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From keyhole to 'no-hole' using radiosurgery, a clinical treatment to removing cancer tumours in patients

On the 21st November 2015, an afternoon symposium organized at Gleneagles Hospital in Singapore, gathered ~100 clinical experts and healthcare industry leaders from the United States, Canada and Asia. During a media panel session with Dr. Vincent Chia (Gleneagles Hospital), Dr. Daniel Tan Yat Harn (Asian American Radiation Oncology) and Dr. Dwight E. Heron (University of Pittsburgh School of Medicine), the topic was a focus on minimally -invasive hepatopancreatobiliary surgery or much better to achieve no surgery and yet successfully remove tumours in cancer patients.

'Advancement in technology has enabled clinicians to do more with less, particularly with the options of advanced radiotherapy techniques and minimally-invasive surgery to treat cancer patients,' said Dr. Tan.

Accuracy and Consistency in treating tumours at targeted sites has been a quest for radiation oncologists which can now be achieved. Dr. Tan illustrated on the challenges in radiotherapy, 'Precision is the ability to consistently reproduce treatment parameters onto the patient, whereas accuracy refers to these parameters culminating into hitting the intended target during each cancer treatment. Since no incisions are made on the patient to expose the internal tumor, the radiotherapy treatment needs to be both precise and accurate each time it is delivered for effective tumour destruction.

Dr. Tan continued, 'One generation ago, we were still feeling tumors externally and targeting them using marker pen, in what can be termed 1-dimensional RT. This progressed to 2-Dimensional planning methods using X-ray landmark as surrogates for tumour location. Still, this was considered a coarse approach as large treatment fields were required so as not to miss the tumour. This resulted in higher rates of side effects and limited our ability to give higher doses that are required for tumour control

'In the 1980s, CT technology was brought into radiotherapy planning, and we could then do more interesting work (that was beneficial to the cancer patients).' Dr. Tan then continued, 'As we could see the tumours better, we were able to locate them more accurately using 3 dimensional CT images. At the same time, the ability to shape radiation beams using multi-leaf collimators allowed us to move on from square fields to fields that conformed to the shape of the tumour. Hence, the term 3DCRT (3 dimensional conformal radiation therapy).

From the 1990s onwards, rapid advancement of Imaging, computing, and engineering in radiotherapy changed the landscape entirely by enabling clinicians to track tumour location even during natural movements such as in respiration, as well as to shape radiation beams even more closely to the tumour while avoiding normal organs. Clinicians can now be confident in targeting tumours with sub-millimetre accuracy, leading to the safe practice of stereotactic radiosurgery in the body, or stereotactic body radiation therapy (SBRT) where extremely high doses of radiation are used to destroy tumour without the need for any incision.

Dr. Tan illustrated this with MRI images of a patient with a brain tumour which had metastasized from breast cancer whom he treated with stereotactic radiosurgery (SRS). A repeat scan done 6 months after SRS showed that the tumour had disappeared, leaving only a small area of scar tissue. This 'no-hole' or bloodless surgery was made possible because of technological advances of the previous decades, and saved the patient from undergoing a major neurosurgical operation. However, there is still a role for open surgery today, such as when immediate decompression of the tumor is required, or when tissue is needed for histopathology analysis. 'The best treatments are always achieved in a multi-disciplinary setting', says Dr Tan.

Gleneagles hospital receives and treat patients both local (70%) and international (30%). During the second panel session, Dr Cheah Yee Lee said, 'One of the important information that patients requires is the amount of time for their diagnosis, treatments, and if they have to stay in the hospital.' Dr. Chia then mentioned that Gleneagles provide commitments to patients, and most often a 24-hours diagnosis and plan surgery can be achieved from clinicians at Gleneagles.

At the symposium, Dr. Chia also said, 'Gleneagles Hospital is equipped with the capability to perform complex surgeries, and has been a strong advocate in embracing with new health technology. We are delighted to host top practitioners from the medical Industry in tandem without support for these complex surgical procedures. We hope that this will inspire and equip attendees with new healthcare solutions which will improve clinical outcomes and patient experiences.'

Source: Gleneagles & WeR1 & APBN
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APBN Editorial Calendar 2018
January:
Obesity / Outlook for 2018
February:
Searching for the fountain of youth
March:
Women in Science - Making a difference
April:
Digestive health in the 21st century - Trust your guts
May:
Dental health - The root to good health
June:
Cancer - Therapies and strategies for better patient outcomes
July:
Water management - Technologies for biotech and pharmaceutical industries
August:
Regenerative technology - Meat of the future
September:
Doctor Robot - The digital healthcare revolution
October:
Bones / Breast cancer
November:
Liver health / Top science research nations & institutions
December:
AIDS / Breakthrough of the year/Emerging trends
Editorial calendar is subjected to changes.
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