The Present and Future of Radiotherapy

The radiotherapy market is growing due to several factors, such as an increase in the number of new cancer cases and technological advancement in the hardware and software used in radiotherapy. The current international markets are underequipped to address new cases of cancer. In low- and middle-income countries, only 10% of the population has access to radiotherapy. Therefore, there exists a wide gap between the demand and the installed base of equipment, which offers a huge opportunity for the companies to grow in the radiotherapy market. Expansion of the radiotherapy market can be both lifesaving and profitable.

Effective planning for the treatment

It is necessary, and continuous technological developments are taking place to minimize the exposure to radiation of healthy tissue, in order to avoid any side effect. This goal is a driving force of R&D for radiotherapy. Software plays an increasingly significant role in cancer care. Population growth and increased life expectancy are adding to the incidences of cancer. The software & services segment includes software, which is used for treatment planning, analysis, and services, which are needed for the maintenance and efficient use of radiotherapy devices. The software & services segment of the companies are expected to grow, as software products help improve physician engagement and clinical knowledge-sharing, patient care management, and the management of cancer clinics, radiotherapy centers, and oncology practices for better performance. Companies like Varian are continuously increasing their software portfolio. Software plays an increasingly significant role in cancer care. At the same time, healthcare systems are subject to harsh budgetary constraints in nearly every country. As a result, healthcare providers face the challenge of achieving more while using fewer resources. To achieve this goal, hospitals have a strong need for software platforms that make radiotherapy treatment cost-effective. The development of effective software will improve the delivery of advanced radiotherapy in the future.

Introduction of new technology
Technology is another salient feature. Radiation therapy remains a significant modality for cancer treatment, which is the primary driving factor for the designing of new techniques to improve the survival rate of cancer patients. New technologies, like proton beam therapy, are available in developed countries like the United States, Germany, and United Kingdom, due to well-established reimbursement policies. Proton therapy can be used on tissues that are highly sensitive, like brain, spine, and eye tumors. It is more accurate, as compared to other X-ray radiation therapies.

Advancement in the technology is also helping to execute the planning of the radiation therapy.

Technological advancement in existing technologies, such as CT imaging, is making imaging more accurate and consistent. This can give a better representation of a tumor and help in better planning. Already-existing technology, such as IMRT, SBRT, IGRT, conformal 3D, VMAT, and others that are used for radiation therapy treatment is undergoing various advancements. For example, Varian is developing a software, which can be used to develop better planning tools, in which statistical models can be used to calculate the quality of an IMRT treatment for a patient. This is expected to increase the usage of IMRT for treating cancer. IGRT is the type of radiotherapy. Research is more focused on IGRT, in order to prove its fewer side-effects. IGRT may include electronic portal imaging, fluoroscopy, ultrasound, CT scan reconstruction, and respiratory gating technology. SBRT is also growing as an option for treating cancer. SBRT is used to escalate the dose to the targeted tumor, which can increase local control while limiting the dose to nearby critical structures and normal tissues. This will cause minimum damage to the surrounding tissues and hence, will experience strong growth in the forecast period.

Cancer Immunotherapy Use on Cancer Patients

Recent advances in treating cancer patients have resulted in the development of biological therapies that can prove to be a promising alternative to conventional cancer therapies. Immunotherapy harnesses the body’s immune system to identify and fight effectively against cancer cells.

Immunotherapy works by attacking the growth of cancer cells or stimulating the immune system to kill cancer cells. Contradictory to the standard cancer treatment regimes such as chemotherapy, radiation therapy, which act on both normal and cancerous cells, immuno-therapeutic treatments are highly specific. A wide range of cancer immuno-therapy approaches exists such as immune checkpoint blockers, cancer vaccines, immune-modulators, monoclonal antibodies and cell based immuno-therapies have demonstrated to be effective against cancer patients.

The most commonly targeted form of cancer chemotherapy is the use of monoclonal antibodies as they can be tailor-made in the laboratory. They have unique antigen specificity thereby allowing themselves to attach to specific epitopes on cancer cells. This flags the cancer cells and makes it more visible to the immune system so that it can find and destroy those cells. Currently, most of the monoclonal antibodies are undergoing phase 3 clinical trials or awaiting FDA review process. Unlike monoclonal antibodies, non-specific immuno-therapy approaches such as administration of immuno-modulatory cytokines are also being used to treat melanoma. Cytokines are hormones that are endogenously produced by the body to enhance or suppress T-cell response against cancer cells. IFN-α and IL-2 are most commonly characterized cytokines used in cancer immuno-therapy.

The primary cell-based immuno-therapy strategy which is successful these days is the use of T-cell therapy, wherein cancer T cells removed from blood are modified with chimeric antigen receptor (CAR) and is then infused back into the patients to treat metastatic cancer. Another form of cell-based immuno-therapy used is tumor-infiltrating lymphocytes (TIL) therapy, wherein TIL is surgically removed from tumor tissue and is considerably increased in the laboratory by adding cytokines to it and is then re-infused back into the patient.

A promising treatment that has emerged in recent times for treatment of melanoma is the use of immune checkpoint inhibitors. They act by inhibiting the checkpoint receptors on T cells that act as brakes to the immune system thereby mediating anti-tumor responses. Some of the commonly used antibody inhibitors that have been commercialized are PD-1, PDL-1, and CTLA-4. Another more focused approach to cancer immuno-therapy is the use of vaccines to encourage the immune system to generate antibodies that can target tumor specific antigens, thereby eradicating cancerous cells. Cancer vaccines include peptide-based, dendritic cell-based, tumor cell-based and DNA cell based. Cancer vaccines can be broadly classified as preventive or therapeutic. Preventive vaccines are commercially available for against cervical and liver cancer causing viruses such as human Papillomavirus and Hepatitis B virus, respectively.

However, in spite of these advances, limitation such as tumor heterogeneity, unpredictable efficacy and identification of potential markers still exist in the field of cancer immuno-therapy. Therefore, new more targeted cancer immuno-therapies and preventive strategies are being developed and tested, which will deliver novel efficacious therapy against relapsed or refractory cancer patients.

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