New Model Can Predict Response To Radiotherapy

The use of gamma knife surgery as a means of tackling brain metastases has been established for many years, but alongside this is a growing understanding of how to measure the success of operations when they are carried out.

Of course, it can be easy enough to establish what the outcome is in time after an operation, but surgeons and patients alike can be helped greatly when predictive technology can give them a prior guide as to the effects of any procedure.

Just such a piece of predictive technology has been developed in China, where a team from the Hefei Institutes of Physical Science of Chinese Academy of Sciences has devised a radiomic model for predicting how patients will respond to radiotherapy treatment in brain metastases.

Their findings, published in European Radiology, were based on the data that radiomic features in MRI images can provide about the biology of tumours.

These elements, which are not detectable by normal methods of image interpretation, can then provide bodies of data that can be accessed by machine learning methods to predict the responses of different tumours according to their radiomic profiles.

If this method proves to be successful, it will further enhance the value of radiotherapy, by providing a basis for understanding the likely outcome of any single operation and thus enabling specialists to plan treatments accordingly.

For instance, if one operation is predicted to have limited success and a second is likely to be required, this can be planned for, while in other cases a single operation may be seen as likely to achieve the aim in one go.

As the first author of the paper Wang Yixin explained, a key benefit of this approach is to avoid the ‘black box’ element of machine learning algorithms, which can only use previous data. In this instance, the machine learning makes use of game theory based on Shapley Additive Explanations (SHAP), which the team established was useful for formulating the precise treatments needed.

If the method proves to be successful, it will for the first time provide an accurate system for predicting the effects of radiotherapy, making what is already an effective method of treatment that can save lives into something even more powerful.

The news emerges at a time when alternative means of treating brain metastases are still in the early development stage.

For instance, in the US researchers at the University of Alabama have just hailed some very promising results in stage 1 trials for a new glioblastoma multiforme treatment called INB-200, with all of the patients in the trial living longer than expected.

The results, presented at this month’s American Society of Clinical Oncology Annual Meeting, revealed how the therapy, using Gamma Delta T-cells that can help distinguish between healthy and diseased tissue, has proved effective thus far.

However, as this is just stage 1 of the trials, the treatment is some way off the point where it might be used to treat patients around the world.

While such developments can add to the armoury of oncologists in the battle against brain cancer, radiotherapy remains the swiftest, most effective weapon. More accurate projections of outcomes could make this even more powerful in the future.

What Is The Difference Between Benign And Malignant Conditions?

In the field of neurology and brain health, there are a number of tumours, lesions and growths that can cause pain and affect normal brain activity, most of which are observed and managed differently based on a range of different factors.

These are known as benign and malignant brain conditions and are often treated very differently from each other, with some conditions not receiving any treatment at all, whilst others require a very rapid response.

What is the difference between different conditions, why are some conditions not treated and how has gamma knife treatment fundamentally changed certain conditions, such as acoustic neuroma treatment?

Benign Vs Malignant Conditions

Most lesions, tumours and growths are graded based on their potential to spread, their present danger and how quickly they grow, with these elements affecting which treatment paths are available to a patient and in some cases whether treatment is possible at all.

Lesions and tumours that are benign are those that grow pretty slowly, do not spread away from the initial growth area and usually do not come back if they are entirely removed. This does not mean they are not serious, and in many cases, they can cause painful symptoms.

On the other hand, malignant tumours are cancerous tumours that grow quickly, can spread to different parts of the body and can be very difficult to treat, especially if not caught quickly

Why Were Some Tumours Not Treated?

Before the advent of more advanced targeted radiotherapy, some benign tumours and lesions were left untreated because of the risks inherent in brain surgery.

Due to the potential for complications, neurosurgery had enough of a risk that it was only used when the risk of the disease outweighed the risk of surgery, and where there is a certainty that the whole tumour can be removed and thus there is no risk of the tumour growing back.

This meant that for benign tumours where there was a low enough risk that observation was an option, or for tumours so fast-spreading and malignant that surgical intervention may not help, other treatments are attempted instead.

However, the rise of radiotherapy has helped to fundamentally change how some conditions are treated.

The Rise Of Radiotherapy

In 1951, Swedish neurosurgeon Lars Leksell pioneered stereotactic radiosurgery, more commonly known as Gamma Knife treatment, which allowed for accurate and precise doses of radiation to be used to target and destroy lesions whilst destroying as little healthy tissue as possible.

This treatment, which did not require any surgery, helped to transform the treatments of benign tumours such as acoustic neuromas and pituitary adenomas, not only because it could help to effectively control the growth of abnormal cells but in some cases could reduce the need for surgery at all.

This can also be used to reduce potential complications involved with certain types of neurological conditions and allows surgeons the option of removing most of the tumour safely whilst destroying the rest with careful use of stereotactic radiosurgery, a treatment that has a far shorter recovery time.

How Gamma Knife Surgery Began

Cancer is something that affects up to a third of people at some point in their lives and in many cases will be fatal, but the advances in medical science over the last century have greatly reduced the numbers who have lost their battle against the disease.

Whether it is greater awareness of carcinogenic substances from tobacco to asbestos, the development of new drugs or the use of chemotherapy and radiotherapy, millions either recover completely or have their lives extended by a range of treatments.

In the midst of this comes gamma knife surgery, one of the most significant innovations when it comes to treating brain tumours.

If you are seeking treatment, you will no doubt want to ask many questions about it. Some of those will be about how it works and what happens afterwards, but it is also useful to know something of the history of his technique.

The gamma knife is not as new an invention as one might think. It was actually invented back in 1967 by Swedish doctor and neurosurgeon Lars Leksell of the Karolinska Institute in Stockholm.

Prof Leksell’s work did not begin there. Working with Prof Borje Larsson of the Gustaf Werner Institute, University of Uppsala, they first published a paper in 1951 on the potential benefits of using a focused combination of proton beams and guidance systems that could focus them on very precise areas of the brain. 

By then it was known that the use of radiation could kill cancers, but the problem for patients was the side-effects this could bring, especially to the brain. Moreover, early use of radiosurgery on the brain was more to do with musculoskeletal and psychological disorders emanating from brain issues, rather than tackling tumours. 

The use of guiding devices to focus all the radiation on the brain was a clear solution to need to concentrate radioactive beams, but it was an expensive and complex method and a more effective, elegant and advanced device was needed. The result was the gamma knife powered by cobalt 60 that was first used in 1967.

However, it was in the following years that the potential for a gamma knife to be used on brain tumours was established, with Proj Leksell developing a second generation device. In the years that followed, more and more medical facilities around the world started getting and using them, with new models emerging over time.

Nowadays, of course, tens of thousands of people a year around the world benefit from gamma knife surgery, including patients here in Vienna. 

For Prof Leksell, the development of the gamma knife really had been a lifetime’s work. Born in 1907, he started studying as a neurosurgeon in 1935. This meant he was already into middle age when he was collaborating with Prof Larsson in the 1950s and beyond it as the first and second gamma knife devices were developed.

However, by the time he passed away suddenly at the age of 78, Prof Leksell will have known that he had helped bring about a major step forward in the treatment of brain cancer, one people benefit from today and will continue doing long into the future.

‘Climbers Against Cancer’ Donate To TKFI

The Tiroler Krebs Forschungs Institute (TKFI) will be given a financial boost after receiving a donation from the ‘Climbers Against Cancer’ (CAC) organisation. 

This is the second time the CAC has raised money for the TKFI, having already supported the group, which is part of the Tyrolean Cancer Research Institute (TCRI), in 2015. 

“Climbers and researchers have more in common as it might seem at the first glance: both we are focused on reaching the top – might be a mountain or the deciphering of how to kill cancer cells,” a spokesperson for the TCRI stated.

CAC raises awareness and funding for cancer research through various events around the world and the sale of its branded products.

It was set up by John Ellison who was spurred on by his terminal cancer diagnosis to establish a worldwide climbing community to help find a cure for this terrible disease. 

Before his death in 2015, four years after his diagnosis, John said: “The world of climbing as a family has so much power to deliver a message across the globe.”

Since CAC’s launch in 2012, it has gone on to secure collaboration with climbing centres around the world, including Kletter Zentrum Imst in Gemeinde Imst, Tyrol. 

This fundraising is very important, as figures from the World Health Organisation (WHO) showed there were 48,241 new cases of cancer in Austria in 2020, resulting in 22,495 deaths. 

The most frequent cancers excluding non-melanoma skin cancer were prostate, breast, lung, colorectum and melanoma. 

 

Find out more about cancer treatment radiotherapy by giving us a call today. 

How To Prepare For Gamma Knife Surgery

The advances that Gamma Knife Treatment represents have been very well documented. Its capacity to tackle brain cancer tumours, save lives and avoid the long-term rehab involved with invasive surgery is well-established. 

All that is extremely good news if you are a cancer patient. It may mean at the very least that time is added to your life, or even that the treatment will ensure you are still here many years from now. The question is, how should you prepare for such an operation?

The first thing to note is the fact that this is a safe form of surgery. It’s not one of those dreaded operations where its touch and go that you’ll wake up from it, which can happen in other cases. 

This means you won’t have to make the kind of provisional preparations some will have to undertake, such as writing various ‘goodbye’ letters in case it doesn’t work out or making other practical arrangements. While it always makes sense to have a will anyway, the urgency of doing things – and the fear involved – need not be there. 

A second element of the operation is the fact that, because it is non-invasive but uses radio waves, it is rare that you will even need to stay in hospital overnight. The reason for this lies in the design of a gamma knife. It focuses the beams of gamma radiation with such precision that any spot on the brain outside the area being operated on receives very little radiation. 

The best aspect of it all is that this means you can plan ahead for the days beyond. Because it is unlikely you will be in hospital for long, you can make your plans for a post-op meal or family gathering, with hope and optimism that the future will be so much brighter.

What is a Gamma Knife

Gamma knife surgery: About the operation | Private Healthcare UK

A Century of Radiotherapy

Radiotherapy has long been an invaluable tool in the battle against various cancers, particularly brain tumours. Today, visiting a radiotherapy centre is a highly recommended course of treatment the world over. It is possible to chart the evolution of this area of medicine throughout the 20th century, and a fascinating journey it has certainly been.

In 1895 X-rays were first discovered by German-Dutch physicist and mechanical engineer Wilhelm Conrad Röntgen, a breakthrough for which he was later awarded the first ever Nobel prize for physics in 1901. Not long after this achievement the fields of radiation oncology and radiotherapy were born.

Before the negative effects of prolonged exposure to radiation became more widely understood, radiotherapy was used in the treatment of many conditions. In the early 20th century it was a standard treatment for tuberculosis. 

Around this time some of the most brilliant and pioneering work in the field of radiation was being undertaken by married physicists Marie and Pierre Curie. The former would become the first woman to win a Nobel prize, alongside her husband and colleague Henri Becquerel, in 1903 for the development of the theory of radioactivity.

There followed throughout the century several phases and eras in the development of radiotherapy. The Orthovoltage era, generally regarded as spanning from 1930 to 1950, saw advances in brachytherapy. This term denotes radium based interstitial radiation, and it allowed physicians to specifically target tumours more effectively than ever before.

After this came the Megavoltage era from 1950 to 1980. During this time advanced studies were undertaken in order to further the evolution of treatment for deep tissue cancers. Innovative therapeutic devices and approaches such as Cobalt teletherapy were discovered here, and significant progress was made in the development of proton beam therapy.

Today physicists and their colleagues are looking closely at what the next step in radiotherapy will be. That very question was posed at the recent ESTRO 2022 conference held in Copenhagen, Denmark.

Several experts from across the globe stepped up to argue for different approaches for the future. These included automation and robotics, inter-fraction adaptation and faster delivery of radiotherapy in shorter periods of time.

Meanwhile, in the United States, guidelines for the treatment of brain metastases by radiotherapy have recently been updated by the American Society for Radiation Oncology. Vinai Gondi, M.D., from the Northwestern Medicine Cancer Center and Proton Center in Warrenville, Illinois was one of the main participants in updating evidence-based recommendations.

“With the emergence of novel radiotherapy techniques and technologies, brain-penetrating drug therapies and neurosurgical interventions, modern management of brain metastases has become increasingly personalized, complex, and multidisciplinary,” Gondi was quoted as saying.

In terms of medical science, the practice of radiotherapy is quite young. Throughout the 20th century many advances have been made, and looking ahead to the future one can only imagine where the technology will go and how the practice will evolve. No doubt it will be a fascinating second century for what has become one of the most widely practised forms of care in the world.

Language Test Could Detect Brain Tumour

There could be another way to identify brain tumour sufferers, as researchers have found a language test could help GPs determine whether people with common symptoms, such as headaches, might, in fact, have something far more sinister. 

The Brain Tumour Charity funded a study of 270 people, which tested those with brain tumours and those with headaches who did not have brain tumours. 

The findings showed that those with brain tumours had significantly lower ‘verbal fluency task’ than the control group. 

The first symptom of a brain tumour is often a headache. However, for every 1,000 people who go to the GP with a headache, just a couple will have a tumour. Therefore, this could be a helpful triage test to help identify who would be in urgent need of a brain scan or not.

According to the study, published in BMC Neuroscience, 87.5 per cent of those who had a poor score in the test, which involves naming as many animals as possible in a minute, had a brain tumour. 

It also revealed almost half (48.1 per cent) of those with a good score did not have a brain tumour. 

In conclusion, people who got a score of 14 or above were nearly eight times more likely to be brain tumour-free. On the other hand, a poor rating increased the likelihood of a brain tumour by more than three times. 

Ben Wilson is one such patient who went to see his GP when he was having severe headaches and dizzy spells. He said he only booked an appointment as he was furloughed from his job as an area manager for a brewery in 2020 and had more time on his hands. 

The 34-year-old was subsequently diagnosed with a low-grade Pilocytic Astrocytoma and underwent treatment just seven days after the initial GP appointment. Find out more about Gamma Knife Surgery in the UK for brain tumour recovery.

Trials Hint At Major Progress In Brain Cancer Treatment

The results of new trials for treating brain cancer in children have shown very promising results, suggesting this may soon be added to the options for helping fight the disease.

Swiss pharmaceuticals firm Novartis has revealed the trial, using a combination of two drugs called Tafinlar and Mekinist, saw tumour shrinkage in 47 per cent of the patients, compared with 11 per cent in a comparative group that was being treated with chemotherapy. Moreover, the time without disease progression nearly trebled to 20 months.

The tests were being carried out on youngsters aged between one and 17 with low grade gliomas (LGGs), which are the most common childhood brain cancer. The drugs were administered orally.

However, the treatment itself was limited to a certain category of patients; they all had a genetic condition called BRAF V600, which is a factor in between 15 and 20 per cent of LGG occurrences in children. 

The drug combination itself has already been approved to treat some other cancer conditions, including skin, lung and thyroid cancer, but again this is focused on those with the BRAF V600 mutation.

While these results have been presented to the American Society of Clinical Oncology (ASCO) at its annual meeting and will now be passed on to regulators in an application for approval, it is therefore clear that they are only applicable to a minority of cases for one particular condition, based on a genetic mutation that accounts for no more than a fifth of LGG cases.

While that is not to understate the benefits of the treatment for those who can benefit from it, it is clear that this is not a catch-all miracle drug. Nor does it provide a permanent cure. This is why using radiotherapy for brain tumour conditions remains for many the most viable and effective form of treatment.

Novartis is far from alone in seeking to develop new pharmaceutical treatments for brain cancer. Oncology drugs maker Kazia Therapeutics has just presented the latest findings of research into paxalisib, a drug designed to tackle brain metastases. 

Phase II trials have shown that patients enjoyed longer survival times, a median of 15.7 months compared with 12.7 months for those using another drug, temozolomide, which the patients in the trial had a genetic resistance to. Progression free survival was also longer, at 8.6 months compared with 5.3 months in the temozolomide cohort. Side effects were few and mostly mild.

This was significant because at present, temozolomide is the only drug approved for this type of condition in the US. 

Kazia CEO Dr James Garner said: “The directionality of these analyses gives us greater confidence in the efficacy signals observed and appear encouraging for future development.”

Like the Novartis results for its combination therapy, the results were presented at the annual ASCO event and will have provided plenty of reasons for optimism going forward. 

One again, however, they are limited results that may offer less of a solution for brain tumour patients than radiosurgery, which as well as being non-invasive will not require continual treatment. These drug developments may be good news, but the possibilities offer by a Gamma Knife may remain far greater.

Novartis says drug combination outperformed chemo in children with brain cancer (NYSE:NVS) | Seeking Alpha

Novartis drug combo shows promise in childhood brain cancer (yahoo.com)

KaziapresentsfinalPIIdataatASCO (kaziatherapeutics.com)

Amethyst UK, first to use new frame to transform patient experience

Amethyst UK, first to use new frame to transform patient experience at its London treatment centre Queen Square Radiotherapy Centre.

Read the full article from htworld.co.uk here.

Ian Paddick, Amethyst Physicist, to receive Fabrikant Award

We’re delighted to announce that Amethyst Physicist, Ian Paddick, recently received the esteemed Fabrikant Award in Milan at the ISRS Congress 2022.  The Award is given every two years to an individual or individuals who are members of the International Stereotactic Radiosurgery Society (ISRS), and have made longstanding and significant contributions to the field of radiosurgery.

On receiving the Award, Ian Paddick said, “I’m truly humbled to receive this award. It’s the first time a physicist has received the prize on their own and I’m also the first recipient from the UK. The award is usually given to radiation oncologists or neurosurgeons, but this year’s award demonstrates that physicists are valued by clinicians and make a significant contribution to shaping clinical practice”.

He went on to add, “I’ve published over 50 articles on stereotactic radiosurgery (SRS), and have been lucky to have my work on indices incorporated into all the major treatment planning systems. I’ve also been fortunate to visit and teach at over 100 Gamma Knife centres around the world, so my work really has a global reach. My current and future research is in radiobiology where I believe we can make significant improvements in the efficacy and consistency of treatments.”

Importantly, the winner of the Fabrikant Award is invited to give a ‘Fabrikant lecture’, which is then published as a paper in the ISRS Journal – the Journal of Radiosurgery and Stereotactic Body Radiation Therapy . The winner also receives a grant of $5,000 and a commemorative certificate. During his lecture, Ian discussed ways to improve clinical research, encouraged attendees to question dogma which holds back the discipline of SRS, and highlighted aspects of work published such as the Paddick Conformity Index, Gradient Index and Efficiency Index and the importance of being able to standardise treatments so that centres can compare their data.

Ian was the first physicist to serve as president of the ISRS (2017-2019), and today he serves as an Ex-officio member of the board where he chairs the Certification Service. This Service provides the only in-person quality audit for SRS centres that is offered by a device agnostic organisation. This is an exciting initiative, which Ian hopes will raise the standard of SRS around the world. Two centres have been audited so far with the first, Koç University in Istanbul, receiving their certificate of quality in radiosurgery at the meeting in Milan.