Radiotherapy Treatment in Gleneagles Hospital Penang

Radiotherapy is a vital treatment for many cancers, playing a key role in both curative and palliative settings. It is the one of the most effective curative treatment, with statistics suggesting it is responsible for 78% of non-surgical cancer cures (Cancer Services Collaborative, 2002). At least half of those individuals with cancer will require radiotherapy at some point in their illness. 

Accurate Targeting for Effective Radiotherapy Treatment

Precision is important. Radiotherapy success relies on precisely defining the tumour and surrounding area for treatment. Advanced imaging techniques play a crucial part in this process. Doctors identify three key volumes:

1. Gross Tumour Volume (GTV): The visible or detectable tumour using imaging or physical examination.

2. Clinical Target Volume (CTV): Includes the GTV and a margin to account for microscopic cancer spread beyond the visible tumour.

3. Planning Target Volume (PTV): Accounts for uncertainties during treatment, ensuring the CTV receives the necessary radiation dose.

Attention to detail in planning, guided by high-quality imaging and an advanced treatment machine, are essential for successful radiotherapy outcomes.

Radiotherapy is most effective when:

• High dose is delivered to the tumour, increasing the chance of local control.
• Local control is achieved, preventing cancer spread and improving overall cure rates.
• Healthy tissues are spared, minimizing side effects. [1] [2]

Modern techniques like volumetric arc radiotherapy (VMAT) and radiosurgery (SRS) allow doctors to increase the dose for better tumour control while significantly reducing side effects.

At Gleneagles Hospital Penang, our commitment is to you, the patient. We prioritize your well-being above all else, ensuring you receive the highest standard of care through a patient-centered approach. This is reflected in our core value, ‘patients first,’ which means your health, comfort, and satisfaction are paramount in every aspect of your journey here.

Elekta Versa HD: A Powerful Tool for Precise Cancer Care

Gleneagles Hospital Penang not only utilises a multi-disciplinary team of specialists but also leverage cutting-edge technology to deliver exceptional care. One such innovation is the Elekta Versa HD Linear Accelerator (LINAC), an advanced medical device designed for precise radiotherapy treatment for various cancers.

The Elekta Versa HD Advantage:

• Exceptional Accuracy: Targets tumours with incredible precision (sub-millimeter delivery system) minimizing side effects, with studies showing more than 96% passing rate in quality assurance metric.
• Faster Treatments: Delivers radiation faster than older machines, improving convenience and potentially treatment outcomes.
• Advanced Imaging: Provides detailed 3D views of tumours for personalized treatment plans through integrated cone-beam computed tomography.
• 4D Motion Management: Tracks tumours in real-time, ensuring targeted radiation delivery even with slight movement.

The Versa HD integrates Monaco, a treatment planning system that maps out the radiation path, and Agility, a high-resolution multileaf collimator (MLC), a tool that acts like tiny shutters, blocking radiation with millimeter accuracy. This combination allows for precise delivery of radiation treatments with virtual leaf sizes as small as 1 mm, even within a large treatment field of 40 x 40 cm. Additionally, the Versa HD can effectively treat several small tumours without needing to move you around as much. Studies, like one published in the National Institutes of Health (NIH), have demonstrated the Versa HD's exceptional accuracy in delivering SRS for small tumours [4].

Radiotherapy Flowchart in Gleneagles Hospital Penang

Consultation with Oncologist

↓

Agreement to Treatment

↓

Registration

↓

Precise CT Simulation (dedicated CT simulator)

↓

Tumour Marking & Drawing (Contouring) by Highly-trained Oncologist for Personalized Treatment Plan

↓

Customized treatment plan by Medical Physicist

(Average 7 years’ experience with world recognition)

↓

Oncologist Confirms Treatment Plan

↓

Validation of Treatment Parameters to ensure safety and accuracy

↓

Treatment Delivery by Highly-experienced Radiation Therapists

*Above planning and treatment time for each session may vary depending on case complexity.

Beyond Imaging the Visible Tumour: Targeting Microscopic Spread

At Gleneagles Hospital Penang, we integrate the GTV, CTV, and PTV in our radiotherapy treatment plan using the Elekta MONACO treatment planning system. This advanced technology allows us to deliver precise and personalized treatment plans, ensuring optimal outcomes for our patients. Our commitment to utilizing cutting-edge equipment and adhering to international guidelines is why we excel in providing exceptional care.

Figure 2 (a) and (b): An example of precise dose targeting within tumour area for Nasopharyngeal tumour (NPC) in the head and neck area. Red/orange area illustrate high dose area confined to the tumour while sparing normal tissues such as the oral cavity, brainstem, trachea, and spinal cord.

As illustrated in Figure 2, Gleneagles Hospital Penang demonstrates its commitment to excellent radiotherapy practices as evidenced in its meticulous planning process for the treatment of nasopharyngeal cancer. This approach involves the three key volumes as discussed above:

• Gross Tumour Volume (GTV): This represents the visible tumour identified through advanced imaging techniques or physical examination.
• Clinical Target Volume (CTV): Understanding that cancer cells can spread microscopically beyond the visible tumour, we go a step further. A margin is meticulously added to the GTV to create the CTV. This ensures all potential cancer cells are encompassed within the treatment area, maximizing the chances of successful eradication.
• Planning Target Volume (PTV): Additional margin created to recognize the possibility of slight patient movement. This accounts for potential uncertainties and guarantees the CTV receives the necessary radiation dose to eliminate cancer cells.
  

By employing this multi-layered targeting strategy, Gleneagles Hospital Penang ensures precise radiation delivery to the tumour while minimizing exposure to surrounding healthy tissues. This meticulous approach is a hallmark of Gleneagles Hospital Penang's commitment to delivering the highest quality and most effective radiotherapy care for patients.