INTERVIEW

Proton therapy: No more a distant dream

Sneha Pillai

Senior Subeditor, Kochi

February 04, 2016

In the last few years, we have seen a visible progress in technology in both diagnosis and treatment sectors in India

With the advent of technology, the world is witnessing a fast growth in the development medical devices for cancer treatment. Already, India is the third largest medical device market in Asia, but where do we stand in terms of medical technology in the fight against cancer?

In an email interview with THE WEEK, Edmond Paul, Head Biomedical & Materials Management, Aster DM Healthcare Limited, opens up about the areas where medical technology is growing by leaps and bounds and the challenges it faces in the fight against cancer. Read excerpts:

What are the latest technologies and devices being used by doctors and hospitals in India for diagnosis and treatment of cancer?

In the last few years, we have seen a visible progress in technology in both diagnosis and treatment sectors in India. Today, we on par with most of the developed countries. For diagnosis, specialists are using top-of-the-line Time-of-Flight PET CT, PET MRI, MRI scans, CT scans, Ultrasound with latest software for cancer diagnosis. In laboratories, we have latest equipment for the diagnosis of various tumours. Now, best in the industry Linear Accelerators with flattening free filters for high dose radiotherapy, X-Knife and Gamma Knife are available in India. The Proton therapy, the long awaited treatment modality, is also coming up in two cities in India. For onco surgeries, doctors in India are now using high-precision equipment, such as the da Vinci surgical robotic system is powered by robotic technology and Indo cyanine green (ICG), to isolate and resect cancer tissues completely.

Which five recently-introduced devices have brought about a major change in the way doctors look at and treat cancer?

In diagnosis, Time-of-Flight PET CT and PET MRI are the most revolutionsing introductions in the field of imaging. These devices help doctors to find the cancer accurately in much earlier stages. These also help clinicians to find the progress of the treatment and change the line of treatment, if needed. The new technology in MRI also offers oncology-dedicated sequences like diffusion-weighted background substrates and blood oxygenation level-dependent sequences to identify cancer lesion.

In onco surgery, the surgical robots help surgeons to isolate and resect tumor tissues accurately. Now, many difficult onco surgeries can be performed in minimal invasive ways using robots. ICG helps in better lymph node detection and removal and the da Vinci System allows high-precision surgeries.

In the field of radiation therapy, image-guided radiation therapy along with Flattening Filter Free (FFF) system have proved to be a game changer. Now, a patient undergoing treatment can be imaged and the treatment pattern can be corrected or replanned on treatment table itself on daily basis. The FFF systems provide high-dose photon output. The new Linear Accelerator (Linac), which comes with FFF and cone beam CT facility for imaging during treatment, has made the Stereotactic radiosurgery possible. Now, Linac can treat small tumours easily and accurately.

CyberKnife is another important modality that was introduced a few years ago. It helped in performing stereotactic radiosurgery anywhere in the body, including the parts that were tough to access earlier and moving parts like lungs.

The Proton Therapy is the most-advanced modality launched in the recent past. The entry and exit dose is too low in Proton Therapy compared to Linear Accelerator, making it possible to deliver the maximum dose to a tumor, thus completely destroying the tumor and minimising the chances of developing a secondary tumor to almost nil. The treatment duration is reduced to less than 50 per cent.

What would you say is the biggest innovation in cancer treatment in the last decade?

Even though the photon therapy is the biggest invention in the last decade, it is yet to evolve fully and is available only in few centres across the world. In diagnosis, PET is the biggest innovation in cancer treatment. Today, nobody can think about cancer treatment without a PET Scan, be it for the diagnosis or the treatment. PET Scan can also assess the progress of the treatment.

Can India expect simpler and cheaper diagnostic screening tests, surgery, and other forms of cancer treatment devices in the near future?

In diagnosis, India is already utilising many simple and less expensive solutions such as Pap smear test, breast self-examination, basic ultrasound, among others. Unfortunately, all high-end treatment and diagnosis techniques are expensive. Panacea is doing some work in the field of indigenous Linear Accelerator, and commercial production of the device is expected to start soon. They also have Cobalt therapy units. This may bring down the cost of radiotherapy treatment considerably. The device is expected to be made available commercially by the end of 2016.

What are the medtech-based options available for cancer care at home, if at all?

For cancer care, as of now, no treatment modalities, other than palliative care, are available for home use. For bedridden patients, various technologies such as air mattresses, BiPAP machines for respiratory support etc are available for home care.

What can we expect from medical technology for cancer treatment in the next decade?

The next few years will see further development of the Proton Therapy. As of now, the Proton Therapy needs a lot of energy and space. In the future, it will definitely become more compact and less energy consuming, making it cost-effective for hospitals and affordable for patients.

Second ongoing development is in the field of chemotherapy. The drugs used for chemotherapy not only affects the cancer cells, but the whole body of the patient. The targeted delivery of chemotherapy drug will be big game changer. Philips is working with Celsion to develop heat-activated special drugs for chemotherapy (ThermoDox ®) which will be activated by temperature higher than body temperature. This Celsion-Philips combinational treatment approach may change the paradigm for addressing a broad range of cancer. Their joint research is focused on the treatment of pancreatic cancer and cancer metastases in bone.