Radiotherapy centre Austria - radiotherapy

Could ‘Mini CERN’ Provide The Next Radiotherapy Innovation?

Ever since the possibilities of radiotherapy were first discovered in the 1890s and put into practice in the 1900s, the potential of this technology to treat cancer has been a keen subject of intensive research around the world.

Indeed, if you or someone you know comes to be treated at our radiotherapy centre in Austria, the treatments available will be vastly more advanced than anything that could be offered in those pioneering days, enabling thousands of patients to enjoy years of extra high-quality living.

Until such time as someone produces a magic bullet that will kill all cancer, terminate all tumours and ensure our cells behave benignly, the need for research will never end, with new radiotherapy techniques as important as any other treatment option.

What that means in practice is finding better ways of delivering more precise and carefully aimed doses of radiation, intending to provide the maximum radioactive blast to kill tumours and cancerous cells, while minimising the exposure of healthy cells, which can bring all kinds of unpleasant and occasionally hazardous side-effects.

CERN Provides A New Innovation

The latest development that may promise new treatments comes from work in Germany, using mini versions of the particle detectors used at CERN, Medical Express has revealed.

CERN is famous as the giant underground laboratory under the Alps that spans the Swiss and French borders, using the Large Hadron Collider to fire particles down vast underground tunnels while measuring various bits of data.

Discoveries like the probable existence of the Higgs Boson – which determines why things have mass – and gravity waves will have excited physicists, but some may ask what the practical benefits of these advances in knowledge might be.

Part of the answer may be found in Germany, where the same kind of technology on a smaller scale is now being tested in a combined effort by the German National Centre for Tumour Diseases, the German Cancer Research Centre (DKFZ), and the Heidelberg Ion Beam Therapy Centre.

Working together at Heidelberg University Hospital using a Czech-made device, the researchers are using a Timepix3 pixel detector developed by CERN to monitor head and neck tumours during radiotherapy sessions.

How The Technology Works

“One of the most advanced methods for treating head and neck tumours involves irradiation with ion beams,” said the head of the DKFZ team Maria Martisikova.

She added: “This has one unique feature: it can be precisely tailored to the depth inside the human head where the particles should have the maximal effect.”

What that means is that by using the new CERN-designed technology to provide a level of monitoring way ahead of anything previously available, the researchers can establish exactly where and how deep the ion particles are going and by monitoring the effects, establish the most effective measurements to use to bring about optimal outcomes for patients.

The importance of this, the article noted, is that like other forms of radiation therapy, ion therapy risks hitting healthy tissues, organs and nerves with radiation. In the case of brain surgery, it gives examples of the memory centre and optic nerve as among the most vulnerable areas.

Up until now, there has not been a means of closely measuring the ions sufficiently to target them precisely. This is exacerbated by the fact that the brain can change during treatment in ways that may not become apparent in ‘real-time’ during treatment, rather than showing up in later CT scans.

Lukas Marek from ADVACAM, the firm making the particle detector, said: “Our cameras can register every charged particle of secondary radiation emitted from the patient’s body. It’s like watching balls scattered by a billiard shot.”

He added that this means the balls will “bounce correctly” if the latest CT scan is up to date, while if they don’t it means the brain has changed and a new scan and revised targeting are needed.

What Else May Come From CERN?

Such possibilities may not have been imagined when CERN began operating, but they have emerged as tangible benefits that the world of radiotherapy can benefit from enormously.

In the meantime, work goes on at CERN on various experiments, such as using a laser to cool a form of antimatter called positronium, which it states could pave the way for a new series of antimatter experiments, including the creation of a matter-antimatter system that emits a gamma ray-like light.

Could such a ray have the same effects as the gamma rays used in radiotherapy? Or could it exhibit some other characteristics that may one day have a medically beneficial use? It remains to be seen. But as long as such research is taking place, it could help take radiotherapy in unexpected new directions in the future.

radiotherapy centre - Gamma Knife Radiosurgery

The Motivation That Made Gamma Knife Radiosurgery Possible

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.

Gamma knife cancer treatment - doctors prepares the patient for the procedure

What Your Recovery From Gamma Knife Surgery Involves

Major treatment for any kind of ailment, especially cancer, can be quite gruelling. But with a gamma knife, it can be much less so than some imagine.

If you have a tumour that requires precise attention, sometimes the solution your oncologist will choose is excision by invasive surgery. Like any surgical operation, this will require anaesthetic, usually a general one for such a procedure.

Recovery in such cases can be hard. It may take several days for the effects of the anaesthetic to wear off, while the bruising, stitching and healing of wounds can often leave patients immobile for a while, with restricted mobility for some time after that.

However, other forms of cancer treatment can also take their toll. Chemotherapy and radiotherapy can bring a range of side-effects, with regular treatment bringing consequences such as hair loss, fatigue, nausea, stomach trouble, loss of appetite, skin irritation, urinary issues and ‘brain fog’, when thinking clearly and concentrating is difficult.

A particular concern, especially with radiotherapy, is the possible impact on sexual function and fertility, the last of these having potentially life-changing consequences for those whose plans to start or extend a family may be frustrated.

Why Gamma Knife Treatment Is Different

Gamma knife cancer treatment is something only used in specific cases when warranted and is a potent treatment, blasting the affected areas with a powerful beam of radiation. However, the actual effect on the patient in the aftermath is relatively mild compared with many other treatments.

The most important thing about Gamma Knife surgery is that it is non-invasive, which means none of the tissue trauma or potential infection risk that comes with invasive surgery. 

You will have to prepare for the operation in the right way, of course, such as washing your scalp the night before the procedure and making sure someone else is on hand to drive you to and from the operation.

During the procedure your head will be held in place, either with a metallic frame or a frameless plastic device, securing you in position so that the work can be done with precision. A local anaesthetic may be used, but not a general one. These are only given to children undergoing the procedure. You may be given sedatives to relax.

The fitting of the frame or frameless plastic is not an enjoyable experience and some may feel claustrophobic, but the good news is that what comes thereafter is not painful. Some people can even take a nap during the operation.

The Side-Effects Of Gamma Knife Surgery

Because it is so simple, involving no incision, no blood and no stitches, the process can be relatively quick, lasting no more than two hours and potentially as little as 30 minutes.

You may be kept in the hospital overnight for monitoring, but more often than not you will be able to go home. The sedatives will make you a little drowsy, but these will soon wear off.

Among the steps you might have to take will be wearing head bandages for a few days (which should be changed daily), using extra pillows to elevate your head more for a week, and washing your scalp 48 hours after the procedure. However, you should be careful not to pick at any scabs around the pin sites as that could cause infection.

Side effects could include nausea and vomiting, headaches, puncture wounds where you have had injections (such as local anaesthetic),  as well as some numbness, bruising and slight pain for up to a week around sites where your head has been pinned in place (such as to the frame) for the procedure. Hair loss can happen if the tumour is close to the scalp.

However, these are all very temporary features that will soon wear off, whereas other treatments can produce ongoing side effects (such as the loss of hair from chemotherapy).

Getting Back To Normal

More importantly, having gone home within a day of the procedure, you will be able to go about your daily routines fairly normally, apart from the likelihood that you will be advised to avoid strenuous exercise.

Indeed, you may even be able to work as soon as the next day, or do things like flying in a plane within a few days.

Gamma Knife surgery is not for everyone. It is designed to tackle particular conditions and there may be medical reasons why you cannot have it, including pregnancy (radiation can cause birth defects) or having cardiovascular devices fitted, such as a pacemaker.

Nonetheless, it is a procedure that has made a huge difference in the lives of many people. Therefore, it is very good news that it is a far less arduous treatment to undergo than so many others.

radiotherapy centre - Doctor shows information on blackboard

The Differences Between Internal And External Radiotherapy

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.

radiotherapy centre - radiotherapy

What Is Immobilisation & Why Does It Matter In Radiotherapy?

Whilst based on a single, unifying principle, the development of radiotherapy as a treatment has taken over a century and even in the 2020s there are fundamental changes in how treatments are planned, organised and carried out.

There are many different types of radiotherapy, each with different purposes, effects and durations, but many of them share commonalities and one of the core principles of many types of radiotherapy treatment that does not get talked about as often is the necessity of immobilisation.

Whilst immobilisation is an important part of healthcare, particularly in the emergency services as a way to prevent potential complications in people with spinal injuries, keeping patients as still as possible during treatment is an essential part of radiotherapy treatments.

There are many different reasons for this, both straightforward and somewhat more complex, as well as the potential for treatments to be developed that make the need for immobilisation obsolete.

What Is Immobilisation In Radiotherapy?

Radiotherapy is a complex treatment pathway that could be described as akin to shooting a moving target.

The body is in a constant state of flux, with organs and other internal parts of the body constantly shifting, pulsing, growing and shrinking as the various bodily systems that keep people alive work.

This is a complexity for radiotherapy, as it can potentially mean that a tumour, growth or lesion found using a diagnostic scan could have moved, affecting the efficacy of treatment.

At that point, there are two options a radiotherapist would have; increase the scope of the treatment, guaranteeing that more healthy tissue would be damaged but also increasing the likelihood of successful treatment, or locking down the body part in such a way as to minimise this natural movement.

This is the principle known as immobilisation and takes a wide variety of different forms depending on the treatment being undertaken.

For example, Gamma Knife, a form of stereotactic radiosurgery used to remove brain tumours with surgical precision but no surgical incisions, requires the fitting of a metal frame to the head, attached with pins.

This keeps the head stable, rigidly in place and provides reference points for the multiple targeted beams of radiation. Both of these make the chances of a successful treatment substantially higher, whilst avoiding the potential consequences of radiation damage.

The Gamma Knife method, in particular, is famously very precise with a margin of error within just a millimetre, avoiding damage to healthy brain tissue as much as possible. 

This is how the treatment can be undertaken in a single day with tremendous accuracy.

People move a lot, often unconsciously, and these slight movements can seriously affect the potential accuracy and therefore success of treatments. This ultimately makes immobilisation necessary.

Other forms of immobilisation can be as simple as restraining straps, bite blocks, wedges, rollers, headrests and masks.

The Principles Of Immobilisation 

Ultimately, seven main principles are used by radiotherapists when deciding on appropriate immobilisation tools:

  • Patients must be as comfortable as possible whilst wearing them.
  • They must be as simple to set up as possible.
  • They must not cause problems with radiotherapy treatment.
  • They must not make the radiation beam weaker.
  • They must not cause artifacting or other issues with diagnostic scans.
  • They should ideally be transparent so a doctor can see where they are aiming their treatment.
  • They should be easy to make marks on to assist with the initial calibration of radiation beams.

However, whilst the frames, masks and apparatus are designed to be as light and comfortable as possible, there is no denying that the concept of immobilisation is potentially distressing.

In a 2018 study on head and neck cancer treatment, which relies on a perspex mask to keep the face in position, a quarter of patients reported “mask anxiety”, or a fearful or distressing feeling experienced before and during treatment whilst the mask was on.

Most of the time, this can be managed, and a considerable amount of treatment time is taken to educate a patient about immobilisation, being comforting, reassuring and explaining why it matters.

However, there is the potential for this critical part of radiotherapy to change, if developments in the field of real-time adaptive radiotherapy become widely applicable to treatments.

Thanks to the increasing power of computer technology and the rise of medical AI, studies and tests have found ways to provide diagnostic data at the same time as treatments and adapt the treatment accordingly.

This would, in theory, make radiotherapy treatments accurate even without the need for immobilisation, but at present, its use is still limited due to the lack of a standard adaptive radiotherapy treatment.

Radiotherapy Centre - Blood test process

Could Blood Test Give Brain Cancer Radiotherapy Help?

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.

radiotherapy centre - magnetic resonance therapy

The Principle Behind The Effectiveness Of Radiation Therapy

Either by itself or in combination with other treatments such as chemotherapy, radiotherapy is a fundamental part of many cancer treatments, and millions of people will set foot into a radiotherapy centre to start or continue cancer treatment, as well as other abnormal growths and lesions.

Whilst the concept is shared amongst the wide variety of radiotherapy treatments, there is a broad spectrum of different methods used to achieve different results, from the highly targeted brain tumour-targeting Gamma Knife methods to generalised palliative radiotherapy for soothing advanced-stage patients.

For most people who are diagnosed with cancer and prescribed a course of radiotherapy, what primarily matters is that it is safe, it is effective and it will remove the cancer or reduce the potential danger it can cause to life.

However, there are guiding principles behind its effectiveness, and by understanding these, we can understand when and why radiotherapy is used and why continuing advances in technology help to improve effectiveness and reduce risk at the same time.

The root of this lies in the very reason why cancer causes harm in the first place.

Why Does Cancer Cause Harm?

There are hundreds of different types of cancer, each with varying levels of severity, different courses of treatment and targeting different parts of the body. However, all of them are caused by DNA damage which alters the normal ways in which cells grow and die.

These cause mutations that lead to genetic mutations, some of which affect the normal processes that cells use to grow, die and repair themselves. These changes are known as the hallmarks of cancer, and there are eight primary examples:

  • Growing without external growth signals (self-sufficiency).
  • Resistance to signals preventing cell growth.
  • Evading programmed cell death (anti-apoptosis).
  • The infinite potential for replication with damaged chromosomes (cell immortality).
  • The ability to form new blood vessels to stimulate growth (sustained angiogenesis).
  • The ability to invade other tissue and spread to other organs and parts of the body (metastasis).
  • Deregulating the metabolism and generating energy through ways other than conventional respiration (often described as the Warburg effect).
  • The ability to evade the immune system despite causing inflammation in cells.

As well as this, instability of genes and chronic inflammation have been seen as characteristics that cause cancer cells to develop.

This means that the key to getting rid of cancer is to stop these traits, and the main way to do this is to destroy the DNA of a cancer cell.

Why Radiotherapy Works So Well 

Radiotherapy uses particles or waves of radiation with high levels of energy that are targeted at cancer cells and damage their DNA in such a way that it will stop them from dividing rapidly, which stops cancer’s primary form of harming cells and harming people.

What makes this so useful is that the very mutations that lead to cancer developing and proliferating also make them especially vulnerable to DNA damage, as they lack the ability to repair cells with anywhere near the level of effectiveness as healthy cells do.

In most cases, this makes radiotherapy the primary form of treatment, particularly when it is carefully targeted and the person being treated is appropriately immobilised to ensure a high level of accuracy with treatment.

However, in some cases, cancer cells have a resistance to radiation, but this is the exception, rather than the norm.

What can be more of an issue, and the reason why specialist cancer treatments such as Gamma Knife exist, is how radiotherapy can damage surrounding tissue.

This is why immobilisation equipment and frames are used to precisely hold patients in place to ensure that the beam of radiation hits tumours and lesions, instead of any surrounding tissue. 

Besides immobilisation, there are other ways in which this concern is being thwarted, such as more intense bursts of radiation that cause less damage to surrounding tissue, as well as heavier ions that damage cancer cell DNA more effectively.

Beyond this, there are promising evolutions in diagnostic equipment that would vastly improve the treatment pathway by allowing tumours to be tracked in the body in real-time.

As tumours can move in the body based on breathing and other impossible-to-stop subtle movements, using real-time body scanning equipment such as MRI, ultrasound or X-ray induced radiation acoustic imaging to track where a tumour is located and modify treatments accordingly.

The more precise the radiation dose, the less damage it will cause surrounding tissue, making it more effective and more viable in cases where treatment would otherwise be unviable or too risky to attempt.

radiotherapy centre - linear accelerator technology

What Is Biology-Guided Radiotherapy And How Does It Work?

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

Can Radiotherapy Advances Beat Europe’s Cancer Rise?

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

What Is The Future For Gamma Knives And Radiotherapy?

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.