The purpose of a modern radiotherapy centre like ours is somewhat different from those established long ago, when the technology involved and the medical understanding of it were in their infancy.

Radiotherapy has been used therapeutically since the turn of the 20^th century. But in the early years, it was only able to have a palliative effect on patients with a terminal cancer diagnosis. Although it can still be used this way, extending life in the process, it now offers many more possibilities, including the promise of a full recovery for many.

Advances in treatment have been partly aided by increasing understanding of radiation and its effects on the human body, as well as the capacity to deliver radiation in ever more precise ways.

The Benefits Of Stereotactic Radiotherapy

The most precise form of radiation delivery is known as stereotactic radiotherapy, which uses very concentrated beams of radiotherapy to target tumours while minimising exposure to surrounding tissue. It is commonly used in areas where precise aim is of particular importance, such as the brain, lungs or spinal cord.

That has been possible both through the development of new technology, with Gamma Knife being a prime case in point, as well as scanning technology to identify exactly where precise beams of radiation can be aimed.

Not only does this raise the prospect of treating the cancer more effectively, especially when it is a primary cancer that can be targeted in one specific location, but the lack of exposure of the surrounding tissue and reduced number of appointments required to deliver the required dosage can both minimise the side-effects and maximise the impact of the treatment.

For this reason, we have invested in the latest and most precise equipment to provide patients with radiotherapy. In the future, we will continue to do so as new innovations emerge.

Amethyst & AI In Radiotherapy Treatment

At Amethyst Healthcare Group, we already use AI in radiotherapy planning and tumour contouring.

Out of the three stages (planning, contouring and treatment delivery), AI currently supports the first two, while dose distribution is earlier in integration but progressing. In image analysis, AI can match or exceed human performance in spotting early signs of cancer, as we expand diagnostics, we will integrate these tools to strengthen prevention.

How AI Innovation Could Help Cancer Patients

Among the areas of great potential at present is artificial intelligence (AI). While the wider impact of AI on society and economies has been widely debated, the evidence is that it can bring some significant medical benefits.

The latest instance of this is research produced by the Shenzhen Institute of Advanced Technology, published in Digital Medicine. Experts at the institute have developed a new multi-modal deep learning model that can improve decision-making over the delivery of precision radiation.

Focusing on cervical cancer, this research set out to tackle the problem that while 70 per cent of patients can be successfully treated and cancer-free, the rest suffer metastasis (where cancer spreads into other parts of the body) and therefore face a worse prognosis and the prospect of extensive further treatment.

Machine Learning May Solve Treatment Dilemma

Although more intense treatment can reduce the risk of metastasis, this will produce more toxicity and the side effects that come with it. However, the researchers found, the AI innovation has made it possible to judge more precisely exactly where radiation should be directed, meaning less treatment is required to achieve optimal outcomes.

Known as CerviPro and using CT technology to assess patients and make judgments, it has been tested on 1,018 patients in Chinese hospitals, with very promising results. In particular, it proved very effective at distinguishing between high and low-risk patients when it came to the likelihood of metastasis.

This development is not, in itself, an innovation that can deliver stereotactic radiation with greater precision than existing devices. What it is, however, is a means of assisting in decision-making that can help achieve a better balance between maximising treatment to tackle cancer and minimising the side effects.

Why Side Effects Should Be Minimised Where Possible

Anyone who has had some radiotherapy already will be familiar with common side effects, such as fatigue, hair loss, skin problems, digestive issues, and, occasionally, reduced immunity caused by a low red blood cell count.

None of these are permanent issues, of course; for example, your hair will grow back after treatment and your appetite will return to normal. Nonetheless, the course of treatment will be easier for patients if the radiation exposure and its side effects are minimised.

Looking To The Future

The use of AI in the Shenzhen research may be just one of many innovations to come from that quarter that will help enable even more precise and well-calibrated delivery of radiotherapy. Alongside this may come yet greater precision tools for delivering beams of radiation.

Some of this will be for the future and therefore not be of benefit to patients in the present. However, we have always sought to acquire and use the most advanced equipment currently available and the best possible techniques associated with it to offer the best treatment to cancer patients.

Indeed, while AI may be the technology of tomorrow, many of the devices and methods we use today were once in that same category.

Learn more about our advanced radiotherapy treatments for different cancers on the Amethyst Group website.

Prostate cancer is a major health issue for men across the world, especially those aged over 50. Although the risk varies significantly with factors such as ethnicity, family history, age and so on, it is the most commonly diagnosed cancer in men, affecting one in eight at some point in their lifetimes.

For this reason, finding the right treatment for each patient is a high priority. Not every prostate cancer is the same and some treatments (such as hormonal therapy) can work effectively for some patients, but not others. This is why personalised care is particularly important.

However, at Radiotherapy Healthcare Group, we know that radiotherapy can be an effective treatment, potentially used alongside other treatments (such as surgery, chemotherapy or hormonal therapy) that also play a part in a cancer management programme.

A key question for many patients and their oncologists often arises when the decision to be made lies between using surgery and radiotherapy. Surgery can have a lot of lasting (and often permanent) side-effects, including some loss of urinary and sexual function, which means radiotherapy can be preferable from a quality of life perspective.

New Study Supports Radiotherapy Over Surgery

New research from the United States has indicated that in the case of high-risk prostate cancer, radiotherapy is a better option than surgery. The study, by experts at the University Hospitals Seidman Cancer Center in Cleveland, Ohio, was published in European Urology Oncology.

It stated that when faced with high-risk cancer (defined as having a greater than normal chance of metastasis, which is when it spreads to other parts of the body to become secondary cancer), radiotherapy was more effective in preventing this from happening.

The key finding was that a combination of radiotherapy and androgen deprivation therapy reduced distant metastases by 32 per cent more over an eight-year period than the surgical option of radical prostatectomy.

Speaking to Medscape Medical News, one of the study’s authors, Daniel Spratt MD, said: “While it’s not a head-to-head randomized trial between surgery and radiation plus ADT, it provides compelling comparative data suggesting that radiotherapy plus ADT may not just be equivalent.”

Instead, he added, the radiotherapy treatment “might be better when it comes to controlling disease and reducing treatment escalation.”

More Research Needed

Dr Spratt acknowledged that the study “moves the needle but does not end the debate”, which means further research is required. Nonetheless, it does suggest that the best available evidence at present points to the preference of radiotherapy over surgery in high-risk prostate cancers.

Because the findings are tentative, they will require peer review and there is some scepticism about the findings.

Medscape Research News also spoke to William Kelly, head of oncology at Thomas Jefferson University Hospital in Philadelphia, who said the question of whether radiotherapy for this kind of cancer was the best option has “still not been answered”.

Nonetheless, it is studies of this kind that can mark the first step in a new understanding of what can be achieved by radiotherapy. Indeed, if more research backs up the study from Cleveland, the next stage may involve examining whether some methods of delivering radiotherapy are better calibrated than others to maximise the benefits.

Another Shift Away From Prostate Surgery?

The new study is not the only recent development with the potential to swing medical opinion in favour of alternatives to prostate cancer surgery.

Last month, British charity Prostate Cancer UK criticised what it called ‘outdated’ recommendations for slow-developing prostate cancer by government regulatory body the National Institute for Health and Care Excellence (NICE), which it said were leading to around 5,000 unnecessary surgeries every year.

It argued that NICE had failed to update guidance despite the knowledge that many slow-growing prostate cancers take so long to become a serious health risk that they won’t impact the patients in their lifetimes, in which case any side-effects from surgery, such as incontinence and impotence, may be suffered without due cause.

The charity revealed that its campaign on the issue brought a rapid response from NICE, which has expedited a review of its guidance. The last update of the guidance was made in 2021.

Personalised Care Matters

Although this particular review could lead to a greater focus on monitoring rather than surgery instead of increasing the use of radiotherapy, it does go to show that as medical science advances (both in terms of diagnostics and treatments), guidance can be amended and surgery can become less favoured.

If, therefore, you have prostate cancer and are unhappy with the treatment given so far, we may be able to offer an alternative through a fresh, evidence-based and personalised approach that makes use of the very latest treatments and understanding of your condition.

Learn more about our advanced radiotherapy treatments for prostate cancer on the Radiotherapy Healthcare Group website.

One date of note for the medical profession in general and oncology in particular is August 1^st, when World Lung Cancer Day takes place each year.

This occasion helps to raise awareness of the disease, not just in terms of the risk factors for developing it, but also the symptoms that can indicate a problem and the associated importance of early detection.

Here at Amethyst Healthcare, the importance of all this is increased by our role in treating lung cancer, which is not just an area of expertise, but a focus of some of our most notable recent innovations, with our Austrian arm being especially prominent in the latter area.

Risks And Prevalence Of Lung Cancer

According to the World Health Organisation, lung cancer is the leading cause of cancer mortality among both men and women worldwide.

It is eminently preventable, as 85 per cent of cases are caused by smoking, but the key to raising survival rates is early diagnosis, as it is common for the disease only to be identified at a late stage when treatment options are more limited.

The fact that most cases are related to smoking does mean those who smoke or have done so in the past should be aware of symptoms indicating the possibility of cancer and get checked out. Equally, the fact is that a minority of cases have other causes, such as air pollution.

Experts have also noted that non-smokers usually only get one type of lung cancer, lung adenocarcinoma, which is a type of non-small cell lung cancer. Smokers, by contrast, can catch different forms of lung cancer.

Spotting The Symptoms

Raising awareness of lung cancer is not just about warning of the dangers of smoking, which are well known and have contributed to a steep decline in smoking rates across the world. It is also about spotting the symptoms so that a diagnosis can be made as early as possible, maximising the possibility of successful treatment.

Among the common early symptoms are chest pain, a chronic cough, and breathing issues. Unplanned weight loss may also occur. More advanced symptoms will include wheezing and coughing up blood. Anyone suffering such symptoms should see their doctor as soon as possible.

How We Treat Lung Cancer

When it comes to treating lung cancer, radiotherapy is a powerful and commonly used method of treatment. There are different ways of administering radiotherapy and our approach involves using personalised and tailored treatments for each patient, rejecting a one-size-fits-all approach with individualised care to seek the best possible outcome.

In the case of lung cancer, we use non-invasive treatment, which involves the delivery of radiation by means of intense beams, usually with the patient lying in a linear accelerator.

The modern equipment we use ensures that the maximum amount of radiation is delivered to the cancerous area to destroy cancer cells, while minimising exposure for surrounding tissue.

A New Innovation In Austria

While our treatments are very modern and powerful, we are always seeking methods of delivering even more effective and personalised treatments, bringing the latest research and innovations to bear. When it comes to lung cancer, Amethyst Austria is leading the way with the newly introduced TTFields therapy by Novocure.

This CE-marked treatment, which is aimed at tackling metastatic non-small cell lung cancer, uses electric fields to target cancer cells. This is based on the simple fact that electric fields have different effects on the human body depending on the frequency. This has already enabled the development of various medical devices and innovations, such as pacemakers.

In this instance, the treatment takes advantage of the fact that cancer cells have polar cellular components, which means they can be affected by electrical fields at certain frequencies, between 100 and 500 kHz.

At this range, the electrical waves can breach membrane walls in cancer cells and disrupt the operations of those cells, killing them in the process. The good news is that it can do this without harming healthy tissue, leading to effective treatment without causing significant harm to the surrounding area.

In the case of metastatic lung cancer, this means attacking cancer cells in the lungs and elsewhere, including other important organs, without causing a lot of damage to the organs themselves.

This innovation is a demonstration of the kind of cutting-edge technology and medical science we are bringing to bear at our different cancer centres. Each step forward enables us to offer more powerful treatments, widens the range of treatment options and therefore enables us to provide a more tailored approach to the needs of every patient.

Learn more about our advanced radiotherapy treatments for lung cancer on the Amethyst Group website.

The ultimate goal of the surgeon is to do no harm, and in the field of cancer care and treatment, this means using the most precise, minimally invasive procedures and tools necessary to preserve and prolong life.

One of the greatest oncological innovations that abides by this principle is Gamma Knife, a highly advanced radiosurgical treatment that allows for tumours, lesions and malformations to be ablated and destroyed without the need for any incisions.

It differs from conventional radiotherapy because the precise nature of the system allows for suitable treatments to be completed in just one day, from consultation and planning to the computer-guided process itself.

The system was developed in the 1940s and 1950s by Lars Leksell (1907-1986), an innovative Swedish neurosurgeon who dedicated his life to making brain surgery more precise, more advanced and more effective.

The Aesthetics Of Healing

Interestingly, Professor Leksell did not intend to become a doctor, let alone one of the most important medical innovators of the 20th century. His desire to help people came about in part due to an unfortunate accident.

When he was a teenager, he was admitted to hospital following a car accident and his experiences with his doctors proved to be deeply inspirational to him that he signed up for medical school in 1927, becoming a neurosurgeon in the 1930s.

However, as his son would later note, Professor Leksell struggled with the operating theatre as it existed in the 1930s and wondered if a different form of surgery might be possible.

In part, this desire came from a general belief that less invasive procedures are typically safer, but it also came from a place of aesthetics.

Such surgeries were cleaner, more intricate and involved far fewer scars and lingering aftereffects; the only marks that are found after Gamma Knife treatment are from the bolts used to secure the frame in place.

By 1935, this became his driving force, and for the next 20 years, he would develop, refine and start to perfect the next step in brain cancer surgery.

3 Steps To Radiosurgery

Aside from radiotherapy itself, there were two other major innovations that helped Professor Leksell in this ambition to treat brain conditions.

The first was the Horsley-Clarke Frame, initially developed as a tool used to help create atlases of animal brains by allowing for precise measuring for incisions.

Invented in 1908 by Victor Horsley and Robert Clarke, the stereotactic frame would be adapted for use on the human brain a decade later, but it would take until 1933 for the stereotactic method to be used in neurosurgery.

This second innovation was thanks to surgical pioneer Martin Kirschner, who used a type of stereotactic frame to perform a procedure to treat the pain syndrome trigeminal neuralgia.

Before precise radiation application at the precision required for use in the brain was available, Dr Kirschner used a minimally invasive surgical procedure to insert an electrode to a precise location in the trigeminal nerve and burn it. This procedure is now typically undertaken using radiosurgery.

Both of these technologies would be more widely recognised and adapted in the late 1940s, when an adaptation of the Horsley-Clarke frame was used to map the human brain for the first time, thanks to the work of Ernest Spiegel and Henry Wycis.

Their innovative human brain atlas would inspire a lot of researchers in the field of stereotaxy, including Lars Leksell.

He first adapted the frame to use a polar coordinates system rather than the Cartesian measurements that had been used since 1908, which made it much easier to use in an era before CT scans were common.

He then found a way to use it to make radiotherapy more precise.

No Tool Is Too Refined

The idea behind stereotactic radiosurgery is that if you know exactly where to focus a point of radiation, it is safer and more effective to target multiple beams of radiation onto a single point rather than one.

This ultimately proved to be very effective, with successful trigeminal neuralgia cases treated as early as 1953. However, from its invention up until Professor Leksell’s retirement in 1974, he continued to adapt, refine and upgrade the frame.

His guiding principle for this, and one of his most famous quotes, was the idea that any tools that a surgeon uses have to be adapted to suit the task, and there is no tool that is too refined when it comes to treating the brain.