Radiation Oncology specialist, Dr. Kuczer

 


3D-CRT vs. SBRT

 


Respiratory Motion Management

Conventional (ITV-based)
– Contour and treat full tumor ROM

Accelerator beam gating
– Patient breathes normally; beam only on while patient is in a certain phase of the respiratory cycle

Active breathing control
– Patient holds breath in a certain position; beam only on in that phase of the respiratory cycle

Dynamic tumor tracking
– Patient breathes normally; tumor is tracked; beam always on and moves with tumor

Regardless of the motion management used, an additional “CTV/PTV” margin around our target is needed to ensure that we hit it.

 

 


Curative Indication - NCCN Guidelines – NSCLC

 


Curative Indication - NCCN Guidelines – NSCLC

  • Surgical resection is the preferred local treatment
    – An anatomical resection with lobectomy or segmentectomy is preferred to wedge resection
    – Includes sampling of at-risk ipsilateral hilar and mediastinal LN
  • SBRT for patients who are medically inoperable or refuse surgery
    Limitations: High volume (DM > 5cm) and  “ultra-central” tumors should be treated more cautiously (e.g. 10 instead of 3 fractions)
    –Limited data yet supporting the addition of systemic therapy to SBRT

Potential SBRT Toxicity Depends on Tumor Site

Risk of toxicity can be reduced through risk-adapted dose-fractionation

 


Outcomes of SBRT for Early Stage NSCLC

 


Take Home Pearl and Further Indications of SBRT for NSCLC

 


Reirradiation of Recurrent disease

 

  • Feasibility of treating with curative intent depends on site of primary (P) and recurrent (R) tumors
  • Advanced treatment techniques are particularly useful for sparing normal tissue (e.g., IMRT, SBRT, protons)
    – Reirradiating central structures (e.g., esophagus, airway) most challenging
    – Long-term toxicity is the major concern – impacted by dose/fraction

SBRT in the Management of Stage IV NSCLC

Palliative Radiation For Symptom Relief

  • Pain
    –Bone metastases
  • Neurologic symptoms
    –Spinal cord compression
    –Brain metastases
  • Bleeding
    –Endobronchial tumor
  • Dyspnea/Dysphagia
    –Tumor obstruction causing SVC, respiratory distress or esophageal narrowing

Is all metastatic disease the same?

  • No! Lung cancer has M1a, M1b and M1c designations because the metastatic state at diagnosis impacts prognosis; a small subset of patients may be cured
  • Oligometastaticrefers to a situation where distant metastases may be limited in number (typically defined as < 5 mets in < 3 organs), and potentially curative treatment can be delivered prior to the development of widespread disease

 


UT Southwestern Randomized Phase II Trial

  • Iyengar et al, JAMA Oncol, 2018
  • 29 patients, oligometastatic NSCLC with < 5 sites of disease (EGFR/ALK negative), PR or SD after induction chemo, randomized to +/- SAbR
  • SAbR à ↑ M-PFS (3.5à9.7mo)

 


SABR-COMET Randomized Phase II Trial

  • Palma et al, Lancet, 2019
  • 99 patients, variety of oligometastatic cancers with < 5 sites of disease, PR/SD on systemic therapy, randomized 1:2 to +/- SAbR (at ablative doses)
    – Most common histologies: breast, lung, colorectal, prostate
  • SAbR à ↑ M-PFS (6à12mo, p<0.001) & M-OS (28à41mo, p=0.09)
    – Also ↑ G2 or higher toxicity, but no difference in QOL

 


Multi-Institutional Randomized Phase II Trial

  • Gomez et al, J Clin Oncol, 2019
  • 49 patients with oligometastatic NSCLC with < 3 sites of disease, SD/PR after Pt-based doublet or EGFR/ALK inhibitor, randomized to maintenance systemic therapy +/- local consolidative surgery/RT
  • RT à ↑ M-PFS (4.4à14.2mo) and M-OS (17à41mo, p=0.02)

 


The Future…

Immunotherapy May Change Our Approach to Locoregional Management Too

A stronger immune response may be elicited by leaving a tumor in and irradiating it, rather than removing the largest source of antigenic stimulation.

 


 

 


The Future……Aktive Protokolle

PACIFIC-4 / RTOG 3515

Inclusion Criteria

  • Clinical Stage I/II node negative (T1 – T3 N0)
  • Medically inoperable or refuse surgery
  • ECOG PS 0-2
  • All comers for histology and PDL-1 status
  • Sync/Metach allowed

The Future…A Few Examples of Active Clinical Trials in Lung Cancer

CAVE: Not all new substances proofed to be safe with SBRT. Additional surveys needed!

  • NRG LU002: Adds RT (to all sites of disease) to systemic therapy for oligometastatic NSCLC
  • NRG LU004: Adds immunotherapy to IMRT or 3-D CRT for stage II-III NSCLC with high PD-L1 expression (instead of chemotherapy)
  • PACIFIC 4 and NRG/S1914: Adds consolidative immunotherapy to SBRT for stage I NSCLC
  • AEGEAN: Adds neoadjuvant immunotherapy to surgery for resectable stage II-III NSCLC
  • ALCHEMIST: Evaluating adjuvant use of targeted agents for resected NSCLC
  • RTOG 1308: Compares proton therapy to photon therapy for LA-NSCLC
  • NRG LU005: Adds immunotherapy to chemoradiation for limited-stage SCLC
  • NRG CC003: Hippocampal avoidance PCI for SCLC

Quellen


SBRT bei NSCLC

VIELEN DANK!

radiotherapy centre - linear accelerator technology

Technological advancement is one of the core parts of the development of radiotherapy, much in the same way that radiation therapy is one of the core parts of the treatment of many lesions, tumours and types of cancer.

Because of this, radiotherapy tends to be one of the most unique and fast-moving fields of research in all of medicine, as each revolutionary change serves to make treatments that were previously impossible almost routine in their effectiveness.

One of the most interesting recent developments is in the field of Biology-Guided Radiotherapy (BgRT), a promising emerging field of radiotherapy that allows for more adaptive treatments and avoids overly cautious treatment plans that might make certain tumours inoperable due to unacceptable levels of risk.

At this early stage, only a few treatment centres are using BgRT, but as the concept increases in its capabilities and more radiotherapy centres look to adopt the most state-of-the-art technological advances, here is everything you need to know about this new field.

 

What Is Biology-Guided Radiotherapy?

The core principle behind BgRT is that it combines radiotherapy treatments with positron emission tomography (PET), a system that creates digitised, detailed imagery of the body as it is currently functioning, rather than a static two-dimensional or three-dimensional model of how it looks.

It works through the use of a radiotracer, which is injected into the bloodstream and through tracking the activity of this radioactive substance in real-time, can also track the exact position of cancerous cells at a given time.

PET is often used in conjunction with CT scans for more accurate readings, but in radiotherapy, it delivers something potentially far greater and something that can unlock a very powerful treatment that it would be impossible to use otherwise.

 

How Would It Change Treatments?

At present, radiotherapy is undertaken through the use of a static body scan (typically a CT scan) that is used to coordinate and prepare the treatment, as well as explore what exact options are available.

The problem with a static scan is that whilst the scan itself is accurate and detailed and static, the human body it is depicting is very much not, and various organs and parts of the body can shift and change position in the body, both naturally and as a process of movement.

This means that where the tumour was when the CT scan was made days or even weeks before, and where it is when the radiotherapy treatment takes place can be very different indeed, and in order to compensate for this, radiotherapy treatments tend to be broader than they perhaps need to be.

Because there is the potential for collateral harm, radiotherapy is often best used with smaller tumours, and is often combined with chemotherapy or other forms of cancer medication to shrink the tumour and make it far easier to destroy without damaging too much healthy tissue.

The best way to undertake radiotherapy, therefore, would be to combine it with a real-time diagnostic imaging system, as there would be no difference between the scan and the body that was being treated and this would lead to radically more accurate treatments.

There are a lot of ways to do this potentially, with explorations into using real-time CT scans and even modified forms of ultrasound, but the one with the most potential is BgRT, because of the inherent real-time nature of how PET interacts with cancer cells.

Cancer tends to be particularly easy to spot with PET, and even if it moves, it is very clear to see where it is at any given point, allowing for rapid adaptation to tumours that are moving around the body.

This not only leads to more accurate treatment and faster recovery times for treating tumours and growths that are already managed through other more conventional forms of treatment, but also allows for more complex cancers to be treated.

In particular, treating multiple tumours is a complex process that requires each tumour to be treated individually, with a separate CT scan and planning process for each.

This novel BgRT approach allows for several tumours to be treated at once, helping to reduce overall treatment times and ensure there are fewer complications.

It also allows for subtle patient movements to be factored in, which means that patients do not necessarily have to be held completely still in order for a treatment to be effective.

It could potentially mean that tumours too close to vital organs to be viably operable up to this point could be treatable in the near future.

Radiotherapy centre Austria - Patient with doctor radiologist

The wonders of modern medicine and allied improvements in the understanding of matters like nutrition and toxicity have had a massive positive impact on the life expectancy of people in the most advanced countries in the world. But the benefits of advancement and affluence can bring with them a number of other health problems.

Whether it is pollution caused by industrialisation, easy access to unhealthy food that combines with sedentary lifestyles to increase obesity, or the health challenges that come from people living longer, there are some unfortunate trade-offs to contend with.

Cancer is undoubtedly one of those. Although some causes of cancer through exposure to carcinogenic substances are on the wane, such as fewer people smoking and better awareness of the risks from sunburn, other cancer-causing factors remain common and the chances of suffering from them increase with age.

EU data for 2022 has shown what the nature of the challenge now is for the Bloc’s 27 countries, including Austria. There were 2.74 million new cancer cases last year, up 2.3 per cent in the previous survey in 2020. Cancer deaths were up by 2.4 per cent to 1.3 million.

While the 0.1 per cent gap between case and death rates may not be statistically significant, nor does that indicate that a greater number of people are surviving.

The data showed that the most common form of death was still lung cancer, accounting for 19.5 per cent of cases, with colorectal cancer second at 12.3 per cent.

This differed somewhat from the detection rates, with lung cancer only accounting for 11.6 per cent of diagnoses, less than the 12.1 per cent figure for prostate cancer, the third most commonly diagnosed cancer but not one of the top four killers.

Of course, cancer treatment was impacted by Covid as lockdowns left some hesitant to seek medical examinations and a possible diagnosis for fear of contracting the virus, a genuine concern for older and more vulnerable people. However, the figures identified in the survey reflect some longer-term trends and pose a significant healthcare challenge.

If more people will contract cancer, it is important to ask what can be done about that. Should it be simply accepted that for many, this is how they eventually die in old age when in the past they would not have lived so long? Or can advances in radiotherapy and other treatments bring down mortality rates?

At our radiotherapy centre in Austria, every life saved is a triumph, although it must be noted that sometimes even the best radiotherapy can only prolong the life of cancer patients, not cure them outright.

The science of radiotherapy has been advancing ever since it was first used at the turn of the 20th century. Given the side effects that the use of radiation against cancer produces, the trade-off has always been at the centre of research into ways of making radiotherapy more efficient.

Of all the innovations in this area, the gamma knife may be the greatest, because it is so effective at focusing radiation exactly where it is needed, leaving surrounding areas virtually untouched, a critical issue when dealing with brain tumours.

However, other radiotherapy developments have similarly advanced the focus of beams, helping to direct radiation with ever more intensity and precision.

With this in mind, alongside advancements in other cancer treatments, there can be genuine hope that overall deaths can be reduced and that in time, even if cases rise, mortality can head in the opposite direction.

Indeed, while the EU figures were prefaced with the acknowledgement of the significance of old age in increasing cases and mortality, it also noted that 25 per cent of women and 31 per cent of men were expected to be diagnosed with cancer before the age of 75, with mortality rates of nine and 14 per cent respectively. Cutting the latter is a real goal to aim for.

Of course, the overall EU picture is different from that of individual countries. The charts show Austria fared better than average for both identified cases and mortality. That may indicate both better healthcare and healthier lifestyles to start with.

The EU currently projects that all-age mortality from Cancer will rise by 18.39 per cent to 3.25 million a year by 2040, with demographic factors accounting for the whole of this increase. With some EU countries having low birth rates and even falling populations, this is likely to be a matter of populations being older, not more numerous.

Austria is tipped to remain one of the countries with the lowest increases, but here and everywhere across Europe, the challenge will be to find ways of getting the numbers down.

Gamma knife surgery - Male nurse preparing patient for CT scan

It has often been said that in Western countries with long life expectancy, around one in two people will get cancer at some point in their lives. This can come in many forms, but it is also a threat that is increasingly preventable and treatable. Both these facts will shape how cancer is approached in the years to come.

What we now know compared to a few decades ago is highly significant. In the early 20th century, for example, it was believed that smoking was a healthy thing to do, while it was also believed that exposure to radioactivity could have some health benefits.

In time it was learned that one of these things was not true and efforts to bring smoking levels down have been largely successful, reducing the risks of diseases like lung cancer. In that case, prevention has been the lead strategy.

 

The Reality Of Radioactivity

Radioactivity is another matter. We are all exposed to it at low levels, from natural background radiation and also ingesting mildly radioactive substances vital to life, like potassium (bananas are mildly radioactive). These levels are perfectly safe, as are things like X-rays and other medical treatments with low levels of radioactivity.

What causes alarm in the minds of most people is the spectre of what high levels of radiation can do. Extreme causes such as the atomic bombings of Japan in 1945 or the nuclear power station accidents at Chernobyl and Fukushima can be cited as causing radiation sickness, with cancer one of the symptoms.

On a lesser level, too much of one form of naturally occurring radiation – the sun’s ultraviolet rays – poses a skin cancer risk for people with pale skin.

However, the fact that radioactivity can, when directed in the right way, actually fight cancer by destroying affected cells and tumours provides hope for life where otherwise there would have been nothing to do except receive palliative care before death.

 

Radiotherapy To The Rescue

Radiotherapy has been used for decades in this way and the invention in the 1960s of gamma knife surgery by Swedish professor of neurosurgery Lars Leksell provided a precision instrument for use in directing radiation in very sensitive areas, enabling brain tumours to be tackled with a focused gamma beam without any harm to the rest of the brain.

Professor Leksell developed a second gamma knife in the 1970s and an obvious avenue for further development of this technology in the future will be increased precision. The same may apply to various radiotherapy techniques.

What comes next and over the future decades is a matter that many experts in the field have given a lot of thought to.

 

What Does The Future Hold?

For instance, an article in Nature Reviews Clinical Oncology a decade ago noted that while radiotherapy has been used since 1895, it is in recent years that the most significant breakthroughs have been made.

It stated: “Such achievements, of major importance for the quality of life of patients, have been fostered during the past decade by linear accelerators with computer-assisted technology.”

This, it added, has been supplemented further by “proton and particle beam radiotherapy, usually combined with surgery and medical treatment in a multidisciplinary and personalised strategy against cancer.”

What this means is that the more recent technologies have been increasingly effective at focusing radiation treatment on the areas of the brain or body that need them most.

That the field has a lot of new developments to come, building on the foundations of various innovators (not just Prof Leksell) is a point emphasised by many others too.

Writing two years ago, British publication The Lancet said radiotherapy remains “the most poorly understood of the cancer disciplines,” but highlighted that a number of new developments promise to take this field to new levels.

The article alluded to the way data collation can help treatment and there is no doubt that AI may play a larger role, as it is already showing signs of being effective in helping with early diagnosis of conditions.

An obvious advantage of this is that it means treatment can start sooner and may be especially effective at ensuring the cancerous area is treated effectively using radiotherapy before it can progress further. That may mean less need for more advanced and specialised treatments in some cases, but also shorter treatment times and higher recovery rates.

 

A Role For AI?

While the next few years may see AI diagnostics bring the biggest advances, it is exciting to think about what may be achieved by 2050. In 2020, Molecular Oncology sought to answer the question with some bold predictions.

Not all of these are positive. It stated that the increase in cancer diagnoses in recent years will continue to soar, with the likely reason being a real-life increase in cancer, not just better detection. A larger global population will be part of the reason, but so too will lifestyle elements. 

Indeed, while smoking may be in decline and fair-skinned people take more care in the summer sun, issues like diet and more sedentary lifestyles may be an increasing problem in some countries as they get more affluent.

Meanwhile, in Europe, the rise in cases will not be down to an increase in population (the reverse will happen), but an increasingly aged population that is more medically vulnerable.

Whatever the causes of increasing cancer cases, they will drive the imperative to be better at detecting cancer, to do so sooner, and to find more effective treatments.

In the last case, it is not just about new technological developments, important as they will be, but how they are used. One prediction is for increased use of personalised oncology. This will enable more innovation; instead of arranging radiotherapy treatment programmes based on standard models, each one will be calibrated to the particular needs of individuals.

That could ensure gamma knife treatment becomes the primary means of treating some very specific conditions after an early diagnosis, with a personalised approach swiftly establishing that this is the best way to tackle a problem.

Whatever new developments come in the years ahead, here at Amethyst we will always seek to be at the forefront, using cutting-edge technology, treatments, data and understanding to help provide the best treatment and outcomes for our patients.

radiotherapy centre - Modern MRI machine

Typically, when people enter a radiotherapy centre for treatment to remove prostate cancer, the course prescribed can sometimes involve as many as 39 doses of radiation over several weeks.

This is a long treatment, but typically if caught early enough has a 90 per cent chance of stopping the cancer from spreading further if not outright destroying it.

However, the length of the treatment along with the fatigue that can often arise as a side effect has led researchers to explore the possibility of using a more intense radiotherapy treatment such as stereotactic body radiotherapy (SBRT), and a major study by the Institute of Cancer Research has provided promising results.

The PACE study, conducted on 874 men with low or medium-risk prostate cancer tested SBRT in a course of five treatments over two weeks against conventional radiotherapy in both its 20-dose and 39-dose pathways over four weeks or 7.5 weeks respectively.

Both treatments were highly effective, with 94.6 per cent of traditional radiotherapy patients being cancer-free after five years. However, what was surprising is that a percentage point more of the patients on SBRT were declared the same.

This is a relatively small increase, but what it highlighted is the potential to use a shorter treatment that is more effective, more convenient and less overall exposure to radiation over the five doses compared to the higher number of doses.

This suggests that it could potentially become the standard radiotherapy treatment for early-stage prostate cancer patients going forward, although there are some patients for whom a long-term radiotherapy treatment would be more suitable.

Prostate radiotherapy can exacerbate urinary issues in people who already have them, and whilst it would be a shorter-term treatment, there will be people who would rather not deal with the irritation, although in the case of SBRT, these symptoms only last a few weeks.

Ultimately, time and further study will tell, but this could potentially be a game changer and ensure people get the treatment they need sooner.

Radiotherapy Centre - Examination by doctor urologist of prostate gland photo concept

Prostate cancer is one of the more common cancers, but if detected early enough, men who suffer from it can have a very good chance of survival. Accessing a radiotherapy centre can often be a crucial factor in enabling them to do so.

However, the rates vary widely between countries, with Austria far from being among the worst affected. There are various reasons for this, not least ethnicity, as the majority of Austrians are white. Research in various countries has shown that, for example, black men are far more likely to suffer the disease.

World Cancer Research Fund International (WCRFI) data published in 2020 showed that the highest rates were in the French overseas territories of Guadeloupe and Martinique. Migration from those Caribbean countries to France may partly account for the fact that it was ninth on the list.

Caribbean countries featured heavily among the highest rates, reflecting the ethnic divide, with the top ten also including Barbados, St Lucia and the Bahamas. These countries all had rates of more than 98 per 100,000 men, compared with the global average of 30.7.

However, that was not the full picture; the third-highest rate was in Ireland, while Estonia and Sweden were also in the top ten, showing that European countries with mostly white populations were second-worst affected. High incidence rates in European countries may arise from secondary influences like obesity and high dairy consumption rates.

Another notable fact is that prostate cancer rates vary widely between European countries; EU and EFTA stats in 2018 had put Sweden slightly ahead of Ireland, with these being among five countries with over 200 cases per 100,000 that year.

Yet, at the opposite end of the scale, the rate was only 63.6 in Romania and 83.7 in Poland. The overall average was 151.2, with Austria well below this at 130.4.

However, the difference between the cancer incidence rate and mortality was the most notable finding of the WCRFI figures. No European country was in the top ten for death rates from the disease. Instead, Zimbabwe had the highest death rate, joined in the top ten by Zambia and the Ivory Coast. The other seven in this list were Caribbean nations.

In these countries, the mortality rates ranged from 29.5 per 100,000 in the Ivory Coast to 41.7 in Zimbabwe, compared with a global figure of 7.7. 

What this indicates is that the most deadly combination is that of a population more demographically prone to the disease and poorly resourced in terms of its cancer treatment facilities. This would certainly apply to a country like Zimbabwe, where controversial agricultural reforms in the 2000s brought the economy to its knees.

The WCRFI noted how the cancer survival rates for various forms of the disease can vary between countries, with higher-income nations benefitting from better screening and treatment services.

All this suggests that those with the means to travel from countries lacking in the necessary treatment facilities such as radiotherapy providers may find centres like ours the best place to get vital, potentially life-saving treatment.

“Als Resümee bleibt mir ein riesengroßes Danke für ihre Leistungen und die ihrer Mannschaft auszusprechen, die in Summe die Bestrahlungen in sehr guter Erinnerung bleiben lassen.”

Sehr geehrter Herr Dr Kuczer,

ich möchte mich herzlich für die bei Ihnen absolvierte Strahlentherapie bedanken.

Aus der Sicht des Patienten stehen sie als Verantwortlicher naturgemäß im Vordergrund, entscheidend ist jedoch das Gesamtpaket.

Es begann mit unserem ersten Kontakt, wo ich bereits neben Ihrer ausgeprägten Kompetenz auch Ihren angenehmen Humor und Ihre deutlich spürbare Empathie kennen und schätzen lernen durfte.

Auch ihr Kollege, der mir die Goldplättchen eingesetzt hat, ist äußerst kompetent, sehr sympathisch und humorvoll.

Positiv möchte ich auch Ihre stets höfliche, reizende und immer hilfsbereite Sekretärin erwähnen.

Dann war ihr Bestrahlungsteam am Zug und hat aufgrund der professionellen, aber auch entspannten und immer freundlichen und humorvollen Abwicklung zum 100% positiven Gesamtbild beigetragen.

Als Resümee bleibt mir ein riesengroßes Danke für ihre Leistungen und die ihrer Mannschaft auszusprechen, die in Summe die Bestrahlungen in sehr guter Erinnerung bleiben lassen.

Die einzige immer mit kurzer Dauer sporadisch aufgetretene Nebenwirkung der Müdigkeit wird angesichts des realistisch erscheinenden Erreichens eines Erfolges und der beschriebenen positiven und entspannten Behandlungsphase in den bedeutungslosen Hintergrund gerückt.

Nochmals ein großes Danke!

Sie und Ihr Team vermitteln und stellen einem Patienten in meiner Lage genau das im medizinischen und psychologischen Bereich zur Verfügung, was er als Werkzeuge im Kampf gegen die Erkrankung und als Beitrag zur Stärkung und Fortsetzung einer bereits bisher stabilen und optimistischen psychischen Entwicklung braucht.


Ich habe binnen kurzem den besten Eindruck von der hohen Fachkompetenz und dem zwischenmenschlichen Zugang von Dr. Kuczer erhalten.

Daß die Amethyst Radiotherapie mit ihrer technischen Ausstattung auf sehr hohem Niveau steht und die Geräte den Patienten kurzfristig zur Verfügung stehen, unterstreicht für mich die besondere Bedeutung dieser Klinik und trägt wesentlich zu meinem Vertrauen auf die menschenmöglichen Chancen auf Leben und Genesung bei.

Von W.G.Sch.

Gamma knife surgery - Radiosurgery word cloud

All over the world, millions of people who have contracted brain cancer will have soon learned there is more hope for extended survival today than ever before, because of the wide range of treatments available.

For those learning about gamma knife surgery, there may be a lot of interest in this option and the circumstances in which it might be used as the best available means of treating a tumour.

Brain tumour surgery has certainly been in the news a lot recently, with news that the former US Open golf champion Gary Woodland has had surgery to remove most of a tumour.

The 39-year-old, who won his major title in 2019, revealed on his X (Twitter) account that he would have the operation on September 18th, having been diagnosed just over three months earlier. He had been seeking to use medication to treat the lesion but had agreed after consultation to undergo the operation.

A subsequent statement on his social media accounts revealed: “After a long surgery, the majority of the tumor has been removed and he is currently resting.” 

No further details of the nature of the operation were provided, but the use of the phrase ‘long surgery’ may be a strong indicator that this was a matter of invasive surgery in which the brain was physically accessed and most of the tumour excised.

A gamma knife operation would not be quite like this. Firstly, it does not actually involve any invasive surgery at all as it involves the focused direction of radiotherapy beams on the specific affected area of the brain.

Secondly, the time taken does not particularly fit the description ‘lengthy’. Although the duration of the procedure can vary, a period of less than one hour is perfectly normal.

Also, while Gary Woodland is ‘resting’ from his surgery and it required someone else to make the social media posts on his behalf – suggesting he may have been under general anaesthetic – this is different from gamma knife operations, where patients can often return to normal activities within a day or two, though regular check-ups will be needed thereafter.

Of course, the specific details of Gary Woodland’s condition are between him and his doctors, but some factors would determine that invasive surgery instead of gamma knife surgery might be required. Some of these could apply in his case, while others would not.

For example, a gamma knife may not be the best solution for those who are very young or very old, although this would not apply to a patient of Gary Woodland’s age.

Other issues favouring different options could include larger or more complex tumours (gamma knife treatment is best for small and well-defined tumours), bleeding disorders or having a metal implant in the head.

Finding the right treatment for brain tumours is important and there will be times when a gamma knife is not the best option. But when it is, it comes with a lot of advantages in enabling you to resume normal activity sooner than invasive surgery would normally allow. 

Keto Food For Ketogenic And Cholesteral Diet, Healthy Nutritiona

When it comes to treating cancer, surgery, radiotherapy or chemotherapy are most frequently used. 

They are designed to either remove the tumour, kill it or shrink it, so it is no longer at risk of spreading.

However, taking steps to improve the patient’s lifestyle can help them cope with the adverse symptoms of these therapies, as well as make their bodies strong to support their cancer fight. 

Having good nutrition, for instance, is essential, helping to boost the immune system, lower the risk of cancer returning, rebuild tissue, and maintain strength. 

Essentially, cancer patients need to eat extra protein, including meat, fish, eggs, dairy or plant-based proteins. 

One of the biggest side effects of treatment is appetite loss, so it is important for patients to set reminders to eat even if they do not feel like this, as they need to remain strong. 

They might also suffer from a dry or sore mouth or throat, or have trouble swallowing. In this case, swapping to liquid foods, such as gravies, smoothies and soups could help them get their calories in. 

Other side effects can include diarrhoea or constipation, so they need to talk with their nutritionist about how to increase or decrease fibre in their diet.

It is also important to drink plenty of water, particularly on days when appetite is low. 

Other ways to manage food intake while undergoing cancer treatment is to eat smaller meals throughout the day, keep snacks closeby, eat something before bed, have soft or cold foods, consume large meals when feeling well, and only sip liquids during meals to avoid filling up too quickly. 

After the treatment is complete, the symptoms should start to subside, making it easier to eat again. 

It is still important to regain strength and boost mood so patients should continue eating well, making sure there is plenty of fruit and veg in the diet, adding pulses to meals, eating whole grains, choosing low-fat milk options, limiting red meat to three servings a week, and easing off fat, salt, sugar, and alcohol.

Radiotherapy uses high-energy beams to kill prostate cancer cells. It is a treatment option for nearly all cancer stages, from early-stage tumours to more advanced and metastatic prostate cancer.

Our radiation oncology team at Amethyst Radiotherapy, represents the largest pan-European network of high-tech radiotherapy centres. Our doctors are committed to providing cutting-edge radiation therapy treatments that effectively target cancer while minimising the risk of side effects. One of these innovative methods is hydrogel spacers.

This technique involves the use of an absorbable gel that temporarily creates a gap between the prostate and rectum, significantly reducing the risk of bowel radiation during treatment. Hydrogel spacers also improve tumor targeting, reducing the total number of treatment sessions from 39 to 7.

This means that you can complete your treatment in 2.5 weeks instead of 8 weeks. The method is used for localised prostate cancer and is performed on an outpatient basis every 2nd working day. A treatment takes about 10 minutes and is painless.

Attached is the example of the first patient we treat using this method. You can see the dose by the very precise color that surrounds the prostate, as well as the white color of the spacer gel that pushes the rectum away from the prostate.

Radiation techniques available at Amethyst Radiotherapy include:

Image guided VMAT radiation therapy

Volumetric modulated arc therapy (VMAT) is one of the most advanced techniques of external radiotherapy. It involves the use of a linear accelerator machine that rotates around the patient while he lies down. The machine precisely delivers radiation doses to the tumor site while limiting the amount of radiation received by the healthy tissues surrounding it.

Stereotactic Body Radiotherapy (SBRT)

Amethyst Radiotherapy is among the few private centres in Europe offering SBRT radiotherapy, and the only one in Austria. SBRT is a cutting-edge radiotherapy technique that can comprise the radiotherapy treatment into a few sessions, by delivering higher radiation doses safely and efficiently. SBRT is an efficient treatment option both for metastasis/lymph nodes as well as for small PET positive relapses for patients that had radiotherapy previously.

Author: Dr. David Kuczer
Literature: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)31131-6/fulltext