Cancer patients often hear about the latest treatment technologies such as Gamma Knife, Radiofrequency Knife, Proton Knife, etc. The Baidu promotion information of various “knives” on the Internet makes patients confused and overwhelmed. All hospitals say their “knife” advantages, not to mention their “knife” disadvantages, patients often passively and blindly accept the unsuitable treatment, and even over-treatment. I once saw a patient with lung cancer who was in good condition, but because of the propaganda of proton therapy on the Internet, he went to Japan to receive proton therapy without understanding the side effects of proton therapy, and as a result, he had serious complications of esophagitis and his condition deteriorated rapidly. For this reason, we have compiled a comparison of the latest radiation therapy “knives” in the world for the reference of our patients.
Modern radiation therapy is a treatment for malignant tumors by using one or more types of ionizing radiation and computer systems to precisely kill local tumor cells, and then improve the local control rate and reduce the distant metastasis rate through combined chemotherapy or drug-targeted therapy, thus improving long-term survival rate. With the development of medical technology, radiotherapy technology has entered the era of precise treatment, and radiotherapy can be applied to any site, especially those tumors that are difficult to be exposed surgically or cannot be removed in important functional areas or tumor invasion, such as brain tumor, spinal tumor, lung cancer, etc. At present, about 70% of tumor patients need radiotherapy. 45% of malignant tumors can be cured, of which surgery accounts for 22%, radiotherapy for 18% and chemotherapy for 5%, as announced by WHO.
Modern radiation therapy technologies include Tom Knife, Radiofrequency Knife, Gamma Knife, Proton Knife, Heavy Ion, and the latest EDGE (no Chinese name yet) non-invasive surgical system, which was launched in 2014. It is difficult for patients to understand the differences between the above radiotherapy technologies from the principle, so the author will only make a detailed comparison in terms of treatment intensity, treatment accuracy, treatment range, positioning system, patient comfort, and side effects to facilitate patients and doctors to understand the differences between different radiotherapy technologies.
Tom Knife
TOMO is the only radiotherapy device in the world that uses spiral CT scan to treat cancer, i.e. tomotherapy, while the other five radiotherapy techniques all use the latest stereotactic radiotherapy technology. ×TOMO is the only radiotherapy device that can treat the whole center, the whole bone marrow and multiple target areas at the same time, in addition to the precision radiotherapy for all parts of the body. TOMO has advantages in radiation therapy for nasopharyngeal carcinoma, recurrent nasopharyngeal carcinoma, lung cancer, pleural mesothelioma, esophageal cancer, brain tumor, breast cancer, prostate cancer, systemic multiple metastases and total spinal cord irradiation.
Stereotactic radiotherapy was first proposed by Professor LarsLeksell, a famous Swedish neurosurgeon, in 1951, and the characteristics of stereotactic radiotherapy are.
(1) precise stereotactic means of positioning.
(2) Multi-path irradiation modality, which greatly exceeds the focal-skin ratio (the ratio of the dose received by diseased tissue to healthy tissue per unit volume) of conventional radiotherapy.
(3) From the perspective of clinical radiation dosimetry, stereotactic radiation therapy has accurate dose irradiation to tumor tissues, which can give tumor tissues a large kill while significantly reducing the irradiation to surrounding normal tissues; and through the computerized treatment planning system, it can implement one-time high-dose lethal irradiation to tumor tissues and “remove” the tumor like surgery. “It is called “radiation knife”, including gamma knife, radio wave knife, EDGE, and proton heavy ion.
Gamma knife
Gamma knife is the Swedish Elekta company invented in 1968, is a hemispherical helmet covered with straight aligner, the helmet can shoot 201 cobalt 60 high dose of ion rays – gamma rays, so called gamma knife. Gamma knife certainly brought a revolution, but due to its narrow indications and other reasons, it was gradually replaced by x-ray radio wave knife.
Radiofrequency knife
Developed by John R. Adler, Professor of Brain Surgery and Radiation Oncology at Stanford University Medical Center, the radiofrequency knife was approved by the FDA in 2001 to treat tumors anywhere in the body. Unlike traditional radiosurgery systems that treat only head and neck tumors, the radiofrequency knife is licensed to treat patients with intracranial and extracranial tumors. Over 50% of the cases in the United States are for extracranial tumors, including tumors of the spine, lung, prostate, liver, and pancreas. In 2012, Accuray developed a new sixth-generation radiofrequency knife, CyberknifeM6, which was approved for marketing in 2014 as EDGE.
The EDGE, which was approved for marketing by the U.S. FDA in 2014, represents the most cutting-edge technology in radiotherapy and is ahead of the other five radiotherapy devices in terms of maximum data dose rate, treatment accuracy, treatment range, treatment time, and treatment side effects across the board.The EDGE radiosurgery oncology treatment system was developed by Varian Corporation and approved by the U.S. FDA on January 23, 2013.EDGE is the most effective non-invasive tumor removal technology to date, utilizing the unique Calypso GPSfortheBody system approved by the FDA on July 21, 2014 and the surface beam monitoring system to dynamically monitor and target tumor “escape” during treatment at a high frequency of up to 10 milliseconds in real time. Combined with next-generation IGRT and other image-guided technologies, the EDGE Tumor Removal System removes tumor tissue with sub-millimeter precision using an exclusive high-intensity HD-MLC collimator of up to 2400 MU/min.
EDGE tumor non-invasive surgical clearance system has the following advantages compared with conventional surgery and other radiotherapy equipment.
1. non-invasive: no incision is required, and patients do not need to undergo the huge trauma of surgery.
2. High maximum dose rate of radiotherapy: 2400 MU/min, which is 2-6 times higher than the other five devices.
3, high precision treatment: 0.1 mm level precision to eliminate tumor cells, which is the most precise radiotherapy equipment so far and almost no damage to surrounding important organs and tissues.
4. Short treatment time: no anesthesia and no hospitalization; treatment time of about 10 minutes each time, which is 1/2 to 1/9 of the other five devices and does not affect patients’ quality of life.
5, less treatment times: 1-5 times a day, once a day, 1/2 to 1/8 of the other five devices, no hospitalization required.
6. high efficiency: up to 5 tumors can be removed simultaneously, and tumors can be removed up to 5-175 px, which is suitable for almost all solid tumor patients for lesion removal.
7. Thorough: locks onto escaped tumors and removes them at a frequency of every 10 milliseconds, completely eliminating tumor cells.
8. Almost no side effects: patients do not have the side effects of conventional surgery and radiotherapy on normal tissues and immune system.
EDGE-Representative of the most advanced radiotherapy technology
The world’s first non-invasive tumor removal system EDGE is located at Henry Ford Hospital Oncology Center in the United States, and there is no equipment operating in China yet. However, Henry Ford Hospital has a China Liaison Office in Beijing, which is responsible for assisting Chinese patients to receive this treatment method representing the most advanced tumor treatment technology in the United States. It is understood that Chinese patients currently receiving EDGE treatment can also receive financial support from Henry Ford Hospital, with an average cost of 350,000 RMB per patient for all treatment in the United States.
Heavy Ion Proton
Heavy ion proton therapy is a form of radiation therapy in which carbon ions or protons are accelerated to about 70% of the speed of light and the resulting high-energy particle beam is used to precisely irradiate the lesion. The physics of the heavy ion proton beam is such that it can form a sharp energy peak (Bragg peak) in the body, and the radiotherapist can focus the energy peak of the particle beam on the tumor lesion to achieve tumor killing without damaging the organs and tissues surrounding the tumor. However, the damage of proton heavy ion to normal tissues and immune system is greater than other radiotherapy systems, and the proton damage brought by treating tumors smaller than 25px is much greater than the benefit brought by the treatment because of the large proton damage. The first proton heavy ion treatment facility in China has been built and put into use in Shanghai, and the average cost of treatment is 300,000 RMB per patient; in the United States and Japan, the cost of treatment is as high as one million.
Due to the different latest radiotherapy equipment available in domestic hospitals, the radiotherapy treatment for the same disease varies from hospital to hospital. Patients can learn more about the advantages and disadvantages of different radiotherapy equipment according to the table below, and consult with radiotherapy experts to get the most suitable treatment method for them.