I am quite grateful that my radiation treatment for breast cancer was in 2007 and not 1907.
Back in 1896, in Chicago, 55-year old Rose Lee had recurrent cancer in her left breast that was inoperable. She agreed to be treated by Émil Grubbé, an early experimenter of this new technology called the x-ray.
The first session reportedly lasted ONE HOUR, followed by a similar 17-day course. I don’t know how she walked away without a hole burned clear through her body.
The Rose Lee story may be untrue, however, as it was based mostly on Grubbé’s telling, and he was a shameless self-promoter known to exaggerate. Nonetheless, radiation treatment in its earliest days must have caused extreme discomfort and painful side effects. Grubbé himself endured terrible burns on his hand, and Pierre and Marie Curie, famous for their pioneering work in radioactivity, also endured burns and radiation sickness, all due to their self-experimentation.
Image: Finsen Lamp, Public domain, via Wikimedia Commons. Derivatives of the Finsen Lamp were used in radiation therapy experiments.
The very good news is that radiology has come a very long way to become an effective (and much safer) treatment for many different types of cancer. Significant advances have been made even in the short 15 years since I underwent a 6-week course.
How radiation works against cancer
Radiation damages the DNA of cancer cells, which slows or kills their growth. According to the National Cancer Institute (NCI), it takes days or weeks for cancer cells to die and they keep dying for weeks or months after radiation therapy ends.
According to The ASCO (American Society of Clinical Oncology) Post:
- Between half and two-thirds of people diagnosed with cancer receive radiation therapy.
- Roughly 70% of the U.S. population lives within 12.5 miles of a treatment facility.
Radiation is used for many different types of cancers and at all stages, including some stage 4, where it may shrink tumors or improve symptoms to extend life and improve quality of life.
The two main types of radiation therapy available today are external and internal. This article will focus only on external radiation, the most common form, and advances in external radiation equipment and technology.
External radiation treatment requires multiple visits to a treatment center. It’s a Monday-Friday job for some number of days or weeks. Unless you live across the street from a facility, commuting usually takes longer than the actual treatment. My radiation experience in 2007, when I was living in the mountains of Colorado, was about an hour commute each way for six weeks to and from the treatment facility. As long as external radiation continues to be used for cancer treatment, it’s an important healthcare goal in this country to make treatment more accessible to underserved populations.
Basic overview of external radiation
External radiation delivers radiation from a machine outside the body, using three different types of beams for different cancer treatment needs.
Photon therapy
The most common beam type of radiation therapy that has been in use for decades, photons are also used in standard x-rays, but at lower doses.
| BENEFIT | DISADVANTAGE |
| Can reach tumors deep within the body. | Scatters radiation and can go into normal tissue past the tumor. |
Proton therapy
Proton therapy delivers more targeted beams to protect normal tissue from exposure. This technology is not as widely available as photon therapy. According to the National Association for Proton Therapy, 39 regional centers across the US offer proton therapy at the time of this writing.
| BENEFIT | DISADVANTAGE |
| Does not scatter radiation and beams stop once they reach the tumor. | Machines are generally large and expensive and not yet widely available. |
Electron beams
Electron beams are only effective at treating superficial lesions. This technology can be found at most radiation treatment centers.
| BENEFIT | DISADVANTAGE |
| Used with a custom block that conforms to a tumor’s shape to shield surrounding normal tissue. | Beams cannot travel very far, which limits their use to tumors on the skin or near the surface. |
Can cancer patients choose external radiation options?
The oncology team will determine the type of radiation treatment depending on the cancer, and as for the radiography equipment, it’s not something cancer patients can easily pick and choose. Once you select your medical center and oncologist, you will be using the equipment they have available.
Some radiography equipment companies, especially companies at the early stage of getting their products installed and deployed, have pages on their website that allow you to check to to see if and where their equipment is available based on zip code or city and state.
Even though radiography equipment is not something most cancer patients can request like they can request specific, in-market cancer drugs, it’s still good to know what’s out there and encouraging to see progress that is light years (radiation beams?) ahead of early x-ray and radiology treatments.
Advances in radiography: Targeting cancer cells only
When I research innovations in radiography equipment, the common themes I see are focused on making radiation therapy:
- Shorter, safer, and more comfortable for the cancer patient.
- More personalized to specific cancers and targeted to spare healthy cells as much as possible.
- More accessible to underserved patients and communities.
One of the innovations that I find fascinating, though not that recent, is the development of stereotactic body radiation therapy, known as SBRT or SRT. This technology began in the early 1990s in Sweden, but wasn’t available to me (or not offered) when I had radiation in 2007.
This form delivers radiation treatment from many different angles around the body. The beams meet at the tumor to target a high dose of radiation on it while protecting healthy cells. Sounds to me like a computer game, yet companies like Elekta and Accuray have brought this to real life and real people.
Advances in radiography: Bringing new technology to market
Following are just a handful of companies that are innovating radiology equipment and radiation therapy for treatment of cancer.
Disclosure:
I am a member of Ehmet Health’s early patient advisory team. I am not being compensated in any way by Ehmet or by any of the below companies.
Ehmet Health
Ehmet has developed a radiotherapy device for breast cancer treatment called the MammoKnife, with “knife” referring to the precisely guided position of the proton beam. The Mammoknife is self-shielding, which means it doesn’t need to be housed in a specially shielded (and costly) room or area, often deep in the bowels of a large medical center, known as a bunker. A bunker is the room that cancer patients receiving conventional (photon) radiation must go to for treatment.
Self-shielding means that the MammoKnife could be placed in most any medical office to bring breast cancer care closer to the patient, including underserved rural and low-income areas. And since radiation therapy is standard treatment for so many breast cancer patients, bringing treatment closer to them would make a big difference. The MammoKnife also enables prone patient positioning and 360° rotation to target tumors while protecting surrounding healthy tissue.
Learn more at the Ehmet Health website.
Accuray
Accuray designs and manufactures a number of sophisticated systems for cancer treatment, including their Radixact® System for focused radiation that spares normal, healthy tissue. Helical is the word they use to describe a continuous 360-degree radiation dose while the patient lies on a table that moves. Radixact® was designed on a CT scanner foundation for imaging, so your oncology team can see and track the shape and location of your tumor before each treatment session.
Learn more at the Accuray Radixact website.
Another product they have in-market is the CyberKnife System, which uses a robot to deliver the high-energy x-rays or photons used in radiation therapy. The robot moves and bends around the patient from many different angles to focus radiation on the tumor while sparing surrounding healthy tissue. Along with robotic delivery, the CyberKnife System also provides image guidance to the oncology medical team.
Learn more at the Accuray CyberKnife webiste.
Elekta
Elekta has a number of different precision radiation therapy models for different types of cancer and treatment needs, again, all of them delivering more precise treatment.
- Versa HD delivers precision treatment to the brain, lungs, and prostate, which are challenging areas to treat.
- Unity combines magnetic resonance imaging (MRI) technology with radiation technology to give the oncology team greater visibility, which in turns allows greater precision.
- Harmony, Infinity, and Synergy are promoted for greater efficiency, uptime and simplicity to balance productivity and patient care. This balance is a necessity for making treatment more cost-effective for the medical center and more affordable and accessible to patients.
Learn more at the Elekta website.
Mevion Medical Systems
Mevion is focused on proton therapy, and their equipment can be found in many NCI-Designated Cancer Centers, which are medical facilities that meet standards for developing new and better approaches to preventing, diagnosing, and treating cancer.
In my description of proton beams, I mentioned that this equipment is not widely deployed because of its size and cost. Mevion invented compact proton therapy which allows them to design equipment with a small footprint for reduced costs.
Mevion has the only equipment in the world that uses a gantry, which is a mechanical support for mounting that allows the device to be moved in a circular path to rotate around the patient for precise treatment from different angles.
Learn more at the Mevion website.
Viewray
Viewray’s radiation technology, called MRIdian, is also guided by magnetic resonance imaging that the company calls SmartVISION for high-definition, diagnostic-quality imaging. This gives oncology teams greater visibility and confidence by allowing them to see and track soft tissue and tumors for better patient outcomes.
The above small collection of companies is by no means a comprehensive list. It does not include some of the biggest companies in radiation equipment. The selected companies are included based on my own research and interest. The main point is to point out how far radiation therapy has advanced, whether we want to go back 100 years or the last 15 years since my own radiation experience.
Better radiation therapy = (hopefully) fewer advanced cancers
Radiation therapy is a standard, workhorse treatment for breast cancer and many other cancer types. Making it more targeted, effective, and accessible will hopefully obliterate tumors and cancer cells completely to stop an early stage cancer dead in its tracks, returning the person to normal, cancer-free living. For people dealing with metastases, the power to shrink or eliminate tumors to extend life and make that extra time as symptom- and side-effect free as possible would be a very good thing.
See The Early Years of Radiation Therapy at the ARRS Medical Imaging Society website for more about Émil Grubbé and Rose Lee,
Get more detailed information on external radiation at cancer.gov.