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New Cancer Treatments

Intensity Modulated Radiotherapy

Intensity Modulated Radiation Therapy (IMRT) is an advanced mode of highprecision radiotherapy that utilises computer-controlled x-ray to deliver radiation that conforms to the threedimensional (3-D) shape of the tumour by controlling the intensity of the radiation beam. This allows a high radiation dose to be delivered to the tumour while minimising radiation of the surrounding normal tissues. IMRT also has the capability of ‘dosepainting’, a technique where diff erent doses can be delivered to diff erent parts of the treated volume.

IMRT is especially useful in cases where normal organs are in close proximity to the tumour. In head and neck cancers for example, tumours often sit next to vital organs such as nerves to the eyes, spinal cord and salivary glands. IMRT allows radiation oncologists to minimise dosage to these critical organs while keeping the dose to the tumour suffi ciently high to ensure cure.

Stereotactic Radiosurgery (Novalis)

Radiosurgery refers to the use of small beamlets of ionising radiation to surgically remove intracranial lesions (brain injury/tumours) which were previously classified as ‘inoperable’ or as an alternative to open neurosurgery.

Radiosurgery offers a non-invasive alternative for many patients for whom traditional brain surgery is not an option and removes the physical trauma and majority of risks associated with conventional surgery.

This procedure has the advantage of requiring no hospitalisation or ICU stay, no general anaesthesia (except in young children), and reduced treatment mortality (from haemorrhage or infection) for most indications compared to conventional open neurosurgery.

Tomotherapy

Literally meaning slice treatment, this machine looks similar to a CT scanner but spew out thin slice high energy x-rays. Like IMRT, this treatment allows highly conformal radiation to be delivered to the tumour, at the same time sparing normal organs.

The added advantages of this modality are the ability for imaging to be done prior to each treatment to ensure accurate positioning as well as its ability to treat a large area in one sitting.

Molecular Targeted Therapy

It refers to a group of drugs that specifically target cancer cells, leaving the other cells unharmed; hence they are regarded as ‘Magic Bullets’. Since these drugs only target cancer cells, they are usually thought to be free of side eff ects. However, this is not true. There are diff erent types of side eff ects, depending on the kind of drug taken. It is also important to note that every individual’s experience with side effects may differ.

Interventional Radiology

This plays a large role in treating hepatic (liver) malignancies that cannot be removed. It is important to stress that these treatments are palliative, and not for curative intent. There are two interventional techniques.

The first is transarterial chemoembolisation (TACE) which combines hepatic artery embolisation with simultaneous infusion of a concentrated dose of chemotherapeutic drugs. Embolisation deprives the tumour of blood supply and promotes tumour cell death.

The second is radiofrequency ablation (RFA) of liver tumours. RFA uses the principle of microwaves to generate heat within the target tissue. It does not distinguish between tumour and normal tissue. The needle is placed into the lesion under imaging guidance. Both CT and ultrasound work well for this technique.