HealthCare Global Enterprises Ltd, The Specialist in Cancer Care, today organized a press conference at Hyderabad, on Robotic Radiosurgery for Urological Conditions.

Dr. G. Kilara, Senior Consultant, Radiation Oncologist, HCG, said, “The incidence of the prostate cancer is on the rise. Lifestyle factors have also contributed to this increase. Prostate cancer constitutes to 6% of all cancers in men. With the advancement in technology, we are now able to target the disease with larger doses of radiation, with sub-millimeter accuracy. Because of the organ motion, traditional methods of radiation had to treat a larger volume of tissue to achieve this and this meant increased dose to some of the normal surrounding structures. For Ex: Bladder, Rectum and Intestine. Robotic Whole Body Stereo Tactic Radio Surgery, tracks the organ motion in real time and directs radiation with sub millimeter precision at the tumor tissue. This is typically applicable in prostate cancer, where we effectively cure the disease, but spare the bladder and the rectum.”

He further adds, “Because of the high doses of radiation per sitting (Hypo Fractionation), the entire process of treatment can be completed in 8 to 10 days as opposed to 7 to 8 weeks with conventional treatments.”

CyberKnife:

It is the world’s first non-invasive whole body robotic radiosurgery. CyberKnife offers patients new hope for the treatment of tumours and lesions, including ones that previously have been diagnosed as inoperable or untreatable with the existing technology. CyberKnife uses state-of-the-art real-time image guidance, similar to cruise missile technology, to precisely target tumours anywhere in the body with pinpoint accuracy and delivers high doses of radiation.

Advantages of CyberKnife:

 Non-invasive and pain-less
 Treats inoperable tumors
 Pin-point accuracy
 Significantly reduces treatment time
 Automatic movement tracking
 No need for invasive body or head frame
 Higher radiation dose possible
 Minimises side effects

About HCG:
Health Care Global Enterprises Ltd, (HCG), The Specialist in Cancer Care, headquartered in Bangalore with over 23 cancer centers is South Asia’s largest cancer care network. HCG has defined the future of cancer care in India by designing, building and managing cancer care centres with a committed vision. HCG focuses on cancer care treatment, imaging and laboratory services, clinical trials and research services. The vision of HCG is to make high quality cancer care accessible by adopting global innovations to all segments of the society.

One in every 10,000 children in India is affected by cancer. According to statistics, 1.6 to 4.8 of all cancer cases reported in the country is among children below 15 years of age. On the occasion of International Childhood Cancer Day, on February 15, experts from the city speak about childhood cancer and treatments available.

In India the reported incidences of childhood cancer have increased over the last 25 years.

“The cause for many cancers is unknown, though theories point to genetic and environmental factors. There is an increased awareness about cancer in children in the society, leading to early diagnosis. Better availability of advanced treatments has led to better outcomes. Today, we can cure 70 per cent of all cancers in children. The survival of cancer-affected children is improving in the country and we are catching up with developed nations in this regard,” said Dr CP Raghuram, consultant, pediatric oncologist, Healthcare Global (HCG).

He further adds, “Also, in case of pediatric cancer, sperm banking is advised before starting chemotherapy for boys above 12 years of age, as there is a risk of infertility in later life due the treatment. However, preservation of eggs in case of cancer-affected girls is yet to take off in the city, said Dr Raghuram.

BANGALORE: Isak Ibraham from Tanzania was one among the unlucky 1,00,000 children across the globe suffering from retinoblastoma or cancer of the eye. It was a double whammy for the two-year-old as he was diagnosed with cancer in both eyes.

A study says it’s the most common eye cancer in children and constitutes 3% of all cancers in kids. The incidence is about 1 in 1,00,000 under 5 years but 80% of the cases are seen in children below 4 years.

SECOND OPINION HELPED

Isak was diagnosed in Tanzania in early 2011, and his left eye was surgically removed. But he faced the danger of losing his other eye. His mother then came to HCG Cancer Hospital in Bangalore for a second opinion and saved his right eye.

Dr CP Raghuram, consultant , paediatric oncologist, HCG Cancer Hospital, said: “We wanted to treat the cancer while trying to save the other eye and his vision. We first gave him chemotherapy to shrink the tumor. We also preserved his eye by reducing the size of the tumor and making it amenable for local treatment by the ophthalmologist.”

Dr Raghuram said organ and vision preservation is the main concern in children with retinoblastoma. Abnormality in the eye with squint is its usual symptom. “If untreated, children will lose their vision and could be life threatening,” he said. Isak also received laser and thermotherapy in an eye hospital. He is completely cured now and has left for Tanzania , said the doctor.

Says Geeta, “I was told that to live, I would have to lose my breast. But now as I live and realize that breast removal was not necessary to cure me or my breast could have been immediately reconstructed, I feel miserable, humiliated, half woman with one breast. It’s terrible. I wear clothes that will not show my missing breast, wear padded bras and do all things possible to undermine this humiliation. Sometimes I wish I had the guts to choose to die rather than live with one breast.”

Breast conservation became standard practice globally since the last three decades as a result of path breaking research. Unfortunately myths and substandard practices rule the roost in our country and hence patients like Geeta, suffer the consequences of these mutilating surgeries.

In India about 1,00,000 women suffer from breast cancer every year and the incidence is increasing rapidly especially in the Metropolitan cities. It affects younger women in India (around 40 to 50 yrs) as compared to the Caucasian race, thus making it even more relevant that we do not disfigure women at this age.

Oncoplastic surgery a recent advancement not only saves lives but also ensures excellent cosmesis. Women globally prefer to have their breasts lifted, reshaped and contoured to make them look younger, aesthetic and shapely. Oncoplastic surgery that combines these principles of plastic surgery with those of cancer surgery helps women look younger, more shapely after treatment for breast cancer adding a new dimension to their quality of life.

Mastectomy or breast removal becomes absolutely mandatory in about a quarter to a third of breast cancer patients due to certain compelling reasons such as large tumors, multiple tumors in a breast etc. Various techniques of immediate breast reconstruction by either using safe breast silicone prosthesis or using borrowed muscle and skin from the back or abdomen have evolved where women can feel complete immediately after their surgery where the reconstructed breast mimics a natural breast accurately. The silicone prosthesis available today are compact, cohesive and safe. There is no credence to the fact that use of the prosthesis can induce cancer. The incidence of rupture of the prosthesis and other complications are negligible.

Thus, Breast surgery has evolved from being simple but mutilating (Radical extirpation of the breast, muscle, skin and lymph nodes from the axilla) to advanced, complex, refined and comprehensive, aimed at providing better quality life. Today breast saving surgery, mastectomy ( breast removal) or skin saving mastectomy both with immediate reconstruction and removal of only one node from the armpit(sentinel node) have replaced radical surgery. These techniques ensure that women feel normal, enhanced younger and have markedly less side effects.
Breast saving treatment and breast reconstruction options address maintains the feminity, body image, sexuality and the sense of being complete, prevent depression and sense of loss in women. They address issues related to the partners psyche and reduce marital problems. Conventional mastectomy causes physical problems as well such as shoulder stiffness, massive swelling of the arm and postural problems

To conclude , oncoplastic breast units address the issues of breast treatment globally and provide an option of leaving or creating an intact perfect breast post treatment. Such a comprehensive oncoplastic breast unit would eventually offer cosmetic surgery options to women seeking solutions for the ageing breast that droops or the young breast that needs to be enhanced.

By focusing on molecular and cellular changes that are specific to cancer, targeted cancer therapy may prove to be effective against the disease.

Cancer, the dreaded C-word, is most often related to pain and inevitable death. But modern medicine is far advanced and new treatments have enabled doctors to treat it, reduce side effects and thus improve the quality of life of a patient. Target therapy is opted as the first line of treatment for most cancer diseases and has yielded positive results.

What is targeted cancer therapy?

Targeted cancer therapy uses drugs that block the growth and spread of cancer.

They interfere with specific molecules involved in carcinogenesis (the process by which normal cells become cancer cells) and tumour growth. As scientists prefer to call these molecules molecular targets, this form of therapy is called molecularly-targeted therapy. By focusing on molecular and cellular changes that are specific to cancer, targeted cancer therapy may be more effective than current treatments and less harmful to normal cells.

Most targeted cancer therapies are in preclinical testing (research with animals), but some are in clinical trials (research studies) or have been approved by the US Food and Drug Administration (FDA). Targeted cancer therapies are being studied for use alone, in combination with each other, and in combination with other cancer treatments, such as chemotherapy.

What are the cellular changes that lead to cancer?

Normally, cells grow and divide to form new cells as and when the body needs them.

When cells grow old, they die, and new cells take their place. Sometimes this orderly process goes wrong. New cells form when the body does not need them, and old cells do not die when they should. These extra cells can form a mass of tissue called a growth or tumour. The cells in malignant (cancerous) tumours are abnormal and divide without control or order. They can invade and damage nearby tissues and organs. Also, cancer cells can break away from a malignant tumour and spread to other parts of the body.

Normal cell growth and division are largely under the control of a network of chemical and molecular signals that give instructions to cells. Genetic alterations (changes) can disrupt the signaling process so that cells no longer grow and divide normally, or no longer die when they should. Alterations in two types of genes can contribute to the cancer process. Proto-oncogenes are normal genes that are involved in cell growth and division. Changes in these genes lead to the development of oncogenes, which can promote or allow excessive and continuous cell growth and division.

Tumour suppressor genes are normal genes that slow down cell growth and division. When a tumour suppressor gene does not work properly, cells may be unable to stop growing and dividing, which leads to tumour growth.

To use the metaphor of a car, the presence of an oncogene is like having a gas pedal that is stuck to the floorboard, causing cells to continually grow and divide.

Tumour suppressor genes act like a brake pedal. The loss of a functioning tumor suppressor gene is like having a brake pedal that does not work properly, allowing cells to continually grow and divide.

Genetic changes that are not corrected by the cell can lead to the production of abnormal proteins. Normally, proteins interact with each other as a kind of relay team to carry out the work within a cell. For example, when molecules called growth factors (GFs) attach to their corresponding growth factor receptors (GFRs) on the surface of the cell, a process, carried out by proteins, signals the cell to divide.

Damaged proteins may not respond to normal signals, and may over-respond to normal signals, or otherwise fail to carry out their functions. Cancer develops when abnormal proteins inside a cell causes it to reproduce excessively and allow that cell to live longer than normal cells.

How does the targeted therapy work?

Targeted cancer therapy interferes with cancer cell growth and division in different ways and at various points during the development, growth, and spread of cancer.

Many of these therapies focus on proteins that are involved in the signaling process.

By blocking the signals that tell cancer cells to grow and divide uncontrollably, targeted cancer therapy can help to stop the growth and division of cancer cells.

What impact will targeted therapy have on cancer treatment?

Targeted cancer therapy will give doctors a better way to treat cancer. Eventually, treatments may be individualised based on the unique set of molecular targets produced by the patient’s tumour. Targeted cancer therapy also holds the promise of being more selective, thus harming fewer normal cells, reducing side effects, and improving the quality of life.

HCG and Art of Living Foundation join hands to create awareness on cancer

February, 4th, 2012, Bangalore: HealthCare Global Enterprises Ltd, The Specialist in Cancer Care, in association with The Art of Living, on World Cancer Day organized a walkathon to create awareness on cancer. Today, cancer has become a lifestyle disease. Lifestyle changes can prevent nearly 60% of new cancers diagnosed every year.

The aim of this walkathon is to create awareness of the fact that people can make changes today that can reduce the risk of developing cancer.

The walkathon was flagged of by Dr. K S Gopinath, Surgical Oncologist, HCG & Mr. Ravindra Prasad, faculty, the Art of Living, which saw hundreds of participants. Doctors, cancer survivors, cancer support groups, corporates, students and public at large participated in the event.

Speaking on this occasion Dr. K S Gopinath, Surgical Oncologist, HCG, said, “Awareness is the key and the first step in fighting cancer. Activities such as these go in a long way in creating awareness and help in the fight against cancer. I’m glad to see so many people coming to lend their support.”

Mr. Ravindra Prasad, said, “We are pleased to join hands with HCG in the fight against cancer. Cancer being a lifestyle disease has found a direct correlation with smoking. Art of Living quite smoking program has been very effective in helping people abstain from smoking and strengthening the resolve to fight cancer.”

Vandana Ramnane, Cancer Survivor, said, “Awareness is the key, once you know the cause you can make changes. Hospitals creating awareness about the disease help people by imparting knowledge. I was diagnosed with breast cancer, it could be detected early only because I was aware of the symptoms of breast cancer and met the specialist at the right time.”

The cancer communication exhibition and awareness talk is organized at The Art of Living campus in the evening where more than 1000 people are expected to participate.
The theme for World Cancer Day 2012 – “Together it is possible” as stated by Union for International Cancer Control

About HCG:
Health Care Global Enterprises Ltd, (HCG), The Specialist in Cancer Care, headquartered in Bangalore with over 23 cancer centers is South Asia’s largest cancer care network. HCG has defined the future of cancer care in India by designing, building and managing cancer care centres with a committed vision. HCG focuses on cancer care treatment, imaging and laboratory services, clinical trials and research services. The vision of HCG is to make high quality cancer care accessible to all segments of the society by adopting global innovations

About Art of Living: Founded in 1981 by Sri Sri Ravi Shankar, The Art of Living Foundation is a not-for-profit, educational and humanitarian NGO (Non-Governmental Organisation) engaged in stress-management and service initiatives. The organisation operates globally in 151 countries.
The organisation as guided by the founder conducts programs which focus on making an individual stress free and healthy life at every level of its existence starting from physical, mental, emotional and societal. Sudarshan Kriya, a rhythmic breathing technique taught during the program helps in detoxifying the body and relaxing the mind leading to a healthier life.

The Art of Living has conducted Stop Smoking, Start Living” workshop to help people quit smoking. The program has also reached out to 400 people in Bangalore. Programs have also been conducted for cancer patients in various hospitals of the country.

Mr X is a two and half year old boy who was diagnosed to have Bilateral Retinoblastoma in Tanzania. He had enucleation of his left eye and received one course of chemotherapy with Carboplatin, Vincristine and Etoposide in Tanzania and came to our hospital for further management. His development was normal. On examination he had right eye leukokoria. Imaging showed localised disease with no evidence of metastasis. He was seen by geneticist and counseled.

He had further 5 courses of chemotherapy with – Carboplatin, Vincristine, Etoposide. He tolerated the chemotherapy well. He had portacath inserted for intravenous access for chemotherapy. The aim of the therapy was to save the vision in his right eye. He was therefore advised chemotherapy followed by focal therapy to save his vision. He had interval imaging done after 3rd course and 5th course which showed good response and interval reduction in size of the lesion. To preserve the right eye and vision, he had laser therapy after 3rd course and also had shell inserted into orbit of left eye. The plan for local treatment was extensively discussed with the ophthalmologist. Other options considered were brachytherapy, cyberknife and local radiotherapy but was given transpupillary thermotherapy after 6th course of chemotherapy in consultation with the opthalmologist. The boy had improved vision on his right eye thereafter and advised regular followup and discharged (See Fig1).

Retinoblastoma is the most common intraocular cancer of childhood1,2 . It represents approximately 4% of all pediatric malignancies. each year, About 5,000 cases are diagnosed worldwide and only about 50% survive because of failure to detect the disease early. In underdeveloped countries retinoblastoma is often detected after it has invaded the orbit or brain. Children with retinoblastoma are at risk for three important, life-threatening problems including metastasis from retinoblastoma, intracranial neuroblastic malignancy (trilateral retinoblastoma), and second primary tumors.

Several classifications of retinoblastoma have been developed to assist in prediction of globe salvage. The most popular grouping is the Reese-Ellsworth classification (Table 1).

Management

Chemoreduction is a method of reducing tumor volume to allow for therapeutic measures that are more focused and less damaging.1 It has evolved to be an important measure in the initial management of retinoblastoma2-6. The chemotherapy regimen is generally given for 6 cycles to allow for adequate tumor reduction. Focal therapy to the individual tumors is delivered at cycle 2 after achieving adequate tumor reduction and subretinal fluid resolution. The objective of chemoreduction is to reduce tumor size so that focal treatments can be applied to a smaller tumor volume in order to preserve more vision and possibly avoid enucleation and external beam radiotherapy. Studies have reported that the retinoblastomas decreased a mean of 35% in tumor base and nearly 50% in tumor thickness after 2 cycles of chemoreduction.34 Subretinal fluid resolved in 76% of cases and both vitreous and subretinal seeds showed regression with the treatment.7 Thus, it is apparent that retinoblastoma is sensitive to current chemoreduction regimens. Ocular salvage rates have improved with the addition of chemoreduction to treatment regimens (Table 2).

HCG envisions use of personalized care for optimizing the treatment outcomes and improving quality of life of cancer patients.

Ahmedabad : HealthCare Global Enterprises Ltd, The Specialist in Cancer Care, launched the first private comprehensive cancer center on 29th January, 2011, at Ahmedabad, Gujarat. The hospital has state of the art facilities and is equipped with advanced technologies like TrueBeam, an advanced radiation therapy in the treatment of cancer.
This comprehensive cancer center was inaugurated by renowned super star Sri Amitabh Bachchan.
Amitabh Bachchan , Superstar, said, “It is moment immense satisfaction that the state of the art cancer center in India has been inaugurated at Ahmedabad ,Gujarat. I’m glad to know that Indian doctors are coming back from overseas to join hospitals such as this. This will be a hope to millions of cancer patients and add to their quality of life.”
Dr. B S Ajaikumar, Chairman, HCG Enterprises, said, “We are proud to launch the first private comprehensive cancer center in Gujarat. This cancer center has the best of medical expertise and the most advanced radiation therapy technology (TrueBeam) in India.HCG has been at the forefront of providing cutting edge treatment and accessible care. Improving quality of life has been the prime focus at this centre.”
Dr. Bharat Gadhavi, CEO & Medical Director, HCG Cancer Centre, Ahmedabad, said, “A comprehensive cancer center in Gujarat was the need of the hour for many a cancer patients who were looking forward to a qualitative life. With the inauguration of this dedicated cancer center to the people of Gujarat, a dream has come true and this will also redefine cancer care in Gujarat.”
About HCG Ahmedabad:
Health Care Global Enterprises Ltd, (HCG), The Specialist in Cancer Care, headquartered in Bangalore with over 24 cancer centers is South Asia’s largest cancer care network.HCG Cancer Center, Ahmedabad, is a state of the art cancer center. The facility proudly houses the latest technology in cancer treatment first time in India through “TruBeam” an advanced radiotherapy machine. The hospital is all set to provide quality cancer care, Surgical, Radiation & Medical all under one roof with 60 beds, an exclusive 15 bedded ICU, 4 high-tech operation theatre, full range of diagnostics.
The centre’s Medical oncology department is equipped with the facility of (1) Day care chemotherapy centre with specially trained nursing staff (2) High dose chemotherapy (3) Targeted therapy (4) biological therapy which is now recent development of cancer treatment.
Our Surgical Oncology team has been trained in best of the centres in India & Abroad specializing in Head & Neck services, Breast & Thoracic services, GI & Hepato – Pancreato- Billary services, Gyneac Oncology, etc…
About HCG Enterprises:
Health Care Global Enterprises Ltd, (HCG), The Specialist in Cancer Care, headquartered in Bangalore with over 24 cancer centers is South Asia’s largest cancer care network. HCG has defined the future of cancer care in India by designing, building and managing cancer care centres with a committed vision. HCG focuses on cancer care treatment, imaging and laboratory services, clinical trials and research services. The vision of HCG is to make high quality cancer care accessible to all segments of the society by adopting global innovations.

Kottayam: HealthCare Global Enterprises Ltd, The Specialist in Cancer Care, today organized a press conference on CyberKnife Radiosurgery Boost, in Kottayam.
Dr. Kumar Swamy, Consultant, Radiation Oncologist, HCG, said, “Conventional radiation works by the principle of small doses every day and allow recovery of normal cells in between doses. However, this allows the partial repair of malignant cells also. Therefore, in radiotherapy not only the total dose given but also dose per treatment can affect the tumour control. When the patient is on the couch during the radiation treatment there will be natural movement of the patient and also that of tumour (due to either breathing or surrounding organ filling with fluid or gas). This may be in terms of few millimeters to few centimeters. To account for this and not to miss the tumour, wider area of normal tissue is purposefully included. As we include larger normal tissue volume lesser the dose that can be tolerated. Therefore, in conventional radiation therapy focus is more on giving dose to avoid toxicity rather than delivering the required dose to control the tumor. Additionally, cancers like glioblastomas, renal cell carcinomas, sarcomas and melanomas are considered traditionally difficult to respond to conventional radiation doses. CyberKnife is the only stereotactic machine, as of now, which tracks the tumour during the treatment and automatically corrects the patient position.”
What is boost therapy?
It is additional dose of radiation given with the purpose of killing the resistant cancer cells.
When can Cyber Knife boost be given?
» After initial radiation therapy of 5 weeks duration, when the tumour size is large
» After the completion of regular radiotherapy treatment and when the disease is still persisting.
» 3 months after completion of radiotherapy if active disease is still present.
» When the disease comes back in the area treated earlier with radiation.
Sites of cancer that require Cyberknife Boost
The common cancer sites that require Cyberknife boost:
» Glioblastoma multioforme and other brain cancers
» Ca. Nasopharynx
» Ca pancreas
» Ca lung
» Cancer in the Head and Neck region
» Others e.g. sarcomas, cancers in the pelvis, including Ca prostate.

Precision: With phenomenal jump in imaging and software technology, radiotherapy has seen unprecedented development in the last 10 years in it’s over 100 years of existence. This astonishing progress is probably not matched by any other field of medicine. The precision has made the radiotherapy far safer and effective in the treatment of cancer. For example earlier to 2000 one could not treat a prostate cancer with radiotherapy satisfactorily, but now radiotherapy and radiosurgery are now becoming the preferred modality of treatment. There are several non cancerous tumours and diseases that are being targeted by these developments also.

Robotics: The other exceptional development is the introduction of robotics in radiotherapy. With this the new technology of radiosurgery that was developing in the recent decades got a shot in the arm. Radiosurgery is a specialized technique of radiotherapy, where innumerable small beams get concentrated at a point, and is biologically acts uniquely in destroying the cancer cells that are resistant to conventional radiotherapy. CyberKnife is the outcome of fusion of imaging, most sophisticated tracking software and robotics. Cyberknife radiosurgery distinctly differs from the linear accelerator based radiosurgery by automatic robotic adjustment of the position of the cancer bringing it in line of the sharp radiation beam, which a human adjustment in a linear accelerator cannot do. This technically makes it more efficient in targeting the cancer and avoiding normal tissue.

Combination: Basis of the effective cancer treatment always has been combination of treatments combining the advantages of different types of treatment to give the best possible cure and least possible side effects. Classically surgery, radiation therapy and chemotherapy are combined such a way to overcome the disadvantage of one over the other. Similarly in radiation treatment, it is not the question whether one machine is better than the other but the answer is in effective combinations of different types of radiotherapy machines. In several situations best outcome is in combining radiotherapy and radiosurgery. Cyberknife being the dedicated and most effective radiosurgery machine plays a key role in supplementing the benefits of linear accelerator based radiotherapy. And with the rapid pace of advances in design of targeted drugs killing exclusively cancer cells without effecting the normal cells, robotic radiosurgery is going to play more and more vital role in cancer and other diseases.