What Is The Future For Gamma Knives And Radiotherapy?

Gamma knife surgery - Male nurse preparing patient for CT scan

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

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

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


The Reality Of Radioactivity

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

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

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

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


Radiotherapy To The Rescue

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

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

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


What Does The Future Hold?

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

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

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

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

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

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

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

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


A Role For AI?

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

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

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

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

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

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

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

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