Today, the treatment of cancer has significantly advanced thanks to technological improvements. However, equipment is not enough: the work of highly trained and experienced clinicians who target the tumor with pinpoint precision is key. At the Department for Radiooncology at the University Hospital in Zurich, technology goes hand in hand with experience, and this reaps surprising results: the fight against tumors has progressed to a new stage, and therapy for patients is as sparing as possible. Here is an interview by SHM with Professor Matthias Guckenberger, chairman of the Department for Radiooncology at the University Hospital in Zurich, about the latest technical devices and methods of treatment of oncological diseases.
– Professor Guckenberger, could you explain, how does the success of radiooncological treatment depend on the de velopment of tech nolog y? Is everything subject to machines?
– Technology is for sure important but the main role still belongs to humankind. Technology is the basis of therapy, but does not guarantee success in therapy – this is the duty of a specialist and his or her unique experience and knowledge. Oncological treatment in the present day is decisively interdisciplinary and
multi-professional and we have created ideal conditions and environments for it at our University Hospital in Zurich. The basis of our work is an experienced team of experts that has been assembled here in this dedicated center for precision radiotherapy. We examine the current medical history of each patient in our
multidisciplinary tumorboard, where all our experts are present: surgeons, medical oncologists , radiation oncologists, pathologists, radiologists, and specialists in the field of nuclear medicine. We study medical images, discuss the nature of the pathology, take into account the patient’s wishes, and then choose the atient’s individual optimal treatment strategy. The doctor appointed as responsible contacts the patient and refers him to therapy.
I always compare this process with the Formula One racing. You can drive the racing car alone, but you can’t win the race without coaches, tacticians, mechanics, technicians. And to win, your car should be equipped with the latest technology.
– Let’s go back to the question of technology – what innovations have you already used in your work?
– We are currently implementing two of the latest technologies available. The first one is particle therapy, which is irradiation with protons. Protons damage the DNA of cancer cells, causing the tumor to break down. This method is often used to treat brain tumors in children. We are working side by side with
the Paul Scherrer Institute, the only center in Switzerland that uses this technology.
We are also actively implementing a contemporary, highly innovative apparatus – the so-called MR Linac. This is a combination of an MRI scanner and an irradiator. One of the most serious problems in radiation therapy is the localization of the tumor. During therapy, the patient lies motionless on the table, but the tumor in the internal organs might move slightly due to breathing. As a result, the radiation beam aimed at the tumor falls on healthy tissue as well. You can see that every millimeter is important in this case. MR Linac allows you to localize the tumor very accurately and register its slightest movement, therefore inimizing the effect on healthy tissue.
– And what are the advantages of radiotherapy before surgical treatment?
– The main advantage of radiooncology is that – sometimes in combination with the appropriate chemotherapy – we have a chance to preserve the organs affected by the tumor. We do not need to cut them out, because the tumor disappears after this treatment. This is important for, for example, prostate cancer – under radiotherapy the nerves remain intact, which allows one to maintain erectile function and sexual activity.
This is also the case for bladder cancer and especially rectal cancer – when there is no need for surgical treatment, you can save the patient’s own organ and do without artificial outlets. It’s very important for the emotional state of the patients while in rehabilitation: they don’t have to be tormented with memories of the illness they have come through. Besides, radiotherapy is indispensable in treating elderly patients, whose bodies will hardly be fit to receive surgery. Radiation
therapy is easier to tolerate and to go through.
– But there are probably some areas of oncology where radiotherapy is still to be used, aren’t there?
– I would definitely say that current developments and research in radiation oncology makes its application possible and useful in almost any field. Moreover, radiation oncology is, unfortunately, still underrated and often underused. Overall, it is most important that patients are consulted at centers where various experts in cancer treatment can offer their input on order to find the optimal treatment strategy: this may be surgery or radiotherapy.
– I would like to learn about the use of immunotherapy in your hospital.
– Immunotherapy is very effective for patients who have melanomas, as well as some other types of lung cancer. However, in these diseases, the proportion of patients whose cancers respond to immunotherapy is about one-third of the total number. Unfortunately, this therapy is ineffective for other patients, and the reason is that cancer ‘hides’ from one’s own immune system before we conduct immunotherapy. We are currently doing research to find out whether radiation therapy can solve this problem too.
– How do new methods help to recognize the disease early on?
– Preventive examination can play a decisive role in the treatment of many diseases, especially colorectal cancer, breast cancer, prostate cancer and lung cancer. If we carry out an examination in time and find the disease at an early stage, before it has become metastatic, then we will significantly increase the chances of medical treatment.
– You have mentioned treatment of breast cancer. If it is discovered at an early stage, can radiation therapy help to dispense with surgery?
– Today, radiation oncology is one of the pillars of breast cancer treatment and, fortunately, more and more women are being irradiated with the operation,
which helps to stop the disease. But it’s impossible to dispense with surgery just yet. This is a matter for the future.
– How effectively can the new technologies be applied in the treatment of stage four cancer?
– We used to think that there was no hope for a patient with fourth stage cancer, because in this case the cancer has already spread to the lungs, to the liver or the brain, and this was a death sentence for a man. Now we know it’s not always the case.
Today we know of the so-called oligometastatic stage of cancer. It means that even if the cancer has spread and has gone through several metastases, up to five, we still have a chance to save the patient. Cancer can be completely cured if local treatment and systemic treatment are combined: surgery and / or radiation therapy, to locally eradicate all visible metastases in the body, and chemotherapy or immunot herapy, to systemica l ly eradicate single cancer cells in the body which cannot be seen with imaging. Due to precision irradiation, the patient still has a chance to live despite the metastasis having begun.
In oligometastatic prostate carcinoma, we aim for a different goal. It is known that antihormonal therapy is often used for this – it stops cancer but causes chemical castration. Our decision is to avoid or defer this treatment by ablating metastases with radiation. We monitor patients closely after this treatment and
use antihormonal therapy only if the cancer comes back and progresses.
Until then, patients do not suffer from chemical castration and can enjoy an active sexual life.
– What other benefits of radio-therapy would you emphasize?
– We plan irradiation in the patient’s absence, meaning we simulate our treatment on an image of the patient. By doing so, we can estimate the side effect of irradiation even before treatment. We can find out whether one or the other method is most effective for a particular person. This is possible only with radiotherapy.
– Are these modern treatments available for foreign patients as well?
– Yes. Many patients come from abroad to undergo the most accurate and effective radiation treatment here in Zurich University Hospital, and we are expanding our work with foreign patients. From 2020, we will have a medical center in Zurich airport, ideal for our foreign patients. We are planning radiotherapy treatment there, where the patient flies into the airport in the morning, the treatment planning is done during the day, the treatment is delivered in the afternoon or evening, and thus he or she can fly home in the same evening. This is part of my vision for modern radiotherapy and cancer treatment.
Matthias Guckenberger
Professor and Doctor of Medical Sciences, he is one of the world’s leading specialists in radiation oncology. He graduated from the medical faculty of Wurzburg University in 2003. For 10 years he has been an active researcher and clinician at the University Hospital of Wurzburg, and the Institute of Cancer Research UK,
London. In 2014, Professor Guckenberger was assigned full professorship at the University of Zurich and became the chairman of the Department of Radiation Oncology at the University Hospital of Zurich. He is an active member of the German Society of Radiation Oncology (DEGRO), the European Society of Radiotherapy and Oncology (ESTRO) and the European Organization of Cancer Research and Treatment (EORTC).
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