Cancer is a leading cause of death worldwide and according to the World Health Organisation there were approximately 14 million new cases and 8.2 million cancer related deaths in 2012.
The burden is expected to increase worldwide due to the growth and ageing of the population, particularly in less developed countries, in which about 82% of the world's population resides.
This is also the case in the Western Cape, where the increase in cancer patient numbers is putting pressure on existing services and facilities to not only treat more patients, but also to continuously improve the level of service delivery.
A new state-of-the-art Elekta Synergy Agility ® linear accelerator (LINAC), which was commissioned at the Division of Radiation Oncology at the Faculty of Medicine and Health Sciences and the Tygerberg Hospital in 2014, will assist the division to render sustainable services.
"It will enable the Division to provide radiotherapy services to an increasing number of patients in surrounding communities and rural areas in the Western Cape within a reasonable waiting period," says Prof Hannah Simonds, the Head of the Division.
There are eight radiotherapy machines in the Western Cape, servicing a population of four million people, excluding the numerous machines available in the private sector. "Our new LINAC has the capability to treat about 450 to 500 patients per year," says Simonds.
According to the latest update from the Directory of Radiotherapy Centres' (DIRAC) database, there are currently 190 LINACs on the African continent, of which four are at the Division of Radiation Oncology of the Faculty of FMHS and Tygerberg Hospital.
"Essentially, if there are 190 LINACs in Africa and we have four, we have 2% of the linear accelerators in Africa," says Simonds. She mentions that 50% of the available services are concentrated in South Africa and Egypt and there are approximately eight to 10 working machines in the whole of West Africa.
The division treats nearly 2 000 patients each year, including curative radiotherapy for cervix, prostate, gastrointestinal, brain and breast cancers. Paediatric cancer patients are also treated in the division with high quality advanced radiation techniques.
The new LINAC also includes the latest hi-tech treatment that involves using Volumetric Modulated Arc Therapy (VMAT), which delivers the radiation dose to the patient in a single moving arc from 0 to 360 degrees. Older technology LINACS deliver the dose to the patient in a combination of separate beams. This new VMAT technology vastly reduces treatment time.
In addition to the VMAT technology, the machine can also treat radical and palliative patients with the more traditional 3-dimensional and 2-dimensional radiation techniques.
Successful radiotherapy depends on the ability of the LINAC to deliver a dose of radiation to the tumour while ensuring minimal radiation to normal tissue. The new LINAC has an improved beam shaping mechanism, termed a multileaf collimator, which consists of 160 0,5cm leaves that can be shaped into almost any shape.
Previous collimators could only shape the beam into squares or rectangular fields. The improved beam shaping mechanism allows doctors to better match the shape of the beam to the shape of the tumour, which decreases radiation to normal surrounding tissue. This reduces the side effects normally associated with radiation treatment.
The implementation of the new technique involves more input, calculations and quality assurance from medical physicists, radiographers and oncologists to prepare the patient's treatment plan. Although the preparation is more time-consuming, once the planning is complete, the individual patient's treatment time is shortened to a matter of minutes. This technology is at the cutting edge of radiation delivery and is on par with techniques used in Europe and the USA.
In addition, the availability of this new technology allows for advanced training for radiation oncologists, radiographers and physicists. "The division currently trains specialists from South Africa, Namibia, Nigeria and Zambia," says Simonds.
Photo: Ms Melanie Grobler, a medical physicist, explains the improved beam shaping mechanism to Profs Vikash Sewram (left), Annare Ellmann, Drs Revere Thomson and Paul Ciapparelli.
