radiotherapy is unavailable, the team may suggest surgery followed by a broader course of radiotherapy to target any remaining cancer cells.

Having access to a wider range of treatment options may help patients and their medical teams choose the most appropriate treatment approach for their individual circumstances.

What Should You Consider Before Travelling Abroad For Treatment?

As with any other cancer treatment, there is a lot to consider, and it is worth asking your cancer team about any questions you have concerning treatment or the plan for how you will receive it.

Here are some of the most important factors to consider before travelling internationally.

Doctor’s Advice And Procedure

Every country of departure and destination has their own laws and guidance surrounding second opinions and travelling abroad for the purpose of seeking medical treatment, and it is very important to seek advice from your doctor and let them know of your plans.

In some cases, funding can be available, or your treatment plan qualifies under a relevant medical insurance scheme, whilst in other cases you may need to pay the full amount. All of this can be discussed with your potential international clinic.

Is It Safe To Travel?

Depending on the progression of your cancer or the effects of other treatments, travelling to an international clinic may require additional interventions or arrangements following a fitness to fly assessment.

How Will Your Aftercare Be Managed?

Given the schedule of any cancer treatment, it is important to know what your next steps will be following the last appointment, how long you will stay in the country you are receiving treatment and how you will know you are medically cleared and healthy enough to travel back home.

Oncology Patients - radiotherapy

How Is Radiotherapy Used To Treat Prostate Cancer?

Prostate cancer is one of the more prominent cancers and has a high profile because it is a male-specific disease. Radiotherapy is commonly involved in treating the condition, but the exact way it is used may vary as part of a tailored patient-specific treatment programme.

The disease can affect any man, but certain characteristics increase the risk factors:

  • Being aged over 50
  • A family history of the disease
  • Men of African or Caribbean heritage are known to have a higher risk of developing prostate cancer.
  • A family history of DNA changes, known as BRCA1 and BRCA2
  • Obesity
  • Smoking

How Do Prostate Cancer Rates Vary In Europe?

These factors are one element of variance, although there are also significant differences between countries. For example, the latest (2024) data on incidences of prostate cancer in the EU shows that:

  • Here in Austria, the rate is 151.1 per 100,000 in men aged up to 85
  • Major countries where the rate is lower include Germany (133.1), Spain (131.3) and Italy (129.8)
  • Most of the highest rates are in more northerly European countries, with five countries – Norway, Sweden and the Baltic states – having an incidence of over 200
  • Lithuania has the highest rate of all at 266.6
  • Romania has the lowest rate at 99.0, followed by Bulgaria at 100.2

Why the rate varies as much as it does is not entirely clear. For example, the Baltic and Scandinavian countries have a smaller proportion of black people in their population than countries like France, where the rate is 167.7.

Whatever the cause, the earlier the diagnosis takes place, the better the prospect for the patients. This can also determine how radiotherapy may be used to treat the cancer.

For example, in a late diagnosis in which secondary cancer is present, radiotherapy may be used to deal with the fact that the cancer is present in several different parts of the body. In such cases, it is applied to the prostate as well as to the other affected areas.

What Are The Common Ways Primary Prostate Cancer Is Treated?

For primary prostate cancer, the main treatment options are:

  • Surveillance, used in cases where the cancer is progressing slowly and no major treatment may be necessary, at least for the time being
  • Surgery to remove the prostate
  • Radiotherapy to shrink the tumour
  • Occasionally, other therapies, such as chemotherapy or hormonal therapies, may be tried

If surgery has taken place to remove the prostate, a form of radiotherapy called adjuvant radiotherapy may be used.

This involves using radiation to attack and disrupt the DNA of any remaining cancer cells that may be present and reduce the chances of the disease recurring.

If radiotherapy is being used to shrink the tumour, the same principle applies, with the radiation damaging the cell DNA, which restricts the capacity of the cells to survive and divide.

The preferred method of treatment is something that will be decided between you and your oncologist at our radiotherapy centre, who will explain the situation and the options available to you.

If you do have surgery followed by adjuvant radiotherapy, this can have significant after-effects.

Some of these are the shorter-term side-effects normally associated with radiotherapy, such as fatigue and nausea, which can also apply if radiotherapy is used to shrink a tumour without surgery being used.

However, it can also include problems with sexual function, which may be long-lasting if the prostate has been removed.

In any event, men who may wish to have children in the future should discuss fertility preservation options, such as sperm banking, with their care team before treatment begins.

Is Prostate Cancer Treated With Internal Or External Radiotherapy?

There are two types of radiotherapy used to tackle prostate cancer.

  • External beam radiotherapy, which involves the patient lying on a table while the machine moves around them and delivers powerful beams of radiation to the affected area
  • Brachytherapy, which involves injecting a radioactive substance into the affected area to deliver radiation

The chosen method will be decided between the patient and the oncologist. This places the emphasis firmly on ensuring that there is patient consent and understanding, as well as tailoring the treatment to each patient.

Among the variables involved in the decision are:

  • The age and general health of the patient
  • The size and precise location of the cancer
  • How advanced the cancer is
  • Considerations relating to underlying causes such as a family history of the disease

Each of these and other matters will vary from patient to patient, so if you are seeking prostate cancer treatment, you can be assured that the approach we take will be sensitive, collaborative and, most of all, personal.

Will Radiotherapy Be Provided In Fewer Doses In The Future?

Ever since the birth of fractionated external beam radiotherapy made cancer treatment possible, there have been constant debates and examinations into how to properly dose and schedule treatment.

The goal of radiotherapy is to be unintrusive, and treatment plans are designed to maximise the effectiveness of radiation exposure in the destruction of cancer cells and tumours whilst preserving healthy tissue and minimising side effects.

Exactly how long a course is can vary depending on the recommended total dose of radiation, with courses varying from a single dose to dozens of doses taking place over several months.

Whatever the case is and your situation, we will help to guide you every step of the way through the use of advanced methodologies, state-of-the-art equipment and a holistic multidisciplinary approach to every aspect of care.

One fascinating trend that has been explored in recent years is high-dose targeted radiotherapy, which uses highly advanced linear accelerators to significantly shorten treatment times whilst minimising potential side effects.

The recent HERMES study undertaken by The Royal Marsden Cancer Charity suggests that the treatment times and treatment sessions could be potentially halved by using highly accurate LINAC systems and higher doses of radiation without affecting safety or efficacy.

To explain why, it is important to explain why radiotherapy is fractionated in the first place and the specifics of the study.

What Is Fractionated Radiotherapy?

The concept of fractionation is the division of a total dose of radiation into multiple smaller doses, sometimes as few as five but can be over 30 or more depending on the type of treatment.

The principle behind fractionation is that cancer cells are more vulnerable to radiation than healthy cells, which causes their DNA to be destroyed and for them to die faster than healthy cells.

However, radiation will kill healthy cells at a high enough dose, so the goal of fractionated radiotherapy is to give healthy cells a chance to recover from the damage done to DNA and to have fewer toxic effects on healthy cells.

Whilst the exact fractions will vary depending on the cancer, oncologist, machine and overall guidelines, a common fractionation schedule will divide the total radiation dose into 30 daily radiotherapy sessions taking place every weekday over six weeks.

Sometimes there are more smaller doses (hyperfractionation) or fewer, higher doses (hypofractionation), depending on the type of cancer, its location, its stage and other factors which require a more aggressive approach.

What Did The HERMES Study Prove About Radiotherapy?

The HERMES study was a trial to determine whether a total radiation dose could be delivered as safely in far higher fractions using accurate MRI-guided external beams.

The focus was on men with localised prostate cancer, and divided 46 volunteers into two control groups; 24 men would have a standard five-session radiotherapy treatment over 14 days, whilst the other 22 would have just two doses over eight days.

The system used was an MRI-guided LINAC machine, which allowed for precisely guided radiotherapy, and the study would determine not only the effectiveness of treatment, but how it affected bowel and urinary function, two common side effects of prostate cancer treatment.

The study found very few differences between the two treatment approaches; moderate side effects were seen roughly equally in both groups, bowel side effects were low overall, and the only difference was slightly milder bowel side effects in the higher-dose group.

Whilst limited in scope, and thus would require a much larger trial to confirm its findings, the HERMES study demonstrates the potential for higher-dose, highly accurate short-term treatments.

Why Are Fewer Doses Better In Radiation?

The biggest benefit of having fewer doses is not seen in the study, which focused on the efficacy of treatment, but on the wider context of having radiotherapy treatment.

More doses means more appointments, more travel, more hospital visits and more disruption to your everyday life. If you have travelled abroad for the best treatment possible, more doses means a longer stay in the country away from home and away from a support group that may not be able to visit all the time.

If the results of the HERMES study translate not only to a wider population but also to more cancer treatments, the benefits to quality of life are potentially astonishing, reducing the time spent being treated, removing cancers more quickly and increasing the availability of treatment for others.

The principle is similar to that used for stereotactic radiosurgery, where brain tumours can be removed in a single session thanks to highly precise and powerful doses of radiation.

heterotope ossifikation

Is Radiotherapy Often Used To Treat Heterotopic Ossification

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.

Why Is Personalisation Essential In Cancer Treatment?

Our radiotherapy centre places great emphasis on offering personalised treatment. However, this is not simply a matter of good customer service or an added extra. In fact, it is an essential element of finding and deploying the best methods to deal with your condition.

When any patient comes to us with cancer or any other condition that can be treated using radiotherapy, there are many different factors to consider in determining the best treatment. It is the combination of these that will determine the best way forward for each individual.

Among the factors that may be included are:

  • What stage the cancer has reached
  • Whether it is highly aggressive or only mildly so
  • The extent to which other treatments, such as surgery, chemotherapy or targeted drugs, may play a role in treatment
  • The age and general health of the patient can set the parameters for what treatment may be given
  • Whether or not the patient has already undergone some treatment which has not been successful
  • The patient’s own wishes, as expressed when discussing treatment options with an oncologist

This list is far from exhaustive. For example, practical issues like how far you have to travel to our radiotherapy centre in Vienna can be a factor in how we approach treatment, as well as the help (such as accommodation) we can provide as part of the treatment.

We also provide advanced treatment planning, image-guided radiotherapy, VMAT, stereotactic body radiation therapy/stereotactive ablative radiotherapy, consultant-led planning and medical physics quality assurance.

How Does Radiotherapy Work?

The role that radiotherapy plays is a prime example of how different, personalised approaches can be offered.

On the one hand, the basic way radiotherapy works in treating cancer is consistent. It uses radiation to disrupt the DNA of cancer cells, which damages their capacity to reproduce or sustain themselves.

In the best-case scenario, this treatment can beat the cancer entirely, placing the patient in remission. Even if this is not possible, however, it can shrink tumours and slow the progress of the disease, providing relief from symptoms and extending life.

What Are The Different Forms Of Radiotherapy?

However, radiotherapy can be delivered in different ways:

  • Internal radiotherapy, or brachytherapy, where radioactive sources are placed inside or very close to the tumour.
  • Internal radiotherapy is often used for specific cancers such as breast, prostate or cervical cancer.
  • External beam radiotherapy, where beams of radiation are fired at the area where the cancer is.
  • Stereotactic radiotherapy, where very intense beams of radiation are aimed at very small, specific areas, such as brain tumours or cancer close to other sensitive organs

If you need radiotherapy, your oncologist will discuss the right type for you depending on your condition.

Another consideration is whether your overall treatment will involve surgery to remove a tumour or other cancerous tissue. This may depend on the location of the tissue and whether it is practically safe to remove it surgically.

If part or all of a tumour cannot be removed this way, the use of radiotherapy will help to shrink it. If a tumour is removed, a form of radiotherapy called adjuvant radiotherapy can be used.

This may be used to counteract any remaining cancerous tissue, but it is also used to help prevent a recurrence.

What Are The Side-Effects Of Radiotherapy?

Radiotherapy does come with side effects, which can be challenging to deal with. These include the following symptoms:

  • Fatigue
  • Hair loss
  • Skin soreness
  • A loss of appetite
  • Low libido and loss of sexual function in some cases when radiotherapy is in the abdominal areas
  • Low blood cell counts

Many of these effects will wear off after radiotherapy ends.

Note, as well, that side effects vary depending on the area being treated. Your oncology team will explain the potential short and long-term effects relevant to your individual treatment plan.

The course of your treatment will not just be calibrated according to your own medical circumstances. Every patient can discuss treatment programmes with their oncologists in order to ensure there is a plan in place that everyone is happy with as the best way forward.

What Other Support Can We Offer?

In addition to this, the support we can provide in helping people to travel to Vienna, take up accommodation while treatment is ongoing, spend time with family if required and have other practical arrangements taken care of is all part of the personal service.

These may not directly impact your treatment, but they are all part of treating the whole person as an individual and helping to ensure your needs are met in the best way possible, including having a supportive, encouraging environment at what may be a difficult time.

Combining these personal elements can help maximise the chances of the best possible patient outcomes.