May has been Brain Tumour Awareness Month in multiple countries, which makes this a very good time to consider what progress has been made in developing the understanding and awareness of brain tumours, as well as advances in treatments.

When it comes to matters as serious as cancer, it really is relevant and important to understand how far we have come and what kinds of treatments exist. This is especially true if you or a loved one is a sufferer.

Of course, it can be easy to lose track of the themed days and months on the calendar, with a plethora of awareness days and months for various causes, many of them medical. Indeed, in the US, a type of brain tumour – Glioblastoma – has its own awareness day in July.

The US, Canada and Australia mark brain tumour awareness month in May, whereas the UK does so in March. In either case, this provides a very good opportunity to take stock of what has been discovered about tumours and also how they have been treated, as well as providing extra impetus (and funding) to research efforts around the world.

The Treatments We Have Now

The standard way to treat brain tumours is either excision by physical surgery or the use of radiotherapy. Sometimes a combination of both may be used. Patients coming to our radiotherapy centres may receive a range of different forms of treatment.

Among the different forms of radiotherapy for tumours is external beam radiotherapy, which involves directing a beam of radiation at the tumour from a source outside the body, usually using a linear accelerator machine.

The development of this treatment has not just been down to the invention and subsequent fine-tuning of the linear accelerator itself, but accompanying technology such as MRI and CT scans. This makes possible 3D conformal radiation therapy, where a 3D map of the tumour helps guide the delivery of the radiation.

Intensity modulated radiation therapy is a variation of this, where the strength of the radiation can be varied between different beams used in the treatment of a tumour. This is especially useful where the area targeted is closer to normal brain tissue, enabling the exposure of such tissue to harmful radiation to be minimised.

The Emergence Of The Gamma Knife

Another form of radiotherapy is stereotactic radiosurgery. This involves a particularly precise focus of the radiation beam on a specific area of the tumour.

This is commonly carried out with a gamma knife, which, despite its name, is not a knife but a device designed to produce a very concentrated beam of radiation, with the great benefit of minimising radiation exposure to surrounding tissue.

Radiotherapy has been used since the turn of the 20^th century, but the gamma knife was a more recent development, which can be attributed to the Swedish neurosurgeon Lars Leksell, who patented it in 1967. A second version was produced in the 1970s as the technology improved, but this has been about fine-tuning a great device, not reinventing it.

In this context, it is useful to observe that there is already a huge amount that can be done to help patients with brain tumours, especially through radiotherapy, often through surgery and sometimes through other methods such as chemotherapy, although the latter is usually deployed in combination with other treatments rather than being used on its own.

What Are The Latest Advancements?

Nonetheless, an article published in the journal Cure Today has highlighted how new developments have further enhanced the power of radiotherapy to offer better treatments for patients with fewer side effects.

The article focused on a discussion to mark Brain Tumour Awareness Month in which Dr Ranjit Bindra, a professor at the Yale School of Medicine in the US, stated that proton therapy and image-guided precision have been major contributors to improvements in both areas.

He also noted that individualised and evidence-based cancer care can be made even better by close collaboration between all those involved, from neurosurgeons to radiation oncologists.

Positive news about developments such as proton therapy may also point the way towards a brighter future, with Dr Bindra striking an optimistic note about what further research can achieve, provided sufficient funding is available.

He commented: “As long as we maintain that funding, we will continue to make wonderful discoveries and change the lives of patients with brain cancer.”

Reasons To Be Positive

What this year’s Brain Tumour Awareness Month (be it March or May) has helped to highlight, therefore, is that radiotherapy continues to advance and deliver better outcomes with fewer side-effects for patients, with good reasons to expect further progress in the years ahead.

At Amethyst, we already use the best radiotherapy techniques and technology to seek optimal outcomes for patients, whether for brain tumours or other cancers. In the years to come, we may be able to do even more.

Learn more about our advanced radiotherapy treatments for brain tumours on the Amethyst Group website.

There are several options available for treating tumours, but whilst the majority of radiotherapy treatments use an external source of radiation, brachytherapy implants a radiation source inside the body close to a tumour to destroy it from within.

It is most commonly associated with treatment for prostate or cervical cancer, although it has been used as part of breast, oesophageal, eye and skin cancers, as well as exceptionally rarely during the treatment of brain tumours.

Because a lot of people who receive treatment for cancer do so through some form of external beam radiotherapy (EBT), it can sometimes be difficult to know what to expect during internal brachytherapy.

Here are answers to some of the most common questions people have about internal radiotherapy.

Why Is Brachytherapy Used?

Brachytherapy is a highly accurate and precise set of treatments where radioactive material is placed in the body close to or directly inside the tumour in order to destroy it from within. This can either be temporary using a catheter or using radioactive seeds implanted next to the tumour.

These are known, respectively, as high-dose rate and low-dose rate brachytherapy.

As a primary cancer treatment, brachytherapy is primarily used to allow for higher doses of radiation to be applied to a target area without damaging healthy nearby tissue.

The principle is similar to the highly accurate external Gamma Knife treatment, although it can be applied in other places in the body besides the brain.

It can also be used as part of a combination treatment with external beam radiotherapy or surgery, although it is rare for brachytherapy to be combined with chemotherapy.

Brachytherapy is over 120 years old, and was one of the first versatile types of radiotherapy treatment, and is a proven, safe and effective treatment for a multitude of different types of cancer.

How Long Does Treatment Take?

One advantage of brachytherapy is that it does not require as many sessions as conventional external beam radiotherapy.

High-dose rate brachytherapy typically takes only one or two sessions because a much higher dose of radiation can be used per session, although this can vary depending on your treatment plan. Each session typically lasts no more than 20 minutes from where the radioactive material is in position.

Meanwhile, low-dose rate brachytherapy is typically implanted in a single procedure that takes less than a day but gives off radiation for a few months.

In most cases, you can go home after treatment, although there are some cases where it might be safer to remain for observation for a few nights.

As with other types of radiotherapy treatment, however, you will need someone to take you to and from the hospital due to the anaesthetic used for treatment.

Radioactivity After Treatment

One question that is sometimes asked regarding brachytherapy regards radioactivity following treatment, and whether any precautions need to be made before and after treatment.

The answer depends on the type of treatment, as you are only radioactive whilst a source of radiation is inside your body.

You will be treated in a room on your own and may not be able to have visitors if you need to stay as an inpatient, depending on the types of treatment you had.

If you have radioactive seeds implanted, you will be radioactive, although only close to the treatment area.

You are typically safe to be around most people, but you may be advised to avoid holding children or being in close contact with pregnant women as a precaution. They can remain in the same room as you, but hugging or holding them for more than a few minutes may need to be avoided.

Whilst the radioactive seeds will remain in your body forever, the radiation itself will fade after a few weeks or months. As it does, you will no longer need to be careful with close contact.

Are There Any More Precautions To Take After Treatment?

You will receive medications to help ease any symptoms and receive a card with contact details and an explanation of the treatment you have had.

For the first few days after treatment, the area where you had treatment may feel sore, and you will need to avoid intense exercise and heavy lifting for at least three days.

Make sure to stay hydrated, eat a balanced diet and take any pain medication that you have been prescribed.

The symptoms will get easier after the first few weeks, and you will have regular follow-up sessions to ensure that if there are any unexpected issues that they can be addressed by your doctor and multidisciplinary team.

A lot of the preparation for a Gamma Knife radiosurgery treatment is undertaken by your specialist radiotherapy team to ensure that your treatment is as effective, comfortable and comprehensive as is safely possible.

In terms of radiotherapy treatments, Gamma Knife stereotactic radiosurgery is one of the oldest, one of the most precise and one of the most effective treatments for a wide range of brain conditions from primary and secondary cancer to trigeminal neuralgia and other types of brain tumours.

The effectiveness of the treatment and the ability to precisely target specific parts of the brain means that treatment can typically be completed in one day. Unlike conventional surgery, most people who undergo Gamma Knife treatments can go home the same day.

There are some basic preparations to make first, in order to ensure that the treatment is as simple as possible, and most of these are similar to those for any other type of surgery or medical procedure.

Referral And Consultation

The first steps will involve a referral by a doctor and a meeting with a radiation oncologist who will oversee your treatment, check your medical history and run tests to determine if it is the right option for you, often working with your multidisciplinary team to develop a complete treatment plan.

Ultimately, whilst an MDT and specialist oncologists can recommend treatments, the final choice will be yours and you will be supported throughout the planning and decision-making process.

Once you agree, we will arrange for the treatment to be undertaken at a time to suits you, discuss the next steps, look at the treatment room with you and have the chance to answer any questions you may have.

Before The Day Of Treatment

You will need someone to take you to the radiotherapy centre on the day of the treatment and back home, so make sure to make suitable arrangements to ensure you have someone with you. They will be there to take you home and make sure you have everything you need before and after treatment.

Your oncologist will let you know what medications you should take the night before and in the morning.

You should wash your hair, but avoid using anything other than shampoo in your hair if you tend to use conditioner or topical solutions as part of your hair care routine.

Avoid putting on makeup, take out any piercings that you can so they do not interfere with MRI scans and opt for loose-fitting clothing. You want to be as comfortable and relaxed as possible.

Planning And Preparation

Depending on the appointment and type of treatment, the first step when you arrive for your Gamma Knife treatment will involve preparing you for the treatment, the final imaging scans and the final planning process.

Because Gamma Knife is typically a one-day procedure, the planning is often done the day of your treatment because precision is key and the closer the scans are to the treatment, the more accurate it will be.

You should not eat after midnight the night of the treatment in order to settle your stomach.

Fitting The Gamma Knife Frame Or Mask

Depending on the treatment you are having, you will either have a lightweight metal frame or a plastic mesh mask fitted tightly to your face or head.

If a frame is being fitted, you will receive four shots of local anaesthetic to numb parts of your head so the frame can be fitted. This part will not be painful but might feel tight for a few minutes.

This is often done during the imaging process, and you will get a chance to relax in another room. Whilst the treatment is painless, sedation is available to help you relax as well, and throughout the treatment process, you will be able to talk to your doctors at any time.

Gamma Knife Treatment

When it is time for the treatment, the frame will be fitted to the bed of the Gamma Knife machine and the plan will start as soon as both you and the doctors are ready.

The treatment itself can last between 20 minutes and four hours depending on the nature and complexity of the treatment, but you will be told beforehand how long you should expect treatment to take.

As it is not a surgical treatment, you may hear a chime, a bell or just be told directly that the treatment is completed, whilst the radiotherapist will take off the mask or frame and apply a bandage to your head.

The private cancer treatment we offer is always geared toward the needs of the individual, which goes beyond simply offering various approaches for different types of cancer.

Everybody is different due to factors such as age, genetics and family history. This can mean the way cancer manifests in one patient has some differences to that of another who has the same essential diagnosis. At the same time, you may want to have a significant say in treatment options, and your choices could be different from others.

An area of significant variation between patients is the area of secondary cancer. Primary cancer is defined as the initial location where the cancer begins. For example, breast cancer can begin in tissue in the mammary glands, brain cancer in a tumour in part of the brain and so on.

If it is diagnosed early, there is often a very good prospect of treating the cancer early before it can spread and ensuring the patient is cancer-free. This may depend on the kind of cancer it is and its location.

Secondary Cancer Defined

However, what can also happen is the cancer spreads to other areas of the body. The technical term for this is metastasis, commonly known as secondary cancer.

What this means is that cancer is now present beyond the original area where it began, even if it is no longer present in its original site. One one of the most obvious examples of this is breast cancer, which may be present in other parts of the body even after a mastectomy, due to it spreading before the operation took place.

It is important to note there is a distinction between secondary cancer – where the initial cancer has spread – and second primary cancer, which is when a patient has two cancers in different parts of the body that are independent of each other.

The reason this distinction is important is that in secondary cancer, the cancerous cells are of the same kind wherever they are found, so a lung cancer cell is still that if, for example, it spreads to the brain. If the patient was also suffering from brain cancer, that would be a second primary cancer.

Furthermore, there is a kind of secondary cancer that is classed as being of unknown primary, which means metastasis has taken place, but the place of origin has not been established. This is uncommon and only accounts for around two per cent of cancers diagnosed each year.

Treatment Options For Secondary Cancer

Radiotherapy is commonly used to treat secondary cancers alongside other forms of treatment. The treatments that are used may vary depending on what kind of secondary cancer is present, alongside other medical factors such as age and broader health.

For example, secondary bone cancer may be treated in several ways, which include radiotherapy, chemotherapy, hormone therapy and certain targeted drugs. In secondary breast cancer, chemotherapy, radiotherapy and hormonal therapy may also be used, as well as bone-strengthening drugs if the cancer has spread to the bones.

Some kinds of secondary cancer can be treated in a large number of ways. For instance, secondary liver cancer can be treated with radiotherapy, chemotherapy and hormonal therapy, but also surgery, tumour ablation, embolisation and targeted therapy.

These options will depend on the kind of cancer present. For instance, with liver cancer, surgery is only an option in a small number of cases, usually secondary bowel cancer or neuroendocrine tumours.

By its very nature, secondary cancer is a very broad topic area, as it covers many different primary cancer types, each of which may spread to multiple areas of the body, with various effects and different implications for treatment.

For example, if a cancer spreads to the brain from elsewhere in the body, the way radiotherapy is used will often be different to a situation where another area is affected. Because of the need to protect brain tissue from radiation exposure as much as possible, stereotactic radiosurgery will often be the best treatment option.

Keeping Treatment Individual

Because there are so many ways in which secondary cancer can manifest itself and such a variety of treatment options that are contingent on many different factors, there will never be a one-size-fits-all approach.

For that reason, if you have secondary cancer, you will be kept well-informed and advised about everything that is understood about your condition and will be able to play a full collaborative role in making decisions about your treatment.

As an individual whose medical situation will be different to anyone else’s, we will always aim at the best course for you in accordance with your wishes.

Treating a brain tumour is a comprehensive process for which success is based on the primary treatment pathway at a radiotherapy centre, as well as the work of the multidisciplinary team before, during and after a course of treatment.

The role of the multidisciplinary team (MDT), is not only to shape the primary treatment and provide clear, comprehensive options for managing a brain condition, taking into account the wishes of the individual, health needs and the potential for progression, but also to manage the preparation for treatment.

This process, known as preoperative rehabilitation or prehabilitation, is about maximising the time spent from the initial diagnosis to the first course of treatment in order to ensure that people are ready for treatment, experience as little discomfort as possible during it and recover as quickly as possible after it.

As with radiotherapy treatments, prehabilitation programmes are tailored for each individual based on a particular set of goals, which means that each one will have a different focus and involve a range of experts.

However, here are some of the core principles behind prehabilitation.

Helping Maintain Physical Health

There is a connection between physical activity and successful treatment outcomes, both for cancerous brain tumours and other conditions that may require radiosurgical intervention.

Energy levels are a key part of recovery, as the body will use more energy during treatment to recover from radiotherapy sessions. Regular physical activity provides more energy, which translates to a better quality of life before, during and after treatment.

An MDT will assist in a multitude of different ways, most commonly through physiotherapists.

A physiotherapist will create a targeted workout routine that is tailored to a person’s ability, energy levels and fitness needs, consisting of stretches, walks and other gentle forms of exercise that it is safe for them to undertake.

Maintain Nutrition

Another aspect of physical health is nutrition, and a dietitian is available to help provide a range of targeted interventions that could improve a person’s quality of life before and during treatment, as well as reduce recovery times.

In some cases, it is a matter of establishing a meal plan of affordable, easy-to-prepare and easy-to-eat meals that provide the body with the sustenance and energy it needs whilst recovering from radiotherapy.

It also is important to maintain variety and to eat delicious meals during this time, as appetite can sometimes be affected during treatment and not eating enough can exacerbate the fatigue that can happen during the recovery process.

In some cases, they can help signpost support such as “meals on wheels” schemes that could provide nutritious meals that are pre-prepared or require minimal preparation.

Whilst less common with brain cancer treatment, a dietitian can help with advanced dietary needs such as the installation of a feeding tube to help meet more complex needs.

Encouraging Lifestyle Changes

In some cases, a major component of prehabilitation is encouraging lifestyle adjustments that can assist radiotherapy treatments and significantly improve a person’s quality of life.

If someone is a regular smoker, they will likely be advised to quit during the course of the treatment, as smoking can have multiple negative effects on the brain as well as the heart, lungs and throat.

A member of MDT will be involved in this process and provide support and proven, effective interventions to ensure that a person can quit responsibly and stay quit. In other cases, they may signpost other appropriate stop-smoking services.

As well as this, it will be advised to minimise the consumption of alcohol during the treatment to within the 14 units per week recommended guidelines, spread out over at least three days and incorporating multiple alcohol-free days a week.

Mental Health Support

Physical health and mental health are interconnected, and both are linked to treatment outcomes, which means that an MDT will include a counsellor or psychologist to assist with any mental health needs.

This will include any existing psychologist or psychiatrist a person is seeing, as managing the mental effects of diagnosis is an important part of shaping recovery. They can also help provide continuity of care and ensure that any medication taken as part of radiotherapy treatments will not interfere with mental health medication.

Mental health support is not limited to people who are currently seeing a psychologist; the stress, anxiety, depression and fatigue can affect anyone who has been diagnosed, and a professional is always on hand to talk to throughout a person’s treatment and reassure them of what they can expect from their treatment pathway.