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.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

October 26, 2022

Die Zahl der Menschen, die eine Krebsbehandlung mit Strahlentherapie suchen,  ist in den letzten Jahren deutlich gestiegen, da neue Techniken und verbesserte Technologien sie effektiver gemacht haben. Jetzt hat die neueste Forschung gezeigt, dass es mehr Wachstum auf dem Weg geben wird.

Markets and Markets Research hat prognostiziert, dass der globale Wert des Marktes von 6,3 Milliarden US-Dollar in diesem Jahr auf 8,1 Milliarden US-Dollar bis 2027 steigen wird, bei einer durchschnittlichen jährlichen Wachstumsrate (CAGR) von 5,1 Prozent.

Der Bericht hob mehrere verschiedene Faktoren für dieses Wachstum hervor. Erstens gibt es die fortschreitende Technologie, die eine solche Behandlung effektiver machen kann. Zweitens ist auch die steigende Inzidenz von Krebs ein Schlüsselfaktor.

Damit einher geht ein zunehmendes Bewusstsein für die Vorteile, die die Strahlentherapie bringen kann, und zusätzlich zu all dem gibt es mehr Investitionen in das Gesundheitswesen, sowohl im Allgemeinen in Entwicklungsländern als auch durch öffentlich-private Partnerschaften auf der ganzen Welt, um weitere Fortschritte in Forschung und Behandlung zu erzielen.

Im Jahr 2021, so der Bericht, war die externe Strahlentherapie die am häufigsten verwendete Behandlung bei vielen Krebsarten, wobei die Verwendung von bildgeführten Behandlungen häufig bei Hirntumoren eingesetzt wurde, obwohl der am häufigsten auf diese Weise behandelte Krebs Prostatakrebs war, der eine der am häufigsten auftretenden Krebsarten bei Männern ist.

Der Bericht ist nicht der einzige, der diese Woche veröffentlicht wurde und einen starken Anstieg der Strahlentherapie auf der ganzen Welt vorhersagt. Reportlinker.com hat eine neue Studie veröffentlicht,  die ein noch größeres Wachstum bei einer CAGR von 6,1 Prozent zwischen 2022 und 2028 prognostiziert. Damit steigt der globale Marktwert auf 9,3 Milliarden US-Dollar.

Wie im anderen Bericht wurden technologische Fortschritte, ein größeres Bewusstsein und höhere Investitionen in das Gesundheitswesen als Gründe für das Wachstum angeführt. Während Nordamerika voraussichtlich eine Vorreiterrolle übernehmen wird, kann auch Europa, einschließlich Österreich, dank dieser Faktoren mit einer Expansion des Marktes rechnen.