novocure - Doctor showing medical records to cancer patient

What Is NovoCure Therapy And What Cancers Can It Treat?

If you have been diagnosed with cancer, chances are you are researching all the available treatment options. For some types of cancer, NovoCure technology is proving to offer an effective alternative treatment.

What is NovoCure technology?

NovoCure is a pioneering, non-invasive technology that has proven effective for treating certain types of cancer. It uses tumour treating fields (TTFields) to target the tumour. TTFields therapy works by interrupting the division of cancer cells.

It does this by using low-intensity alternating electrical fields to disrupt the tumour, which can slow down its growth or even stop a tumour from growing further.

TTFields therapy can also prevent cancer from spreading, or slow its progression to other parts of the body.

The reason it works is because cancer cells have electrically charged components. As a result, they can be affected by changes in electrical fields. What’s more, because cancer cells have different properties to healthy cells, TTFields therapy does not affect healthy cells.

What cancers can NovoCure technology treat?

At present, NovoCure technology is approved for use on hard-to-treat cancers, such as mesothelioma and glioblastoma.

Mesothelioma is a cancer caused most often by occupational exposure to asbestos. It most commonly occurs in the lungs, due to asbestos being inhaled inadvertently while being either installed or removed.

Across Europe, mesothelioma has been identified as the second most common occupational cancer following lung cancer. In 2021, EU figures suggest there were 2,380 preventable deaths due to mesothelioma.

Italy, Germany and France experienced the highest rate of mesothelioma-related deaths in 2021, highlighting the need for an effective treatment option.

Once mesothelioma develops, which can happen between 15 and 40 years after asbestos exposure, it typically grows quickly and has low rates of survivability. This is why research into TTFields therapy for this particular cancer is so valuable.

Glioblastoma, meanwhile, is one of the most common and most aggressive forms of brain tumour. The survival rate at two years post-diagnosis is currently 25 per cent.

However, research into TTFields therapy for glioblastoma has found that it can increase a patient’s lifespan and improve their quality of life. What’s more, when TTFields therapy is combined with an oral chemotherapy drug – temozolomide, or TMZ – it can significantly extend a patient’s life.

One study found that TTFields therapy combined with maintenance TMZ resulted in an overall median survival of 40 months. This is considerably longer than the average of 24 months for those who don’t receive this treatment option.

Research is also ongoing to determine whether TTFields therapy could also be appropriate for the likes of lung and pancreatic cancers. The hope is that this could become an additional therapy to support patients fighting a range of cancers in future.

What happens during NovoCure therapy?

During NovoCure therapy your tumour will receive targeted electrical fields via non-invasive adhesive transducer arrays that are placed on your skin. You’ll often need to wear these for several hours at a time.

However, there will be no need to sit in a medical facility while doing so. One of the beauties of this treatment is that it is completely portable. That means you can continue with your life as normal, carrying the TTFields device with you.

The device itself will fit in a backpack, which means it isn’t onerous to carry with you.

This enables us to deliver your TTFields therapy around the clock without impacting your daily activities or preventing you from travelling and generally living your life.

We’ll provide support to set up the device initially, as well as continued care and support around ongoing device use, skin care and ensuring your comfort is maintained throughout your treatment.

There are very few reported common side effects from TTFields therapy. The most common issue patients are likely to experience is skin irritation beneath the transducer arrays. This is why we offer explicit support around skin care and comfort.

What are the main benefits of TTFields therapy?

TTFields therapy, like that offered via NovoCure technology, can not only improve survivability rates for those with life-limiting cancers like mesothelioma and glioblastoma.

It will also improve your quality of life because it does not cause the same kinds of side effects as other cancer treatments. This will give you more energy for the activities that matter to you and ensure you are able to make the most of every day.

Each NovoCure therapy treatment plan is bespoke and designed to not only target your cancer in the most effective way, but also to fit in with your lifestyle.

This gives you much greater freedom and a sense of control over your treatment, which can sometimes feel lacking with other options.

cancer treatment austria - Abdominal pain in woman

The Early Signs Of Ovarian Cancer And How It Is Treated

Early detection of cancer will generally allow for the widest choice of treatments, with less invasive treatments more likely to be an option if cancer is detected sooner.

This is why many common cancers have screening programmes and why it is vital to know about the early signs of cancers that may not always be easy to spot.

During Ovarian Cancer Awareness Month, this is particularly important, as according to Ovarian Cancer Action, only one in ten people know its early signs and symptoms and to seek additional tests to diagnose their causes or confirm that cancer is the cause.

As a specialist international cancer treatment centre, we want to ensure that you have the best treatment possible, which requires not only the latest advances in medical technology and the knowledge of specialist oncologists, but also raising awareness to ensure people get tested.

With that in mind, here is a guide to the early signs of ovarian cancer, what happens if you are diagnosed, and the types of treatments available to you.

What Is Ovarian Cancer?

A diagnosis of ovarian cancer is the detection of a cancerous growth either on the ovaries, fallopian tubes or the peritoneum lining, which covers your stomach and abdominal organs.

The ovaries are the two small organs at either side of the uterus which store egg cells and produce oestrogen and progesterone, the two female sex hormones linked with fertilisation, whilst the fallopian tubes connect the ovaries to the uterus.

Because they are relatively small organs, the early signs of ovarian cancer can sometimes be difficult to spot.

What Are The Early Signs Of Ovarian Cancer?

There are four primary symptoms of ovarian cancer, as well as several less common but often connected symptoms.

What often connects these symptoms is that they can often be confused for other conditions, but if they persist for over three weeks, get in touch with a doctor, as they could be a symptom of ovarian cancer.

Bloating

Feeling bloated is not uncommon; many people feel bloated during their period, when eating certain foods or as a symptom of conditions such as irritable bowel syndrome.

However, bloating that does not go away, bloating that is more common than usual and particularly bloating that makes you feel like your stomach is hard and swollen is a common sign of ovarian cancer.

It is the most common early symptom and should not be ignored. Your doctor wants to make sure you are okay and to either get an early diagnosis for ovarian cancer or rule it out and look for other possible causes.

Feeling Full Quicker

Similarly, another common early sign of ovarian cancer is a relatively small appetite, where you feel like you get fuller quicker after starting a meal. This is caused, much like bloating, by fluid build-up brought on by the cancer itself.

Whilst most people have a situation where their eyes are bigger than their stomach, persistently struggling with your appetite and feeling put off by the idea of eating could be a sign of cancer, particularly if it is not typical for you.

More Frequent Or Urgent Urination

If you feel like you need to pee more often, especially if it feels like an urgent need to go, that could be a sign of an ovarian tumour pressing against the bladder.

Changes in urinary patterns happen for a lot of different reasons, but if it is different from your normal bathroom patterns and lingers for quite some time, it should be checked out with your doctor to rule out ovarian cancer.

Stomach And Pelvic Pain

Pain around the stomach, particularly from the lower abdomen to the top of your thighs, is a potential symptom of ovarian cancer, especially if it does not go away.

It is caused by inflammation and pressure caused by the cancer itself, and whilst stomach pains can be caused by menstrual cramps and conditions such as endometriosis, if it persists, it should always be checked by a doctor.

What Other Symptoms Can Be An Early Sign Of Ovarian Cancer?

  • Back pain.
  • Either going to the bathroom more or significantly less.
  • Weight loss that cannot be accounted for.
  • Vaginal bleeding after the menopause.
  • Extreme tiredness.
  • Pain during sex.

How Is Ovarian Cancer Treated?

The typical course of treatment for ovarian cancer is either chemotherapy, surgery or a combination of the two, although radiotherapy can often be used to shrink the cancer, to make chemotherapy more effective or to kill the cancer cells following surgery to ensure the cancer does not come back.

external radiation - Woman lying on the floor at home

What Are The First Symptoms Of A Brain Tumour To Look For?

As brain tumours can vary significantly in how they grow and how they affect people, detection is both essential and can be difficult to spot early.

Knowing the potential signs of a brain tumour is a vital skill to ensure that you get access to the specialist care you need, and as March is Brain Tumour Awareness Month, we want to ensure that everyone with a brain tumour gets the care they need as soon as possible.

Early care and intervention increase your options; some brain tumours can be treated using external beam radiotherapy or stereotactic radiosurgery, particularly when surgery is not possible or as part of a combined treatment plan.

What are the signs to look out for that could signal a brain tumour? Why does early intervention matter so much? And can more be done to ensure that people are able to be treated as quickly as possible?

Why Does Early Intervention Matter For Brain Tumours?

As with other types of cancer, early intervention allows for the most treatments possible, with potentially malignant tumours able to be removed more easily, often with non-surgical alternative treatments.

In particular, the use of stereotactic radiosurgery can destroy tumour cells more easily through the use of precisely focused bursts of radiation.

Rather than inpatient brain surgery, a tumour can be destroyed as an outpatient procedure in a matter of hours, and recuperation in your own home (or dedicated nearby accommodation for international patients) can start almost immediately.

As well as this, some brain tumours progress faster than others, and the sooner an aggressive form of brain cancer is targeted, the faster the cancer can be damaged, shrunk and destroyed, either solely using radiotherapy, or a combination of targeted interventions.

The earlier that specialists know, the quicker they can act, set up treatment plans, book appointments, control or shrink tumours and improve outcomes for many patients..

What Are The Most Common Early Warning Signs Of Brain Tumours?

The first step to brain tumour treatment relies on a person understanding that something feels unusual and not right. If you feel in pain, weak, or unusual in ways that you cannot account for, consult your doctor as soon as possible.

Many of the earliest signs of a brain tumour vary based on where the tumour is located, can develop very slowly and can be confused with other conditions. Headaches are a common symptom of brain tumours, but countless conditions can cause headaches.

Instead, the focus should be on symptoms that manifest in unusual ways, and with that in mind, here are not only the most common early signs of a brain tumour, but also what sets a brain tumour symptom apart from other common conditions.

Persistent Headaches

Almost everyone suffers a headache at some point, and as many as one in seven people live with migraines.

However, if you feel like your headaches are becoming more common, getting worse or are hurting in places of the head you are not used to, it could be a sign of a brain tumour putting pressure on the skull.

Similarly, if they feel worse in the morning or when you lie down, it could be a sign of a brain tumour. Get in touch with your doctor to discuss any unusual symptoms.

Seizures

If you start experiencing seizures, especially if you have no previous history of epilepsy, get in touch with your doctor immediately. They are a common symptom of brain tumours, but even if you have epilepsy, let your doctor know if your seizures change.

Unexpected Vision Issues

Blurred vision, double vision, narrow tunnel vision or any other unusual vision issues can be a sign that a tumour is putting pressure on the visual processing parts of the brain, especially if you have no previous history of vision issues.

Hearing Loss

Sudden tinnitus, drastic hearing loss or a much greater rate of hearing loss than can be accounted for by age or lifestyle could be a sign of a tumour putting pressure on the auditory nerves.

Memory Or Speech Issues

Whilst confusion, short-term memory loss and difficulty with speaking clearly or finding the words can be signs of chronic stress, they can also be caused by a brain tumour.

Should There Be National Brain Tumour Screening Programmes?

There have been debates and discussions about whether there should be a screening programme for brain tumours, similar to those used for breast cancer, bowel cancer and cervical cancer.

At present, the benefits are not seen to outweigh the costs for a widespread screening programme, but if this changes in the future or an affordable, easy-to-undertake test is developed, this could change in the future.

Radiotherapy centre

New Research Supports Radiotherapy For Keloid Prevention

Many people think that radiotherapy is useful only as a means of treating cancer. While it does have a vital role in this regard, it also has many other uses that can bring all kinds of benefits to patients. Our radiotherapy centre can provide these.

An example of this is in preventing the recurrence of keloids after surgery to remove them. Keloids are a type of skin growth that arises when the skin does not respond in a normal way to trauma, such as a bad burn or a severe wound.

Scar tissue is a normal feature of some injuries of this type, as well as surgery, but the body is only supposed to produce a limited amount of collagen, the substance that is secreted by skin cells called fibroblasts. This should normally generate new skin to heal the wound.

However, on some occasions, the fibroblasts produce an excessive reaction, with a result that far too much scar tissue is produced. The result is keloids.

What Are The Characteristics Of Keloids?

These are characterised in the following ways:

  • They cover a larger area than the original wound
  • They are characterised by an unsightly raised and lumpy appearance
  • They can cause significant discomfort, including soreness and bleeding

This raises a couple of obvious questions. The first is how this problem is caused, while the second is what can be done about it. Radiotherapy provides part of the answer to the second question.

Among the factors believed to cause keloids are:

  • Skin infections, leading to more inflammation
  • A genetic predisposition
  • Traumatic injuries

In each of these cases, it is believed that the production of extra collagen is stimulated, producing the excess response and leaving these unpleasant pieces of scar tissue. They can be removed by surgery, but they often grow back again.

How Can Radiotherapy Impact Keloids?

The exact mechanism by which this happens has not yet been established and is the subject of ongoing research, but studies have also been taking place into means of curbing the regrowth of keloids, including the use of radiotherapy.

A recent study published in BMC Surgery highlighted the effectiveness of radiotherapy when given in the aftermath of surgery to remove the keloids.

It found that the use of radiotherapy after surgery was much more effective than surgery alone for preventing the recurrence of keloids, especially among older patients.

This was true both for when radiotherapy was used alongside injected drugs designed to suppress the production of collagen, or on its own.

In the study, 121 patients who had undergone surgery to remove keloids were arranged into three groups:

  • Group A had surgery followed by radiotherapy
  • Group B had surgery followed by a combination of radiotherapy and drugs
  • Group C only had the surgery

Of these, Group A had a 93.88 per cent success rate, as very few patients saw the keloids return. Group B was nearly as successful at 87.04 per cent, whereas only 55.56 per cent of Group C did not see the keloids recur.

This provided a very clear indication that, while surgery was central to keloid removal in all cases, radiotherapy played a major role in ensuring that the keloids did not come back.

How Does Radiotherapy Stop Collagen Production?

To establish why this is, it is important to consider what radiotherapy does to cells and how this can prevent unwanted occurrences such as keloids.

Some will be familiar with the mechanism by which radiotherapy works against cancer. Powerful blasts of radiation can damage the DNA of the cells, which makes it difficult for them to reproduce. This can break down such cells and shrink tumours.

Radiotherapy can be used in a slightly different way for keloids. This involves damaging the DNA of fibroblast cells, which reduces their capacity to produce collagen, therefore preventing them from producing excessive amounts of scar tissue.

It is important to note that the amount of radiation involved will not be anywhere close to that used to fight cancer cells, although in both cases, the ideal outcome is cell apoptosis, where the cell breaks down entirely and therefore cannot carry out its undesired function.

This means that while those receiving radiotherapy for cancer may suffer side effects such as hair loss, nausea, tiredness and sore skin, this will not be the experience of those who have radiotherapy to prevent keloids returning after surgery.

Many treatments have been tried to curb keloids, from laser therapy and silicone gels to the application of retinoic acid. But a growing body of research evidence strongly indicates that radiotherapy to curb the capacity of fibroblast cells to produce collagen is the most effective.

Radiotherapy centre Austria

Amethyst’s Dr David Kuczer Receives Radiation Oncology Award

We’re pleased to announce that our partner radiation oncologist Dr David Kuczer has been honoured for his excellent work in the DocFinder Patients’ Choice Awards 2025.

These awards recognise the doctors who are particularly popular within their specialties, with thousands of Austrians voting for their favourite physicians from nine federal states, all of whom are incredibly dedicated to their fields, giving their best each and every day.

Once cancer is diagnosed, radiation oncologists are brought in to cover treatment and follow-up care of both benign and malignant tumours.

Dr Kuczer is a specialist in radiation oncology and radiotherapy, with many years of experience in diagnosing and treating cancer. 

He works closely with Amethyst Radiotherapy Austria to deliver highly precise radiation therapy at its Vienna private clinic.

Dr Kuczer was described as a “competent and empathetic doctor” by patients submitting responses for the awards – and this is the third time he has received the top honour, following previous successes in 2021 and 2022.

DocFinder itself, based in Vienna, is Austria’s leading healthcare platform, used by patients to both find and rate doctors. It receives more than six million user requests every month and, as such, is a particularly useful information portal for the country’s healthcare sector.

The annual Patients’ Choice Awards are determined following comprehensive analysis of patient feedback from the preceding 12 months. 

For the 2025 awards, more than 500,000 patient reports and reviews were evaluated, with winners selected from 1,400 doctors and 25 specialist fields.

Types of radiotherapy - Knee osteoarthritis medical problem

How Can Low-Dose Radiotherapy Treat Knee Osteoarthritis?

When those who have not had radiotherapy before find themselves in a medical situation where it is a possibility, the first question may not be “which type?” Few osteoarthritis sufferers will know there is one kind that could benefit them.

Those who have some knowledge of radiotherapy, either as specialists or patients who have experience of treatment, may be more aware of how many different types of radiotherapy there are and why the distinctions matter.

Indeed, there are several familiar kinds of radiotherapy with various uses:

  • Full body radiotherapy
  • Intensity modulated radiotherapy
  • Image-guidedradiotherapy
  • Stereotactic radiotherapy

The types listed above are all external radiotherapy, but there is also internal radiotherapy, where a radioactive substance is injected into a particular area of the body to focus the radiation on a specific area.

These distinctions, however, are all based on high levels of radiation being used to disrupt cancer cell DNA and shrink tumours. They do not include the distinction between these high doses of radiation and low-dose radiation.

What Causes Osteoarthritis Of The Knee?

Osteoarthritis sufferers would never have their conditions treated by high-dose radiotherapy. But low-dose radiotherapy can be very effective and patients may be particularly keen to try it for joints such as the knee, which by nature will be worst affected by osteoarthritis.

While some other joints may be rested, walking will always put a strain on a sore knee, where osteoarthritis will often occur as a result of the cartilage becoming worn down and thinned, sometimes as a result of injury.

Factors that predispose some people to be more likely than others to suffer osteoarthritis of the knee include:

  • Gender, with women being more at risk than men
  • Age, with over 50s more likely to be affected, although it can strike at younger ages
  • Joint problems, such as gout
  • Repeated injuries to the knee
  • Being overweight, as this places more strain on the knee

How Does Low-Dose Radiation Ease The Pain Of Osteoarthritis?

The effect of low-dose radiotherapy is to impede the inflammatory response, which means your knee joint will become less inflamed and therefore the pain will be a lot less than otherwise.

You may have already considered other treatments for osteoarthritis of the knee, such as surgery or taking anti-inflammatory drugs. But there could be good reasons for these not being suitable for you.

For example, speaking to the Cleveland Clinic about low-dose radiotherapy for osteoarthritis, radiation oncologist Dr Rahul Tendulkar explained: “It’s a great option for patients who can’t take anti-inflammatory drugs due to ulcers, kidney problems or other conditions.”

He added that it is also an alternative for those who are not yet ready to undergo surgery for their condition.

Dr Tendulkar revealed the results of low-dose radiotherapy have been very promising, commenting: “In one recent trial, about 70 per cent of patients who received radiation saw a drop in their knee pain, compared to about 40 per cent in the placebo group.”

The treatment starts with a scan to assess the knee, followed by a short session of treatment lasting just a few minutes. Future repeats are possible.

Not only is this swift and simple without any downtime, but the radiation aspect is not something to be concerned about.

Does Low-Dose Radiation Have Any Side Effects?

The word radiation is often associated with high doses with significant medical effects, which is certainly true for the far higher doses used in treating cancer. But the levels of radiation are so much lower for osteoarthritis treatment and side effects are uncommon at low doses.

To put this in perspective, it is worth noting that everyone is commonly exposed to low doses of radiation every day from various sources:

  • Background radiation from the environment, especially in the presence of certain minerals in the ground
  • Food containing potassium, such as bananas

Because the human body is perfectly geared up to handle radiation at this level, the amount that will be given in a low-dose radiotherapy session will not add sufficiently to that to challenge the threshold at which radiation will have adverse effects.

If you are suffering from osteoarthritis in your knee, or indeed other joints, you may find that low-dose radiotherapy offers a new way of finding pain relief, one that may be especially useful if you are in that category of people who cannot take anti-inflammatories.

Indeed, you may find that it is more effective than the treatments you have relied on so far. For that reason, it may be well worth your investigating the treatments we can provide to help you increase your mobility and suffer far less pain.

external radiotherapy - Meal prep lunch box containers with quinoa

What Should Be In Your Diet Whilst Undergoing Radiotherapy?

When being treated for cancer, every aspect of your treatment and overall care matters.

This is why we take a holistic approach to cancer care; not only do we employ state-of-the-art external radiotherapy machinery to undertake extremely precise treatments, but we also focus on ensuring that everything alongside your treatment is designed to help you recover fully and quickly.

This not only includes highly targeted treatments and specialist options to minimise radiation exposure, but also focuses on your lifestyle, your diet and your fitness routine to ensure that your body is ready for recovery.

Why might your cancer team develop a tailored diet for you? What kinds of foods would be included, and what should be avoided?

Why Does Your Diet Matter When Undergoing Radiotherapy?

Undergoing medical treatment can put an additional strain on your body as it works to heal itself and battle cancer.

According to the World Cancer Research Fund’s guide to eating well during cancer, ensuring your body gets the calories and nutrients it needs to thrive is an essential part of the treatment process and something that is emphasised alongside your course of radiotherapy.

Maintaining a consistent weight will help keep your energy levels high and boost your mood, which in turn can help during the course of cancer treatments.

What Should You Add To Your Diet During Radiotherapy Treatment?

There is no singular “cancer diet” you should eat during your radiotherapy course, and your appetite will often vary on a day-to-day basis.

This means that nutrient-rich, calorie-dense foods are vital to ensure that your body has the vitamins, minerals and protein it needs.

Your cancer team will be able to provide tailored advice, but some general food groups to add include:

  • Healthy proteins, such as lean meat, eggs, cheese, yoghurt, beans, lentils and nuts.
  • Fruits and vegetables, particularly citrus fruits, leafy greens and colourful vegetables.
  • Healthy whole grains and minimally processed carbohydrates.
  • Plenty of fluids, including water, sports drinks, tea, yoghurt and soup.
  • Calorie-dense foods to minimise weight loss, such as avocado, peanut butter, fruit juice and butter.

What Should You Reduce During Radiotherapy?

Try to minimise highly processed foods and foods full of hydrogenated oils, as they can increase inflammation and make you feel more uncomfortable.

As well as this, red meat, alcohol and carbonated sugary drinks should be minimised and ideally cut out entirely.

Your cancer team can explain which types of food will help your recovery and which could help you feel worse.

Are There Any Foods You Should Avoid Entirely During Cancer Treatment?

Some foods should be avoided entirely, particularly if your cancer treatment affects your immune system.

In particular, these foods can carry an increased risk of foodborne diseases that should be avoided:

  • Sushi and other raw or lightly cooked fish and meat products, such as deli meat.
  • Foods with raw or soft-cooked eggs, such as homemade mayonnaises.
  • Unpasteurised dairy products, such as some types of cheese.
  • Fruits and vegetables that have not been thoroughly washed first.

How Can You Make It Easier To Get The Nutrition You Need During Cancer Care?

  • Eat small meals more frequently if you struggle to manage large meals in a single sitting.
  • Eat your biggest meals when you feel at your hungriest. If you struggle to eat in the morning, have a large main meal later in the day, or conversely, have a cooked breakfast.
  • Avoid spicy food and food with overly strong smells to minimise nausea. Instead, opt for water, toast and easy-to-digest dry foods.
  • Take your time and relax. There is no rush to clear your plate.
  • Make meal preparation as simple as possible. Let other people help, buy ready-made meals, use delivery services, shop online or anything that can make your life easier.
  • If you struggle to swallow, opt for soft foods, avoid anything too cold or too warm and use a straw. Nourishing drinks are available if you do not feel you can face solid food at all.
  • Keep hydrated and make sure you have the right amount of fibre for how you are feeling. If you are struggling with stomach pains and constipation, reduce your fibre intake.
  • Try new foods and taste profiles. Radiotherapy can alter your taste sensations, so you may find you enjoy different spices and textures.
  • Talk to your cancer team before taking any supplements, to ensure they do not conflict with your treatments or medication and will provide positive effects.
  • Have a walk or light exercise before eating, as this can help to build up an appetite.
radiotherapy centre in Austria - Dupuytren's contracture disease

Depuytren’s Disease: What It Is And How You Can Treat It

Depuytren’s Disease is not a widely known condition, but for sufferers, it can be very uncomfortable and have a big impact on their daily life.

Therefore, it is important to find a treatment that is effective and long-lasting, so they can function as normal and go about their hobbies and chores as they previously would have.

To find out more about Depuytren’s Disease and how it can be treated at our radiotherapy centre in Austria, read on.

What is Depuytren’s Disease?

Depuytren’s Disease, which is sometimes known as Depuytren’s Contracture, is when a finger is bent towards the palm of the hand involuntarily.

This condition affects the palmar fascia in the hand, which is a fibrous layer of tissue above the nerves, tendons, blood vessels and bones in the palm and fingers, but below the skin.

The collagen in the fascia thickens over time until it turns into nodules that force one or more fingers forward towards the palm.

While the condition is benign, it worsens over time, and can make it very difficult, or even impossible, to straighten the digits. Therefore, sufferers might find it difficult to perform normal tasks with their hands, from holding a cup to turning a key.

What are the first signs of Depuytren’s Disease?

It usually affects the fourth and fifth fingers the most, and is typically first detected when nodules start to form in the palm of the hand. Sometimes, deep dents known as pitting might also be spotted as the tissue pulls and becomes tightened.

This can make it look as though tendons are affected, but these are simply cords that have developed due to the build-up of collagen.

Once the thick cords have formed, this results in fingers being pulled in towards the palm permanently.

This progression could take a few years, often going undetected or untreated until it inhibits daily activities.

However, progression can be highly variable, with some patients developing contracture shortly after their first symptoms.

In the majority of cases, it affects both hands, making it challenging for those affected to have full mobility in their digits.

Though it is usually painless, it is important to seek treatment when it becomes difficult to straighten the fingers. This will enable patients to continue being able to do everyday tasks, such as cooking and dressing themselves, so they can maintain a level of independence.

What causes Depuytren’s Contracture?

The exact cause of Depuytren’s Contracture is unknown, though it is thought to be hereditary.

Therefore, if there is a family history of the condition, this increases the risk of developing it yourself. Those with diabetes, of Northern European ancestry, are male, take medication for seizures, and who are middle aged are also more likely to get Depuytren’s Disease.

It could also be linked to lifestyle choices, such as:

  • Smoking
  • Alcohol consumption
  • A poor diet

Men typically experience progression of the disease more rapidly than women, as well as those under the age of 50.

How to get a diagnosis

Before a diagnosis of Depuytren’s Disease can be given, a doctor will go through the patient’s medical notes and their family history, and discuss their symptoms.

They will then conduct a physical examination, checking the fingers and hand to test the feeling there. They will feel for the nodules and cords and record their location, as further examinations will ascertain whether these are growing.

Doctors will also measure the range of motion and they might take photographs during a ‘tabletop test’, so they can easily see changes in the hand’s rigidity over time. This involves the patient trying to lie their hand flat on a surface to check how far their digits can bend.

They can use this data throughout the treatment process to see how much impact it is having or if the contracture is worsening.

What treatment options are available?

While there is no permanent cure, several treatments can effectively manage symptoms and slow progression, improving functionality of their hands.

The best course of action will depend on the age and health of the patient; how serious the contracture is; previous experience with medicines; and their wishes.

Options for treatment include:

– Steroid injections

People with early stages of the condition can have steroids injected into the affected area. The main aim of these is to reduce the inflammation and ease the pain.

Therefore, they simply help the patient manage their uncomfortable symptoms until the steroid wears off and needs to be topped up.

– Collagenase injections

Another option is to have collagenase injections, which helps to break down the collagen in the cords and nodules without causing damage to the collagen in other areas of the hand.

Typically, the injection takes a couple of days to start working. After this point, the doctor will manipulate the affected fingers to help the cord to break down, improving the hand’s mobility and slowing down the progression of the disease.

– Needle aponeurotomy

Some patients opt for needle aponeurotomy, which is a simple procedure that can be performed quickly and easily. It simply involves piercing the cord with a small needle and moving it around until it ruptures.

The advantages of this procedure are it has a quick recovery time, patients can leave the hospital the same day and it does not involve surgery.

While this helps to improve finger motion, it is not a long-term solution as recurrence will occur.

– Radiation therapy

A progressive treatment that seems to have more long-lasting results than injections and needles is radiation therapy.

This involves passing X-rays through the nodules, which softens the tissue. If administered at the early stages of the disease, this can prevent contracture occurring.

Otherwise, it could improve movement and flexibility of the digits by breaking down the nodules.

Due to being non-invasive, this treatment is growing in popularity wherever it is offered. However, availability of radiation therapy for Depuytren’s Disease is limited, and many patients have to travel abroad, such as to Austria, for this procedure.

– Surgery

The alternative is surgery, otherwise known as fasiectomy. This involves making an incision along the palm and finger under anaesthetic and dividing the cord to reduce the contracture and surgically straightening the finger.

Partial palmar fasciectomy is similar, but zig-zag incisions are made to the hand to break up the cord more for greater results.

In both cases, there are risks involved, including bleeding, numbness, infection, a long recovery time lasting several weeks, and the need for physical therapy to increase motion in the hand.

Radiotherapy treatment - first linear accelerator technology IMRT

Can Radiotherapy Be Used Multiple Times In The Same Area?

Radiotherapy is one of the most powerful and advanced medical treatments in the world, and specialist oncologists will create individual and highly precise treatment plans to maximise its effectiveness using minimal doses.

When you travel to a specialist international radiotherapy centre, the goal is to treat complex conditions using highly accurate computerised planning, highly accurate external beam radiation and a holistic process for maximising preparation and rehabilitation.

In general, radiotherapy is undertaken as a single course of treatment either delivered over multiple sessions or cycles. In some cases, such as stereotactic radiosurgery, the dose of radiation is so precise and so powerful that the entire treatment can be completed in a single day.

However, one question that we are often asked, particularly in cases of recurrence, is whether radiotherapy can be used in the same area multiple times. Can you have radiotherapy target a tumour in the same part of the body a second or even a third time?

The short answer to this is yes, according to some of the limited number of studies in the area, but exactly when or where it is appropriate to do so will depend on a huge number of factors and will almost invariably need to be undertaken at a specialist centre.

To understand why, it is important to know what repeat radiotherapy is, what it is not, and why decisions to do another course of radiotherapy can be particularly complex.

What Is Repeat Radiotherapy?

Repeat radiotherapy, sometimes known in medical literature as reirradiation, is when a second course of radiotherapy treatment is given to the same area, where there is an overlap between treatments or where radiotherapy will affect the same organ.

It must be stated that repeat radiotherapy is not multiple doses of radiation undertaken as part of a single treatment. Most radiotherapy treatments are administered using multiple doses across several days, weeks or even months, but this does not count as repeat radiotherapy.

Instead, repeat radiotherapy is when an entirely new course of radiation targets the same area, and it is often a decision undertaken with a lot of care, consideration and often a specialist multidisciplinary team separate from the existing cancer care team.

Where Can Repeat Radiotherapy Be Used?

Because precise dose control and placement of radiation are such a vital aspect of repeat radiation, it is most commonly used in parts of the body in which the positions and placement of organs and tissue do not change as much.

These include treatment for:

  • Brain tumours and related conditions
  • Central nervous system tumours.
  • Head and Neck tumours.
  • Breast cancer.
  • Solid tumours that are easier to plan treatments for.

Whilst not a firm rule, repeat radiation is almost never considered until at least six months have passed since the last dose.

Why Has Repeat Radiotherapy Become More Common?

Historically, repeated radiotherapy was considered to be almost, if not outright, impossible due to the accuracy required for doses and placement of radiation beams.

As both imaging technology principles, such as in-vivo monitoring and advances in linear accelerators, allow for more accurate and safer doses of radiation than ever before, repeat radiotherapy has become a possibility for an increasing number of conditions.

It is still relatively rare and needs to be considered on a case-by-case basis, but it allows for many more options for treatment without the need for conventional surgery.

What Do Oncologists Consider Before Repeat Radiotherapy?

  • Whether the person is the right fit to benefit from repeat radiation.
  • Whether the tumour or condition would be treated through repeat radiation.
  • Previous radiotherapy doses.
  • The original distribution and potential dosage constraints for repeat radiotherapy.
  • The particular radiotherapy technique used.

Why Is Repeat Radiotherapy Undertaken?

Radiotherapy is delivered in carefully controlled doses to ensure that they do not overwhelm the ability of healthy tissue to regenerate and recover. This is why a considerable amount of time is left between the last dose of your original treatment and any potential repeat doses.

As with any other type of major oncological treatment, it is only even considered if it will provide greater benefits to you than the effects of treatment, something that has only become consistently possible in the last decade.

A second or third round of radiotherapy needs to be treated differently from the first, and will only be attempted by specialists.

What Are The Alternatives To Repeat Radiotherapy?

  • Chemoradiation, a combination of a lower dose of radiotherapy and chemotherapy to enhance the effects of the latter.
  • Immunotherapy or targeted drugs.
  • Novocure, also known asTTFields treatment.
Types of radiotherapy - Achilles tendon sprain

How Can Low-Dose Radiotherapy Ease Achilles Tendon Pain?

Most people are not aware that there are several types of radiotherapy. One distinction is between internal radiotherapy, where a patient is injected with a radioactive substance that provides a high dose of radiation to a certain area, and external radiotherapy, using beams of radioactivity that pass through the skin to provide treatment. But there are other variations.

In particular, there is the distinction between the high-dose radiotherapy used to treat cancer and sometimes to shrink benign but troublesome tumours, and low-dose radiotherapy that offers very different benefits.

The latter can include pain relief from a range of musculoskeletal conditions that have nothing to do with cancer or tumours.

Among these is Achilles tendon pain. This can be a persistent and very troubling condition that can affect everyone from ordinary citizens going about their daily business to keen sports players who struggle with the injury as it restricts their time on the track, pitch or court.

As the tendon connects the calf muscles to the heel bone, it is very important in running and walking.

What Are The Causes Of Achilles Tendon Pain?

Several conditions can cause Achilles tendon pain:

  • Achilles tendonitis, which is an injury that causes inflammation of the tendon and is often caused by repetitive strain, excess exercise or the wrong footwear. Having bone spurs, obesity, high blood pressure, flat feet, or differing leg lengths increases the vulnerability, as may the side effects of some medications.
  • Achilles tendinosis, a long-term condition arising from untreated Achilles tendonitis that involves the breakdown of the collagen fibres that make up the tendon
  • Achilles tendon rupture, where the tendon is torn. Often an athletic injury, it can also happen to those with health conditions such as arthritis, diabetes, lupus and gout.

The last of these may be a one-off injury that will heal well with the right treatment, which can include rest, the application of ice, pressure and elevation of the leg above the heart level in the initial stages. The other two are often bracketed together under the term Achilles tendinopathy.

How Can Low-Dose Radiotherapy Reduce Achilles Tendon Pain?

Painkillers and anti-inflammatories can help ease achilles tendinopathy symptoms, but the use of low-dose radiotherapy may provide relief for some patients who suffer from persistent and chronic Achilles tendon pain.

Sometimes, surgery is required and this may be useful for dealing with underlying causes like bone spurs.

There has also been an increased focus on the development of low-dose radiotherapy as a second-line treatment.

This has been shown to help reduce pain in selected patients in dealing with the inflammation.

Whereas high doses of radiation can achieve dramatic results, such as damaging cell DNA (which is what makes it effective against cancer), lower doses of radiation can have an impact on the body’s inflammation response, reducing it and, as a consequence, allowing the patient to feel a lot less pain and soreness.

This is related to the similar benefits low-dose radiation can provide for a wide array of other musculoskeletal disorders, such as osteoarthritis.

By using radiation rather than the chemical anti-inflammatory properties of certain drugs, this provides a new and often more effective way of treating the problem, working when the medication often does not.

Does Low-Dose Radiotherapy Produce Major Side Effects?

A reasonable question patients may ask is whether there are any side effects from the treatment.

Anyone familiar with the experience of those who have undergone radiotherapy for cancer will be aware of the effects this will have had on such patients, including nausea, loss of appetite, tiredness, sore skin and hair loss.

Minor, rare or theoretical risks are possible, but note that the difference between low-dose radiotherapy used for musculoskeletal issues such as Achilles pain and the high-dose radiotherapy used for cancer treatment is huge, with cancer treatment doses typically being 20 times as high.

To understand this in context, it is important to note that the human body is already equipped to deal comfortably with a certain level of radiation, which exists in the natural world and is sometimes naturally higher in some areas than others.

In addition, radiation is produced at low levels by many appliances, such as mobile phones.

Radiotherapy provides higher radiation doses than people will encounter in the natural environment, but not to a very large extent. It will be enough to alter the inflammatory response in the tendons, but not to cause wider side effects.

If you have been suffering from persistent tendon problems but have not gained the relief you have been looking for from other medical interventions, it may be that we can help provide lasting relief with low-dose radiotherapy.