What is Gamma Knife® and how does it work?

Gamma Knife® is a system of highly accurate, focused delivery of radiotherapy, performed during a day visit, for a number of benign and malignant brain tumours, among other indications. Despite its name, there is no actual “knife” involved and therefore there is no open surgery. In contrast to radiotherapy, Gamma Knife® is delivered usually through a single fraction and there is no need for repeated treatments over weeks.

The process involves four steps:

  • First, application of a frame resembling a helmet.
  • Second, a high resolution, detailed MRI brain scan with the frame on.
  • Third, visualisation, planning and targeting of the lesion(s) using an advanced planning software.
  • Fourth, the delivery of treatment using one of the latest Gamma Knife® models that resemble a scanner. Some more practical details for these steps are below.

Image 1 – The latest Leksell Vantage TM Frame is a major improvement in Gamma Knife® treatments flow as it is light, made from non-metallic glass fibre reinforced epoxy. It is patient-friendly, unobstructive to the face but also allows faster MR image acquisition, up to 50%, with less distortion or artefacts. (Image courtesy of Elekta)

The frame is secured onto the skull with four small pins after local anaesthetic numbs the skull. The patient feels some pressure but not sharp pain. At Queen Square Radiosurgery Centre, we now have the option to use the latest frame model called Vantage TM (Image 1). It is light, does not obstruct the face, and allows faster scanning with fewer artefacts. After planning, the patient lies flat on the Gamma Knife® machine (Image 2). The process is painless, similar to having an x-ray. The duration of the treatment varies, based on the size of the lesion(s) and the number of the lesions, but is typically between 1-2 hours, and is generally tolerated very well.

Image 2 – The Gamma Knife® Perfexion TM. The patient lies comfortably on the table while the treatment is delivered painlessly to the lesions. (Image courtesy of Elekta)

What are the benefits of using Gamma Knife® for brain metastases treatment?

Surgery is typically reserved for larger, single lesions. Gamma Knife®® however, can be used for patients that have more than one lesions, often apart in the brain or in both sides of the brain. Also lesions deep in the brain or close to very sensitive structures can be targeted effectively with Gamma Knife®. Compared to open surgery there is no need for hospital admission or general anaesthesia. Following Gamma Knife® treatment, the frame is removed, and patients can go home within an hour of completing their treatment.

How effective is Gamma Knife® in treating brain metastasis compared to other treatments?

There is vast worldwide experience in treating brain metastases with Gamma Knife®, possibly more than any other type of lesions or tumours. For metrics like overall survival and progression free survival the results are comparable to open surgery. In addition, following open surgery for large, single metastases we now use Gamma Knife® to boost the surgical cavity, thereby delaying recurrences.

Compared to whole brain radiotherapy, Gamma Knife® offers better outcomes. Also avoids brain toxicity and side effects such as cognitive decline observed in groups of patients undergoing whole brain radiotherapy.

Chemotherapy options are generally less effective for brain metastases as the brain has a unique protection system called blood-brain barrier that does not allow chemotherapy to reach tumours within the brain.

What are the risks and side effects of Gamma Knife® treatment for brain metastasis?

Side effects are rare and include infection or bruising of the scalp from the pin sites, local brain swelling that can be mitigated with a short course of oral steroids. More rare risks include haematoma, stroke or seizures. In fact, patients are not allowed to drive for a month following Gamma Knife®.

A well described complication following Gamma Knife® is radiation-induced necrosis. As the photons targeting and kill the metastases, there might be a reaction where the tumour cells die, but continue to upset the brain producing swelling. This complication occurs in approximately 3% of patients. However, as patients survive longer this risk may reach 5% or 10% in patients surviving 3 years or longer.

Is Gamma Knife® treatment suitable for all patients with brain metastasis?

Not all patients with brain metastases are suitable for Gamma Knife®. This depends on the number of brain lesions, the size and location of each lesion, the primary cancer, the severity and spread of the primary cancer, and how well the patient feels and performs in daily activities.

Each case needs to be discussed with an experienced surgeon who has both surgical and Gamma Knife® expertise. In addition, all cases are discussed at a large multidisciplinary team meeting, and the suitability of each patient is examined by a group of specialists including surgeons, Gamma Knife® practitioners, neuroradiologists, and physicists.

The Gamma Knife® radiosurgery centre at Queen Square employs state of the art technology, including the latest Vantage TM frame and operates a large, weekly multidisciplinary meeting where all potential cases are discussed comprehensively.

Mr Samandouras

Consultant Neurosurgeon, Queen Square

Available to discuss treatment options with patients harbouring brain metastases and can be reached here.

World Brain Tumor Day. Persons Hands Are Holding A Gray Ribbon.

Shining A Light On Brain Tumour Awareness Month This March

March is Brain Tumour Awareness month, to help remember those affected by this challenging condition and to help more people recognise their symptoms early and come forward for treatment. The charity Brain Tumour Research is marking the start of March by asking supporters to light a candle and share their photos on social media.

The charity will also observe a minute’s silence at 11am on Wednesday 1st March at each of its Centres of Excellence and lay a commemorative wreath. Many other charities and healthcare organisations around the UK will be holding fundraising events and awareness raising days throughout the month of March to help support those affected by brain tumours.

It is estimated that 16,000 people are diagnosed with a brain tumour each year, which amounts to 45 people per day. This can have a devastating effect on the life of the patient, and also their family and friends.

The finale of the Brain Tumour Research’s month-long campaign is Wear A Hat Day on 31 March. This is now an established tradition, with top millinery designers pitching in to lend their skills and creativity to the occasion. Anyone who wants to participate and help raise funds can register their school, workplace, or community for a sponsored Wear a Hat Day.

This year’s event has a special royal theme, to acknowledge the coronation of King Charles III and the Queen Consort. There will also be a prestigious contribution from the acclaimed milliner Misa Harada.

Misa said: “I am honoured to be chosen to support such an important charity, and to help raise awareness through the joyous, positive and liberating activities organised, such as Wear a Hat Day and the launch of the brooch which I hope will make people smile.”

All the funds raised will go towards the tireless efforts to combat this devastating disease.

 

If you would like some information about Gamma Knife surgery UK, please get in touch today.

Medical Ct Or Mri Scan With A Patient In The Modern Hospital Lab

What Happens When You Receive Radiotherapy Treatment?

Radiotherapy is a cancer treatment that uses high doses of radiation to treat cancer cells and reduce tumours. The type of radiotherapy will depend on the type and size of the cancer, and other individual circumstances.

There are other kinds of treatment available for cancer and radiotherapy will be recommended only if specialists think it’s the best option for you. Whether or not you decide to go through with the treatment is at your discretion and no decision will be made without your consent to receive treatment.

Radiotherapy requires some preparation, including scans and tests to accurately assess the size and location of the cancer. This will determine the highest possible dose that can be delivered, while avoiding damage to healthy cells as much as possible.

The treatment is usually done daily over the course of several weeks and patients can expect from one to around five doses of treatment in a week. This may vary and will depend on the individual plan based on type, size or location of the cancer. You may receive multiple doses a day up to seven days a week.

This will all be determined prior to you starting treatment and a care plan will be created to ensure you know how much time will be spent at the hospital or radiotherapy centre receiving treatments.

Radiotherapy can be given in several ways from external radiotherapy, internal radiotherapy such as taking a liquid or having an implant, or intrabeam radiotherapy which is usually done during surgery.

External radiotherapy uses a beam of radiation which is directed at your cancer. This requires you to lie as still as possible while receiving the treatment to ensure that it stays in the directed area, however, it usually takes a few minutes up to a few hours and is painless. The measures are taken in place to ensure the treatment is delivered in a safe manner.

Liquid radiation can be given internally via a drink, an injection or swallowing a capsule. This is only used for certain types of cancer such as thyroid cancer. This form of radiotherapy usually requires you to remain in the hospital for a few days as you may be radioactive and you must be monitored as a precaution to avoid putting others at risk of radiation exposure.

Radiotherapy implants can be used to treat cancer by inserting an implant close to where the cancer is either with or without surgery. The time the implant remains in your body depends on your individual circumstances and sometimes the empty implant may stay permanently. Again, you may be required to stay in the hospital or centre for several days during this treatment.

Intrabeam radiotherapy works by a beam of radiation being directed directly at the exposed tumour during surgery and is usually used to treat breast cancer. This is a more invasive form of treatment due to the need for surgery and may require a longer hospital stay while you recover.

There are several side-effects associated with radiotherapy so you must research these before deciding to undergo treatment. Discussing these with your doctor before making your decision can give you a better insight into what to expect both during and after treatment.

Novartis building

Novartis joins in Cancer Research UK’s rare cancers study

The pharmaceutical company Novartis has joined the charity Cancer Research UK’s DETERMINE trial to see if current cancer treatments could be applied to patients with rarer forms of cancer. 

The Pharma Times reported that the DETERMINE trial, which was only launched in November, has received a boost from the major pharmaceutical company joining the study. The University of Manchester and Roche are already part of the trail to focus on multi-drug precision treatments for any form of rare cancer. 

This will open access to a broader range of treatments for adults, teenagers, and children. Who currently have a more limited choice of treatments than other cancer patients when it comes to rarer forms of cancer such as brain tumours.

Brain cancers are among the least common types of cancer in the UK. The NHS reports that about 11,000 people are diagnosed with brain tumours each year in the UK, and about half of these are cancerous.  

The Brain Tumour Charity reports that the most common symptoms of a brain tumour include headaches, changes in vision, seizures, nausea and dizziness, tiredness, and loss of taste and smell. Anyone experiencing persistent symptoms is advised to contact their GP for a check-up. 

If your GP suspects a brain tumour, you will be referred to a specialist for a neurological examination. If the diagnosis is a brain tumour, you will be informed about the various types of treatment. 

The most severe cancerous tumours are usually treated with either neurosurgery, radiotherapy, chemotherapy, or a combination of some or all of these. 

One of the most advanced and least invasive types of brain tumour treatment is a type of stereotactic radiotherapy, also sometimes known as Gamma Knife surgery. The technique directs targeted beams of low-dose radiation at the tumour from various angles. 

Whatever the treatment, whether it be multi-drug precision treatments as in the DETERMINE trial. Or advanced treatments like the Gamma Knife. Institutions, organisations and global corporations are working together to treat cancer.

 

Doctor attentively examines the MRI scan of the patient.

From Brain Tumour Patient To Neuro Nurse Hero: Kate’s Story

The story of Kate Baker, the woman who went from being a brain tumour patient to a new career as a neuro nurse, is an inspiring read for anyone affected by this distressing health condition. The Brain Tumour Charity recently highlighted Kate’s admirable approach to life.

Kate was first diagnosed with a brain tumour in 2016, after experiencing a range of symptoms including dizziness, nausea, and headaches for the previous 15 months. As she was only 35 at the time, her doctors were not immediately suspicious of a brain tumour, and instead sent her away with antibiotics.

Despite being previously healthy, Kate eventually collapsed one evening and was rushed to A&E. This eventually led to the long overdue CT scan, and resulted in an emergency neurosurgery operation at Queens Hospital. Fortunately, the procedure went well and most of the tumour at the back of her head was removed.

Kate recovered enough to undertake a charity trek to the Sahara in 2019, completing a gruelling 100 miles in challenging conditions.

She said: “All I wanted to do is just say thank you to the wonderful team on Sahara B, and just tell them that this is how amazing that they actually are, that I am prepared to go and walk 100 miles around the Sahara just to say thank you so much, and actually because of you guys I can do this.”

This was not the end of Kate’s incredible story. She began volunteering and training at the hospital where she was treated, eventually being employed as a healthcare assistant. This led to Kate becoming a fully qualified neuro nurse.

She said: “I wasn’t meant to be blue lighted to Queens to nearly die. I was delivered here safely to be a nurse. I can’t remember the defining moment, but I knew it was everything I ever wanted to do. I just kind of wish I’d seen the signs earlier that nursing was what I should be doing and what I love doing.”

Last year, Kate learned that a low grade brain tumour had returned. She opted for Gamma Knife Surgery, which is not physical surgery but a type of stereotactic radiosurgery that focuses radiation beams into the tumour to deliberately damage the tissues. It is highly accurate, meaning that the surrounding healthy tissue is unharmed.

Kate is still undergoing the treatment but hopes to resume her career as a neuro nurse once she is given the all-clear.

“She said: I would always say to myself looking back, the neuro nurse that I now am to the 35 year old girl who’s struggling with her health, ‘Go and demand answers and look them in the eye and say if this was you or a member of your family would you still send me away with antibiotics for somethings that clearly not a sinus infection.’”

Although brain tumours are relatively rare, many people do not recognise the symptoms in the early stages, and it is hoped that inspiring stories such as Kate’s can help to raise awareness of the condition.

Cancer patient woman wearing head scarf

January 11 Awareness Raising Day For Less Survivable Cancers

Less Survivable Cancers Awareness Day took place on the 11 January this year, the Brain Tumour Charity reports. The aim of the campaign is to raise awareness of the diagnosis and treatment paths for the rarer forms of cancer, and ultimately raise the survival rates within the next 10 years. 

The six least survivable cancers include brain tumours, along with lung cancer, liver cancer, oesophageal cancer, pancreatic cancer, and stomach cancer. All of these cancers have a five year survival rate of just 16%, and together they account for almost half of all cancer deaths in the UK. 

However, the Less Survivable Cancers Taskforce (LSCT) is aiming to increase survival rates to 28% by 2029. A major part of this is raising awareness of symptoms and encouraging people not to delay seeking treatment. 

Anna Jewell, Chair of the LSCT, said: “It is deeply concerning that most of the general public are unaware of common symptoms of less survivable cancers. It’s one of the many challenges that we’re facing in the fight against these deadly diseases.” 

She added: “All of the less survivable cancers are difficult to diagnose. Screening programmes are limited or non-existent and treatment options are falling far behind those for more-survivable but equally common cancers.”

“We’re also calling on all UK governments to commit to increasing survival rates for less survivable cancers to 28% by 2029 by delivering on their commitments to speed up diagnosis and proactively investing in research and treatment options.”

The Brain Tumour Trust is working with the LSCT in order to help people recognise the signs and symptoms of a brain tumour earlier on. In adults aged 18 and over, the most common symptoms include headaches, changes in vision, seizures, nausea, dizziness, fatigue, and loss of taste and smell. 

It is important to note that brain tumours are rare, and these symptoms could have another underlying cause. However, the earlier a brain tumour is diagnosed, the more treatable and therefore survivable it is. Anyone with persistent symptoms is advised to contact their GP. 

Another route you could try is booking an eye test, especially if you are experiencing changes in vision. However, not all types of tumour are detectable from an eye test, but they are useful as they can pick up a tumour before any other noticeable symptoms develop.  

When you go for your GP or optician appointment, it’s advisable to write down what they say, so that you don’t forget any points. It’s also a good idea to prepare any questions you may have in advance, as sometimes the stress of the occasion can cause forgetfulness. 

For example, it may be helpful to ask if they think anything else could be causing your symptoms, and if they have any advice for managing them. Ask if they think it is possible that you have a brain tumour, and if you need to make another appointment.

If you would like some information about Gamma Knife surgery UK, please get in touch with us today.

 

Biotechnology and molecular genetic engineering.

mRNA Technology To Provide Personalised Cancer Treatment

The UK government and pharmaceutical company BioNTech have announced a partnership that will forefront mRNA cancer vaccine research in the UK. The BBC reports that the messenger-ribonucleic-acid technology (mRNA) that was successfully used to develop Covid vaccines will be applied to cancer immunotherapies.

mRNA treatments can be personalised to target only the specified cancer cells in the patient’s body, unlike chemotherapy which can damage healthy cells. There are already several mRNA cancer vaccine trials progressing at locations world wide, but BioNTech plan to establish a major research and development base in the UK.

BioNTech co-founder Prof Ozlem Tureci told BBC News: “The UK is a great partner for this endeavour. We have seen in the Covid-19 pandemic with the fast approval of vaccines in the UK that the regulatory authority is exceptional. And then there is the genomic-analysis capabilities. The UK is one of the leading nations in that regard.”

He added: “The concept here is to use specific molecular features in individual cancers of patients to encode them into the mRNA vaccines and to train the immune system to attack.”

It is hoped that up to 10,000 cancer patients will be participating in mRNA vaccine trials in the UK by 2030, Sky News reports. The BioNTech deal is seen as a huge boost to the government and UK health service, although some commentators have expressed doubt about the cost. The NHS is already under huge pressure as it grapples with post-Covid backlogs.

Health and Social Care Secretary, Steve Barclay said: “Once cancer is detected, we need to ensure the best possible treatments are available as soon as possible, including for breast, lung and pancreatic cancer. BioNTech helped lead the world on a Covid-19 vaccine and they share our commitment to scientific advancement.”

He added: “This partnership will mean that, from as early as September, our patients will be among the first to participate in trials and tests to provide targeted, personalised and precision treatments using transformative new therapies to both treat the existing cancer and help stop it returning.”

A new Cancer Vaccine Launch Pad will be established to provide access to the cancer trials, with data provided by NHS England and Genomics England. This will ensure that a wide demographic with a range of different cancer stages and types will be identified and offered a place on an appropriate trial. 

Cancer Research UK spokesman Dr Iain Foulkes commented: “mRNA vaccines are one of the most exciting research developments to come out of the pandemic, and there are strong hints that they could become powerful treatment options for cancer. Getting there will require lots more research.”

While there are still questions around the affordability of developing and implementing a major new approach to cancer treatment in the UK, the BioNTech partnership is viewed as a success for the UK government. It is thought that the mRNA vaccine technology research will also address other serious infectious diseases. 

If you would like some information about Gamma Knife radiosurgery in the UK, please get in touch today.

 

Algorithm Could Help Detect The Men At Highest Prostate Cancer Risk

Prostate cancer can be treated in several different ways, including hormonal treatments, surgery and radiotherapy. Our radiotherapy centre in Vienna offers the latter and can make a critical difference in ensuring patients can survive what can often be a fatal diagnosis.

For that reason, a new algorithm devised by Cambridge University in the UK to calculate each individual man’s risk of prostate cancer could show the way forward, ensuring those who are likely to suffer it will be screened more and be likely to benefit from early discovery of the disease. 

The algorithm is based on genetic screening for faulty versions of the BRCA2, HOXB13 and possibly BRCA1 genes, which all indicate a high level of vulnerability to prostate cancer. The researchers behind the algorithm devised it to offer a more accurate test than the detection of prostate-specific antigen in blood tests that often produces false positives.

For example, while 16 per cent of all men in the UK get prostate cancer by the age of 85, this rises to 27 per cent for those whose fathers suffered the disease at an old age such as 80, but as high as 42 per cent if the occurrence was earlier, such as before the age of 50. Combining this with the genetic study will help assess individual risks.

The algorithm may prove to be particularly useful and while devised in the UK, it can be used just as relevantly by clinicians in Austria, as well as any other country.

According to EUROCARE-5, the five-year survival rate for prostate cancer in Europe is 83 per cent overall, with this rising to 90 per cent for men aged between 55 and 64. However, there are geographical variations across the continent, with the highest survival rates in northern Europe and the lowest in eastern Europe.

Although the racial composition of national populations will account for some variations in the occurrence of the disease, it is healthcare that is likely to make the biggest difference in survival rates.

 

injection

Vaccine-Style Taskforce To Tackle Cancer

The UK government has announced a Vaccine Taskforce approach to tackling major health problems, including cancer. In a recent press release, a joint statement from the Department of Health and Social Care, Department for Business, and Energy & Industrial Strategy, said that over £113m in funding for new treatments would be available. 

The funding will target the development of new cancer immune therapies, as well as ways to tackle increasing levels of obesity, mental health problems, and addiction. The British Medical Association has welcomed the funding, but also emphasised the need for extra investment in the NHS and social security system.

Sky News reports that the extra £3.3bn of funding announced for the NHS has been criticised by leaders in the healthcare professions. They argue that rising costs and the scale of the backlog caused by the pandemic mean that it effectively amounts to a pay cut, at a time when more substantial funding is required.

The Prime Minister, Rishi Sunak, said: “The NHS faces real pressures, which is why we are investing over £100 million in the technologies and medicines of the future to address some of the biggest public health challenges facing our country.”

“This funding will improve outcomes for patients, ease existing pressures on the system and ensure that we are among the first to benefit from medical breakthroughs. Importantly it will also help save the NHS millions of pounds that could otherwise be spent on patient care – for example by tackling obesity which costs the health service over £6 billion annually.”

He added: “It is hugely welcome too that the highly successful Vaccine Taskforce, which procured millions of life-saving vaccines in record time during the pandemic, will now become a blueprint for how we harness the best talent and expertise from around the world and drive investment in research and development.”

The BBC reports that waiting times for cancer treatments have risen sharply over the past few years, and the number of new referrals is at a record level. It is thought that may be up to 30,000 missing cases, which have not been diagnosed due to the disruption caused by the pandemic. 

The new funding will see an extra £22.5m allocated to cancer research and treatment. Currently, cancer is treated with chemotherapy, surgery, and radiotherapy. Certain types of brain tumour can be treated with Gamma Knife radiosurgery in the UK.

NHS England Chief Executive, Amanda Pritchard said: “We have already seen the incredible ways that new technology and innovation can transform NHS care and the lives of patients across the country – from glucose monitors for people living with diabetes, laser therapy for those with epilepsy to genetic life-saving testing for severely ill children and babies.”

She added: “Just today, we fast tracked a new drug deal for men with prostate cancer that can boost their survival –  showing that the NHS is already at the forefront of delivering the latest treatments for patients.”

Dame Kate Bingham, who was responsible for heading up the vaccine taskforce, will help to select the panel of independent experts who will oversee the new mission to tackle serious health conditions.

 

graph chart

Cancer Survival Rates ‘Will Double’ In Next Decade

Advances in cancer treatments mean that survival rates have the potential to double in the next 10 years, according to the Institute of Cancer Research (ICR). The Telegraph reports that the ICR believes that its goals are realistic, based on recent advances in cancer research. 

New discoveries about the ways cancer spreads through the body, and breakthrough treatments such as combining radiotherapy with viruses, mean that the ICR is confident of a significant improvement in outcomes for patients with advanced cancer within a decade.

Cancer survival rates vary greatly, according to how early the cancer is diagnosed, and what type of cancer it is. In the UK, 58.9% of patients survive for five years after a diagnosis of bowel cancer, but just 19.3% survive for five years after a diagnosis of lung cancer. 

Brain and other intracranial cancers are the 9th most common types of cancer in the UK, according to Cancer Research UK, and rates of diagnosis have increased by almost two-fifths since the early 1990s. There are an average of 5,456 deaths per year, and an average of 12% of patients survive a brain tumour for five years of more. 

Dr Naureen Starling, Consultant Medical Oncologist at The Royal Marsden NHS Foundation Trust and Reader in Gastrointestinal Cancer Clinical Trials at The Institute of Cancer Research, London, said: “Many cancers are difficult to detect, often because they are deep in the body or do not become symptomatic until they’re at a late stage.”

She added: “Yet, the earlier cancer is detected, the more possible and effective treatment is likely to be with a greater the chance of survival. This means finding better and faster ways to detect and diagnose the disease is critical.

“To tackle this challenge, we are pioneering research into improved screening approaches, biomarker testing to identify individual risk as well as innovative diagnostic tools. For example, we are currently using liquid biopsies – blood tests which can identify genetic information shed by the tumour – to personalise treatment and identify recurrence earlier.”

Currently, about 40% of cancers are diagnosed at an early stage in the UK, which significantly boosts survival chances. However, the BBC reports that there has been a steep rise in long waiting times for cancer therapy in the UK over the past four years.

Disruption caused by the pandemic, staff shortages, and more people coming forward with symptoms, have all made the situation worse over the past 12 months. This has led to fears that thousands of potential cases could be missed, leading to a spike in cancer-related deaths. 

The NHS are attempting to tackle the issue, with extra community diagnostic centres being established around the UK. However, according to The Royal College of Radiologists, there is a 17% shortfall in suitably qualified doctors to treat cancer in the UK, and there needs to be a renewed focus on training and recruitment for specialist medical staff. 

The most common forms of cancer treatment are surgery, chemotherapy, radiosurgery, and radiotherapy.