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.

The Life of Mammogram Inventor Stafford L Warren

Stafford L. Warren was one of the most significant contributors to radiology during his lifetime. He not only was the first doctor to perform a mammogram, but was also had a hand in turning UCLA into one of the most prestigious medical universities in the country, was a special assistant on mental disabilities to Presidents John F Kennedy and Lyndon B Johnson, and aided the U.S. government in testing of nuclear weapons before speaking out about the dangers of nuclear fallout from weapons testing, which were controversial at the time. However, his strong opinions would eventually be considered, leading up to the Partial Nuclear Test Ban Treaty in 1963.

Born in New Mexico in 1896, Stafford L. Warren attended the University of California, Berkeley, and graduated with his Bachelor of Arts degree in 1918. Heading to the University of California, San Francisco, he graduated with his Doctor of Medicine degree in 1922 and later did post-doctoral work at John Hopkins School of Medicine and Harvard University.

Warren became an Assistant Professor of Medicine at the University of Rochester School of Medicine in 1926. Since the Department of Radiology was brand new at the time, Warren was one of the original group of medical professionals that Dean George Whipple chose to staff the school. By 1930, Warren was an Associate Professor of Medicine. He began to study the work of Albert Salomon, a sociologist from the University of Berlin who produced over 3,000 images of mastectomy specimens and extensively studied the many forms and stages of cancer in the breast. Since Salomon wasn’t keen to recognize the life saving aspects of his discoveries, Warren expanded on his research, using radiology to track changes in breast tissue and developing a stereoscopic technique in which the patient would lie on her side with one arm raised while being X-Rayed. This was a huge breakthrough for breast cancer detection, as it allowed diagnosis of breast cancer to be possible without surgery. Warren subsequently published “A Roentgenologic Study of the Breast” in 1930. Today Warren is cited as the inventor of the mammogram for his breast imaging technique. Each year mammograms are responsible to diagnosing millions of breast cancer cases, effectively saving the lives of women the world over.

Warren, having now tackled a major milestone in his career and developing a new life saving technique, then went on to take on a new project: overseeing the health and safety of thousands during the Manhattan Project. His new role meant being responsible for the safety aspects of the detonation of the Trinity nuclear test in Alamogordo, New Mexico on July 16, 1945. He later handled radiological safety when he led a team of surveyors to Japan, and to the Bikini Atoll in 1946, where more nuclear testing was done. Warren was in charge of assessing the radioactive contamination of the environment and atmosphere, which he was appalled by.

In response to this, in a piece for LIFE magazine in 1947 he wrote, “The development of atomic bombs has presented the world with a variety of formidable scientific, moral and political problems, nearly all of them still unsolved.” He went on to write an in depth analysis of the effects of the bombs, people and environment affected, the time length in which the effects of the bomb lasted, safety measures used during the Bikini expedition in which “a month passed before men could stay on some of the ships for more than an hour”, and “300 men of the safety section lived and worked in the contaminated area to protect some 42,000 other members of the Bikini expedition. Every group which entered the target area was accompanied by a safety monitor who determined how long it could stay.” The men were then bathed carefully when they returned, and if their Geiger counters indicated radioactive contamination they had to be bathed again. “Occasionally when a man had taken off his protective gloves in the ‘hot’ area, the safety section had to dissolve the outer layer of skin from their hands with acid.” Clothes and other materials found too contaminated were sunk into the ocean a mile below the surface, because there was literally “no other way to keep them permanently away from human beings.”

In the article, Warren concluded that atomic weapons can never be prepared for by anyone involved, and that “no defense would have been effective. The only defense against atomic bombs still lies outside the scope of science. It is the prevention of atomic war.”

Warren left his position in 1946, becoming the Chief of the Medical Section of the Atomic Energy Commission, which is a civilian agency that succeeded the Manhattan Project; and later he was awarded the Army Distinguished Service Medal and the Legion of Merit for his contributions to radioactive and atomic weapons safety.

In 1947, Warren was once again at the helm of a brand new medical university, this time UCLA, which had been voted on to establish a medical school for Southern California. He was appointed as the school’s first dean. In 1951 the first students, 28 in total, were enrolled, and there were 15 faculty members. By 1955, when the class graduated, there were 43 faculty members. The UCLA Medical Center officially opened in 1955, and Warren oversaw many milestones and achievements while there, including the addition of schools for Dentistry, Nursing, and Public Health.

Discussion on Cell Therapy From The Point of Standardization, Scale, and Industrialization

What is cell therapy?
Cell therapy refers to the transplantation or input of normal or bioengineered human cells into a patient’s body and newly-imported cells can replace damaged cells or involve a stronger immune killing function, so as to achieve the purpose of treating diseases. Cell therapy has shown higher application value in the treatment of cancer, hematological diseases, cardiovascular diseases, diabetes, Alzheimer’s disease etc. In general, cell therapy includes tumor cell immunotherapy and stem cell therapy. There are two cell sources for cell therapy, one from the patient itself and the other from the allogeneic tissue.

The Defects of Cell Therapy
The cell is the most basic unit that contributes to a living organism, however, it does not mean that everyone shares the same cells. On the contrary, there is a huge difference in each individual which can be compared to human-to-human differences, that is, two identical people never exist. The huge difference between cells and cell preparations is the biggest drawback of cell therapy. In this post, we will discuss several issues that need attention in the current stage of cell therapy.

Difficulties in the Standardization of Cell Therapy
Cancer cell immunotherapy cannot be standardized from the stage of raw material acquisition. The cell treatment materiasl for each paitient are their own blood leukocytes. The condition and physical condition of each patient are different, and the collected white blood cell growth quantity and kill activity are not uniform and cannot be standardized. As it is impossible to standardize raw materials, preparation processes, and product specifications, it cannot be standardized, industrialized, and scaled up. Each tumor cell immunotherapy laboratory meets the GMP level with the hardware environment, and it can be more like a cell preparation workshop. Researchers ranged in number from a few to a dozen and could not really meet the standards of division of labor of industrialized pharmaceutical companies. Taking stem cell therapy that using umbilical cord mesenchymal stem cells as an example, which raw material is an umbilical cord, and one umbilical cord-produced cell can be utilized by many paitients. The standardization path is more advanced than the immunotherapy of tumor cells, and the raw materials can be standardized to some extent.

Difficulties in The Scale of Cell Therapy Industry
At present, the production mode of the cell therapy industry mainly depends on technicians. In the 10,000-grade clean laboratory, the cells are operated in class 100 clean bench, cultured in a carbon dioxide incubator, centrifuged in a centrifuge, observed through an inverted microscope, and the drug reagents are stored in a medicine refrigerator. All of these devices are operated by independent biological laboratories of the individual and being linked together through the operations of scientists. This type of production model is small in scale and similar to workshop-type production. Although there are some large scales, the essence is a collection of many small workshops. Due to the small scale, the instruments used are laboratory instruments and many of the reagents used are scientific reagents, which will lead to the issue of low efficiency but high cost.

Autologous or Allogeneic
There are two kinds of cell sources for cell therapy, one from the patients and the other from the allogeneic tissue. Autologous cell therapy cannot be standardized from the raw material acquisition stage, and it are only applied to the patient itself, the essence is essentially medical technology. The prevalence of autologous cell therapy as a medical technology is mainly due to the scale of the predicament. Allogeneic therapy, the cells derived from allogeneic. Taking tumor cell immunotherapy as an example, the cell source may be from cord blood, and the larger-scale cell source may be a filter plate for leukocyte filtration at the blood bank. Taking umbilical cord mesenchymal stem as an example, the cell source is the umbilical cord, and one umbilical cord-producing cell can be used by more than one person. If scale can be cultivated, although the quality standards cannot be quantified well, the scaled products themselves have a certain degree of standardized properties.

The cell industry, as an industry, is not the path to the advancement of cell-based therapeutics. If the advanced technology cannot be mass-produced on a large scale, it can only stay in the laboratory and become the object of research for scientists, never have achance to become a drug into the majority of patients. For allogeneic cell therapy that using allogeneic cells as raw materials, the standardized properties of the scaled products can be realized if large-scale cultures are prepared, then scale and standardization can promote each other. The current progress in standardization of cells is not easy, but the progress in scale should be relatively easy to achieve.

Natural cytokine supernatants with more standardized and standardized properties
Cytokines are a class of small molecule proteins with broad biological activity synthesized and secreted by immune cells (such as monocytes, macrophages, T cells, B cells, NK cells, etc.) and certain non-immune cells (endothelial cells, epidermal cells, fibroblasts, etc.) Immune responses are regulated by binding to the respective receptors to regulate cell growth, differentiation and effects. Cytokines (CK) are low-molecular-weight soluble proteins that are produced by various types of cells induced by immunogens, mitogens, or other stimulants. They have the ability to regulate innate immunity [1] and adaptive immunity [2], hematopoiesis, cell growth, and damage tissue repair and other functions.

Cytokines can be divided into interleukins, interferons, tumor necrosis factor superfamily, colony stimulating factors, chemokines, growth factors etc. Cytokines form a very complex cytokine regulatory network in the body and participate in many important physiological functions of the human body. Where stem cells and immune cells cannot reach the body, cytokines can easily reach target tissue sites because of their small size.

In recent years, recombinant gene cytokines have made remarkable achievements in clinical applications as a novel biological response modifier. A large part of the effects of stem cell therapy and immune therapy arises from the action of cytokines secreted in the body. The stem cells and immune cells in the body are introduced back into the body to secrete a variety of natural structural cytokines. Although the amount of these cytokines is relatively small, they are synergistic and act directly on the cytokine network in the body because of their high natural structure activity, lack of antigenicity but diversity. Because of the standardization, standardization, industrialization, and scale of natural compound cytokines, it is more cost-effective than cell therapy, allowing more patients in need to enjoy cell-like therapeutic effects.

Although natural complex cytokines can largely replace cell therapy, but there are still conditions that require the presence of cells to exert a therapeutic effect. We hope that cell therapy can break the current situation, become high efficiency and low cost with large scale, more standardization, and then be applied to more disease treatments.