Life Vincent Pallotti Hospital, in Cape Town, has upgraded its successful ‘first for Africa’ multimillion-rand Novalis Tx radiotherapy equipment, better known as Novalis Radiosurgery. Charlene Yared-West finds out more.

Can cancer really be beaten?

The disease has become so common as more and more people are diagnosed with some form of it. Sadly, we are all programmed to think it could never happen to us or to someone we love – a family member, friend or colleague – but then it does. The question we want answered then is: can cancer be beaten?

Research from the University College London School of Pharmacy projects that worldwide, cancer is expected to reach 26 million new diagnoses and 17 million deaths per annum by 2030. However, with new therapies, pharmaceuticals and technologies, such as the Novalis Tx equipment, constantly being developed, many forms of cancer could be eradicated for most age groups by the year 2050.

Last year, it was reported that more than one million patient treatments worldwide had been performed with the Novalis Tx machine since its launch in 2007, and an estimated 200 000 treatments are now performed annually. Studies have shown one out of every two cancer patients can benefit from Novalis Radiosurgery, which is good news for those diagnosed.

‘I believe that this machine offers top-end technology, which allows us to treat our patients with a high degree of accuracy and, due to its significant output, it can also minimise treatment times,’ says Dr Rainer Fröhling, radiation and clinical oncologist at Life Vincent Pallotti Hospital in Cape Town. ‘It allows us to target cancers in sensitive areas and to minimise side effects, and in conjunction with other treatment modalities, offers the chance of better outcomes to our patients.’

Saving lives without scalpels

The Novalis Tx has been in operation since 2007 in selected countries around the world. It was launched in South Africa at Life Vincent Pallotti Hospital in December 2013, six years after its inception. It is a non-invasive radiotherapy using state-of-the-art high-tech systems to destroy cancer anywhere in the body in short 20-minute sessions – without the need for surgical incisions or serious operations.

With its sleek design, the machine rotates around the patient from every angle, delivering radiation beams onto the body, where needed. The team of attending medical professionals, including oncologists, a medical physicist and radiotherapists, skilfully manage and guide the Novalis Tx, obtaining necessary information about the tumour during treatment.

‘The Novalis Tx is used to treat both malignant and benign conditions. In simple terms, it produces radiation in the form of photons and electrons used in radiotherapy, which causes damage to the structure of a tumour cell, resulting in the cells dying and the tumour shrinking – this can be seen in follow-up scans,’ explains Dr Fröhling. ‘The Novalis Tx produces radiation, which enters the patient from the outside and targets the tumour on the inside. It has the technology to make its treatment as accurate as possible, and has an array of imaging tools to ensure precision.’

The machine is so smart, says Dr Fröhling, it can take into account the patient’s breathing so as to focus the radiation beam on to the tumour only, while minimising the dosage to normal tissues around the tumour. ‘These highly focused treatments are particularly useful for brain tumours, as well as those found in the lungs, pancreas, spine and liver, where you have to be very careful not to damage surrounding tissues – and where surgery would be very difficult.’ Dr Fröhling adds the machine is linked to sophisticated software to plan the treatment, assess the dose and positioning of radiation in the patient, and to deliver the radiation with a high degree of accuracy.

How does it compare to other cancer therapies?

Besides its acute precision to the millimetre, normal tissues are increasingly spared radiation damage. This can therefore also lower the side effects of the treatments as the Novalis Tx shapes the radiation beam precisely to match the tumour or lesion. Conventional radiotherapy also usually takes place over an extended time frame of between two and six weeks, whereas Novalis Radiosurgery is much shorter and can be done in as little as one treatment in certain cases.

‘I do believe the technology available to us with the Novalis Tx allows for highly accurate radiotherapy and, in the correct indication, this accuracy is clinically relevant,’ says Quinton Africa, lead therapist at the Novalis Tx unit at Life Vincent Pallotti Hospital. ‘Chemotherapy and surgery maintain a vital role in the successful treatment of many cancers, and all available treatment options should be accessible to our patients to maximise their results. Radiotherapy on certain brain tumours may lower the extent or eliminate the need for surgery, and so decrease surgery-related death.’ The cost of treatment with the Novalis Tx is more than conventional radiotherapy, but with the correct motivation for the correct indication, it is considered by most medical aids. Eligibility for radiosurgery depends on the type and location of the tumour and the extent of the patient’s disease, and is determined on a case-by-case basis.

Minimal side effects

Novalis Radiosurgery does not require anaesthesia and usually, there is no scarring and very little risk of infection when compared to conventional surgery, explains Africa. ‘You might, however, experience a headache, dizziness and fatigue immediately afterwards, so it would be advisable to arrange for transport home after the treatment,’ he says.

Meet the team

The specialised Oncology Centre at Life Vincent Pallotti Hospital embodies a multidisciplinary team approach to cancer care – a distinction of which the unit is very proud. Patients are treated by a team of oncologists, radiotherapists, medical physicists, nurses, surgeons, psychologists and other specialists who work together to achieve a truly multidisciplinary approach to cancer treatment in a modern, convenient and comfortable setting.

One team member, radiotherapist Lesle Campbell, says it’s her responsibility to deliver accurate treatment and ensure patients are cared for, informed and happy. ‘I respect the fact that I’m helping patients at a very difficult time in their lives. I am able to listen, encourage and give support, as well as to participate actively in helping them overcome cancer,’ she says. ‘I also love that my job is technically challenging. It is not an easy career path, but it is a rewarding one.’

Radiotherapist Jamie-Lee van Niekerk ensures that treatment on the Novalis Tx is administered with minimal discomfort for patients. ‘It is amazing to see how technology has changed the landscape of cancer care,’ she says. ‘It is a very fast-paced job that advances and changes all the time. This is part of why I love what I do.’ Another radiotherapist, Lucinda Oosthuizen, explains that a large part of her role is to listen to the stories of the families she sees. ‘We have to inform families about treatment and the side effects – we really do build strong relationships with our patients,’ she says. ‘The gratitude most patients display for the role we have played in their lives and their treatment journey, and seeing their condition improve, is rewarding and fruitful.’

Other treatable conditions with Novalis Radiosurgery

‘We are finding new ways of using the technology to treat various conditions all the time; the sky is the limit,’ says Dr Fröhling. ‘The patients who entrust us with their care are our daily motivation. Working with a team of dedicated radiotherapists, planners, a physicist and oncologists allows us to get the best out of our equipment for our patients.’

According to Dr Fröhling, the machine can be used to treat malignancies, benign tumours and some non-cancerous conditions included in the list below:

• Malignant brain tumours (metastasis from other cancers, primary brain tumours, tumours of the skull)
• Benign tumours of the brain and in the head and neck area (meningiomas, acoustic schwannomas, pituitary adenomas)
• Functional pain conditions (trigeminal neuralgia)
• Blood vessel malformations (arterio-venous malformations)
• Tumours involving the ocular structures
• Tumours close to the spine where radiation dose to the
  nerves/spinal cord needs to be minimised
• Malignant tumours of the pancreas
• Liver tumours, such as metastasis
• Lung tumours (primary lung cancers and metastasis)