An Oncologist Spotlights the Newest & The Latest in Stereotactic Radiosurgery Technology

WORDS DR AMINUDIN RAHMAN MOHD MYDIN

FEATURED EXPERT
DR AMINUDIN RAHMAN MOHD MYDIN
Consultant Clinical Oncologist
KPJ Damansara Specialist Hospital

It’s an undeniable fact that cancer is one of the leading causes of death both in Malaysia and worldwide.

HOWEVER, CANCER NEED NOT NECESSARILY BE A DEATH SENTENCE THESE DAYS

There are numerous developments in the technology behind cancer screening that allows more precise cancer treatment and hence a greater potential for better treatment outcome.

Many exciting developments have taken place in the field of radiation therapy, also called radiotherapy.

Radiation therapy involves the use of high-powered X-rays and other types of radiation to disrupt the growth of a tumour.

As a result, the tumour will eventually start to shrink.

Depending on the type and severity of cancer, it can be used as a single form of cancer treatment.

It can also be used alongside chemotherapy and other forms of cancer treatments. For example, after a surgery to remove a tumour, the patient may receive radiation therapy to eliminate any leftover cancer cells in their body.

One significant development in radiation therapy is stereotactic radiosurgery, which is available in Malaysia.

WHAT IS STEREOTACTIC RADIOSURGERY (SRS)?

Click on the image for a larger, clearer version.


  • This is a very precise form of radiation therapy.
  • It can be used on both cancerous and non-cancerous or benign tumours.
The advantage of SRS over older radiotherapy systems
  • Delivers high doses of radiation in tiny, precise beams that target the tumour(s) while minimizing damage to surrounding tissues.
  • Its high precision allows for treatment of very small tumours as well as tumours located close to important organs.
  • High doses of radiation allow for more effective treatment of tumours.
  • Less damage to surrounding healthy tissues means fewer potential side effects compared to older systems.

Stereotactic radiosurgery is commonly used to treat the following:

  • Abnormalities in the brain and spine, including cancer.
  • Benign or non-cancerous tumours.
  • Epilepsy.
  • Trigeminal neuralgia, a rare and very painful chronic disease that affects the trigerminal nerve in the brain.
  • Abnormal connections between arteries and veins, or arteriovenous malformations.
THE DIFFERENT TYPES OF STEREOTACTIC RADIOSURGERY
Gamma knife
  • Commonly used to treat tumours and lesions in the brain.
  • No actual knives are involved here—the ‘knife’ here is a highly focused beam of radiation!
  • The beam is typically delivered under the control of a computer-guided treatment.
  • The use of artificial intelligence or AI shows promise in optimizing delivery route of the radiation beam to the targeted areas of treatment.
Stereotactic body radiation therapy (SBRT)
  • Commonly used on cancers that are still confined to a small area of the body and have not yet spread into nearby tissues.
  • SBRT is used for tumours and cancers outside the brain, commonly those in the head and neck, lung, liver, pancreas, kidney, prostate, and spine regions.
  • This treatment method delivers high doses of radiation to the targeted area over a matter of days. (Conventional radiation therapy may take place over a matter of weeks.)
  • While highly concentrated radiation is applied, don’t worry—the treatment isn’t painful.

Proton therapy

  • Commonly used to treat both cancerous and non-cancerous tumours that are located near important organs such as brain and spinal cord. It is also frequently used to treat cancer in children.
  • This is a pretty complicated treatment, as the oncologist and their colleagues would need to first determine the specific location, size, and dimension of the tumour. This is often done via imaging tests such as computed tomography (CT) scans and magnetic resonance imaging (MRI).
  • Once these details are obtained, the radiation oncologist will direct high-energy proton beams onto the tumour.

Linear accelerator (LINAC)

  • Commonly used to treat cancers of the prostate, lung, breast, oesophagus, stomach, rectum, uterus, bladder, liver, and more.
  • This is a high-definition dynamic radiosurgery (HDRS) treatment that allows for accurate delivery to small areas of the body.
  • It can target areas accurately, thereby minimizing exposure to healthy cells and hence side effects.
  • It is also capable of delivering high-dosage radiation beams. This usually means that the patient’s radiotherapy sessions will take less time, and they will also require fewer sessions compared older radiotherapy systems.

A Significant Milestone in Improving the Access of Malaysians to Comprehensive Genomic Profiling

Recently, Roche Pharmaceuticals and Roche Diagnostics cemented a partnership with Premier Integrated Labs with the signing of a memorandum of understanding (MOU). This MOU is effective from November 2023.

The objectives of this partnership include improving patient access to comprehensive genomic profiling or CGP as well as promoting greater awareness and understanding of CGP among Malaysians.

MS HENG CHAI YIN
General Manager
Roche Diagnostics (M) Sdn Bhd

“While awareness and understanding are crucial, our ultimate goal is to ensure that CGP is accessible to all patients in Malaysia. It is about providing every patient with the best possible chance for an accurate diagnosis and tailored treatment plan,” says Ms Heng Chai Yin, the General Manager of Roche Diagnostics Sdn Bhd.

WHAT IS COMPREHENSIVE GENOMIC PROFILING (CGP)?

With a single test, comprehensive genomic profiling (CGP) can analyse a broad panel of genes that is known to drive cancer growth. This type of testing produces comprehensive patient reports with broad and deep assessments of the possible underlying cancer drivers.1

HOW CGP PLAYS A KEY ROLE IN PRECISION MEDICINE

Precision medicine involves the use of personalized treatments for an individual with regards to a disease.2

Different people can respond differently to the same medication for the same disease, and there are many possible factors that are responsible for these differences.

Hence, a big part of precision medicine involves the identification of these differences through investigative methods such as in the image below.

Click on the image for a larger, clearer version. CGP falls under omics. Hence, it is one of the important procedures that provide healthcare professionals with the necessary data to design the best personalized treatments for their patients.
HOW CGP CAN IMPROVE THE PRECISION OF CANCER TREATMENT IN MALAYSIA
MS DEEPTI SARAF
General Manager
Roche (Malaysia) Sdn Bhd

According to Ms Deepti Saraf, CGP holds the key to unlocking the full potential of personalized medicine. It allows us to explore the genetic makeup of individuals, thereby enabling more precise and tailored treatment approaches.

Let’s look at lung cancer as an example.

How CGP could improve treatment for lung cancer and benefit both the patient and the oncologist. Click the image for a larger, clearer version.
CGP IS DIFFERENT FROM CONVENTIONAL GENOMIC TESTS

Ms Deepti Saraf points out that, unlike those genomic tests in the market that let you know about your genes and ancestry, CGP is more of a diagnostic tool that empowers doctors, especially oncologists, to create the most optimal personalized treatments for their patients based on available data.

EN HAREEFF MUHAMMED
Chief Executive Officer
Premier Integrated Labs

En Hareeff Muhammed brings up that, with the wealth of genomic data obtained through the use of CGP, databases can be created to analyse which treatments would work best for different groups of patients.

This goes back to Ms Deepti Saraf’s statement that CGP allows healthcare professionals to design the best personalized treatments for their patients. They can do this by using the information found in the database to help shape their decisions.

“It’s not just useful for the patients and saves time,” En Hareeff elaborates. “It also supports doctors in making better decisions.”

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References:

  1. Foundation Medicine. (n.d.). Why comprehensive genomic profiling? https://www.foundationmedicine.com/resource/why-comprehensive-genomic-profiling
  2. König, I. R., Fuchs, O., Hansen, G., von Mutius, E., & Kopp, M. V. (2017). What is precision
    medicine?. The European respiratory journal, 50(4), 1700391. https://doi.org/10.1183/13993003.00391-2017
  3. Omics-based clinical discovery: Science, technology, and applications. (2012, March 23). In C.M. Micheel, S.J. Nass, & G.S. Omenn (Eds), Evolution of translational omics: lessons learned and the path forward (p. 33). National Academies Press (US). https://www.ncbi.nlm.nih.gov/books/NBK202165/
  4. Tan, J., Hu, C., Deng, P., Wan, R., Cao, L., Li, M., Yang, H., Gu, Q., An, J., & Jiang, J. (2021). The predictive values of advanced non-small cell lung cancer patients harboring uncommon EGFR mutations-the mutation patterns, use of different generations of EGFR-TKIs, and concurrent genetic alterations. Frontiers in oncology, 11, 646577. https://doi.org/10.3389/fonc.2021.646577
  5. American Lung Association. (2022, November 17). EGFR and lung cancer. https://www.lung.org/lung-health-diseases/lung-disease-lookup/lungcancer/symptoms-diagnosis/biomarker-testing/egfr

IFPMA Launches New Video to Share How Innovative Ideas Are Changing Cancer Care for the Better

WORDS LIM TECK CHOON

#AlwaysInnovating is an initiative by the International Federation of Pharmaceutical Manufacturers & Associations (IFPMA), which aims to share with the world the expertise, collaboration, and perseverance involved in transforming ideas and innovations into real-world medicines and vaccines.

We’re pleased to share with you the latest film and expert insight from #AlwaysInnovating, in which an animated guide called Sparky will explain how decades of dedicated cancer research and innovation have paved the way for a reimagined approach to cancer care bringing fresh hope to people with cancer as well as their carers.

HERE’S THE VIDEO

FOR MORE INFORMATION

Click here to access the IFPMA webpage to learn the sobering statistics of the cost of cancer of our lives and how, driven by this cost, the pharmaceutical industry is driving innovation across all areas of medicine to delivering new medicines to those in need. Link opens in a new tab.