High Definition Radiotherapy and Radiosurgery at Sri Shankara Cancer Hospital & Research Centre

In the voice of our brand new Linear Accelerator:

Allow me to introduce myself. I am the new member of the Shankara family. I go by the name of True Beam STX. You all are familiar with my two older sisters, Trilogy who is 9 years old and True Beam who is 6 years old. They have toiled very hard at Shankara and have together treated more than 10,000 patients efficiently over the years. I have been brought in not only to help ease their workload but also to bring in new skills.

My eldest sister was very advanced at the time. She can deliver very accurate and fast treatment by using Rapid Arc technology. She is also capable of Stereotactic Radiosurgery treatment. But when multiple sites needed to be treated, she took a long time as there we

re a lot of manual interventions needed. My second sister is more automated than the eldest. She comes with a technology called Flattening Free Filter (FFF), which combined with automation delivers accurate and very fast treatment. But their small limitation was that they could not correct rotational errors that occurred especially during stereotactic treatment.

So you might ask how I am better. Basically, I emit photons for treating cancer. I come equipped with a couch that can move in 6 dimensions (6DoF) that is, apart from the standard anterior-posterior, lateral and cranial-caudal movements, I can also correct rotational displacements. I have an inbuilt CT scan to measure these errors and my couch corrects them. This makes the delivery much more accurate and gives my physician more confidence to treat small tumours. All processes are automated and manual errors are eliminated. I even have automated quality assurance kits that confirm that whatever is planned on the computer is accurately delivered to the patient. My planning system called ECLIPSE is also upgraded and the latest version with which planning is fast and precise.

TrueBeam STX with HyperArc and Eclipse - Best Radiotherapy in Bangalore

I also come equipped with a technology called HyperArc which is wonderful for frameless cranial Stereotactic Radiosurgery (SRS) for treating brain cancers. With HyperArc, SRS becomes more precise and efficient. The planning is faster and therefore more patients can be treated.

I can also treat multiple sites faster using HyperArc. This is similar to what another machine called Tomotherapy can do. The multiple sites can be treated with just a press of a button and the couch movement is automated. There is no manual intervention required. I can therefore finish a patient’s treatment in far lesser time than my sisters and as a consequence treat more patients.

Cancer patients will derive maximum benefit from my capabilities. I hope to serve Shankara’s patients efficiently and effectively for a long time to come.

Written by Dr Karthik. S. Rishi

Senior Consultant Radiation Oncologist, Sri Shankara Cancer Hospital and Research Centre, Bangalore

Email: karthik@sschrc.org

Robotic Surgery Unit & 3rd Linear Accelerator - Latest additions to Sri Shankara Cancer Foundation

Sri Shankara Cancer Foundation (SSCF) has always been at the forefront of adopting the latest technological advancements to deliver the best care to our cancer patients and the addition of the state of the linear accelerator True Beam STX with HyperArc and induction of Sri Shankara Centre for Robotic Surgery at Sri Shankara Cancer Hospital and Research Centre (SSCHRC), Bangalore is a testament to this fact.

The inauguration ceremony for these additions to Sri Shankara Cancer Hospital and Research Centre, Bangalore was held on 26th February 2022.

The Chief Guest for the event was Dr (Prof) M K Ramesh, Hon'ble Vice-Chancellor of Rajiv Gandhi University of Health Sciences (RGUHS), and the Guests of Honour were Smt Susmita Bagchi, Chairperson, Mo School & Minister of State, Government of Odisha, Sri Subroto Bagchi, Chairman, Skill Development Authority and Cabinet Minister, Government of Odisha and Sri Ashok Kakkar, Managing Director, Varian Medical Systems India.

Ganapathi Homa, Vaasthu Homa and Lalita Sahasranama Homa were performed to mark this auspicious event and to seek the almighty's blessings to help us continue serving our patients with the best treatment.

The state of the art Linear Accelerator with HyperArc is housed in a newly constructed bunker, which was supported by Sitaram Jindal Foundation, for which we are eternally grateful. The Chief Guests and Guests of Honour were given a tour of the new facility followed by the opening of the 3rd Linear Accelerator room by the Hon'ble Chief Guest.

The inauguration ceremony began with Dr Tulsi Nagesh invoking the blessings of Goddess Sharadambe on the universe. Sri B R Nagaraj, Trustee - SSCF welcomed the guests and the gathering followed by a virtual tour of Sri Shankara Cancer Hospital and Research Centre through a video. A beautifully animated video of the plan of Bagchi Sri Shankara Cancer Centre and Research Institute was also presented to the audience.

Dr B S Srinath, Managing Trustee - SSCF and Head of the Institution - SSCHRC provided a highlight of SSCHRC's achievements till date with a special focus on the Bone Marrow Transplantation Centre, Paediatric Oncology Unit, Academics and Research.

This was followed by the lighting of the ceremonious lamp by the Hon'ble Chief Guest and Guests of Honour to signify the inauguration of the 3rd Linear Accelerator and a new Robotic Surgery unit at SSCHRC. Launch videos of the machine were played to give an insight into the highly sophisticated capabilities of these cutting edge, top of the line machines.

Dr Karthik Rishi, Master of Ceremonies then invited Chief Guest Dr (Prof) M K Ramesh, Hon'ble Vice-Chancellor, RGUHS to address the gathering. Dr (Prof) M K Ramesh praised SSCHRC for becoming one of the leading cancer centres in the state within a short span of 10 years. He also lauded the foundation's efforts in making state of the art, corporate standard, comprehensive cancer care accessible and affordable to all members of the society.

The event was concluded with Dr Giri G V thanking the guests and the audience for gracing the occasion and for their unstinted support towards SSCF's activities.

HPV and Cancer - how far have we come!

The word ‘cancer’ incites many emotions in us.

Fear, helplessness, and loss of hope are common emotions that we feel. But, not anymore!

Presently, I can talk to my patients with conviction and gauge the treatment to a fruitful outcome!

Moreover, we have VACCINES to prevent some cancers!

This has been made possible due to the vast research & development that have taken place in the world of science. Today, cancer diagnostics & treatment is not the same, as it was some 30 years ago. Today, tumour biology is deciphered by multi-omics, targeted treatment is available to prolong the life of the patient and halt cancer.

Nevertheless, as always, we know that PREVENTION is better than CURE.

Therefore, when a vaccine is available and early detection of the cancer is possible, it makes sense to go for it!

Let me take you through the journey of detection of the Human Papillomavirus, (HPV), -as a causative agent for the development of cervical cancer.

Human Papilloma Virus (HPV) causes Cervical Cancer

The idea that some cancers in humans are caused by microorganisms like bacteria and viruses was there since the 1970s. Research work in the labs of the world was being conducted on some viruses as cancer-causing agents. Dr Herald zur Hausen, a German Virologist was working on the papillomaviruses. In 1983, his team discovered that HPV 16 and 18 are the causative agents of 70% of cervical cancers.

Dr Herald zur Hausen, Nobel Laurate 2008 in Medicine / Physiology

Dr Herald’s team hypothesised that cervical cancer was caused by papillomaviruses. They successfully isolated and characterised the two most frequent HPV types in cervical cancer, ie HPV 16 and HPV 18.

They subsequently demonstrated the fine print of HPV-mediated cancer development in cervix cells and were involved in the development of the preventive vaccine in the late 1980s. This mammoth effort of Dr Herald zur Hausen’s team made him bag the Nobel Prize for Medicine or Physiology in 2008.

Pharma companies did not take up this idea of vaccines for cancer in the 1980s. However, in the 1990s, National Cancer Institute allowed young researchers Dr Doug Lowy and Dr John Schiller to study vaccines for HPV. Their work led to the development of multiple copies of protein covering of HPV virus, called L1, which could be assembled as virus-like particles, VLP. There is no HPV virus in this VLP, only the virus’s protein coat. The experiments then showed that injecting these VLP produced antibodies against the HPV virus. The pharma companies, Merck and GlaxoSmithKline, then brought out these CERVARIX and GARDASIL to the world. FDA had approved them in 2006. WHO introduced them to the world in 2009.

HPV Vaccine is used worldwide to prevent cervical cancers.

Today, 105 countries in the world use the HPV vaccine in their national immunisation program.

For India, the population of women at risk for cervical cancer is around 483.5 million.

The HPV related cancer burden in India is around 3,40,324 in 2020! This includes not only cervical cancer but also other cancers that are caused by this HPV virus. They are- in females- cancers in the cervix, vulva, vagina, anal canal, anogenital, oral cavity, oropharyngeal and larynx. In men, we get cancers in the penis, anal canal, oral cavity, larynx, and oropharynx.

More than 70% contribution of HPV in cancer development is for – cervix, vagina, anal canal, around 50% for penile cancers. India contributes to nearly 1/5th of cervical cancer cases and 1/3rd of cervical cancer deaths in the world.

Cervical cancer is a preventable cancer and treatable! In May 2018, WHO had given a call to eliminate cervical cancer from the world. The WHO Cervical Cancer Elimination strategy includes coverage targets for scale-up by 2030 of HPV vaccination to 90% of all adolescent girls, twice-lifetime cervical screening to 70%, and treatment of pre-invasive lesions and invasive cancer to 90%. HPV vaccination has resulted in a reduction of precancerous conditions and a decrease in warts by 30-50% over 8-10 years in developed countries. The HPV virus also causes warts in the genital parts. The vaccine GARDASIL covers protection for warts too. For a decrease in cancer incidence, we have to wait for another 15-20 years to see the effects. The good point in these HPV related cancers is that they grow slowly over 20-30 years.

HPV vaccines provide 90% protection against the development of cervical cancer. Vaccination at an early age of 9 to 26 years will give the children a lifetime of protection. In India, vaccination is undertaken by a few states - Punjab, Delhi, Sikkim at the school level. Cost is the major deterrent for this vaccine. Each dose of vaccine costs around Rs.3000, and 2-3 doses are needed to complete the schedule.

Apart from vaccination, other protective measures that help prevent these cancers are -

• To reduce multiple sexual partners,

• To treat sexually transmitted infections promptly,

• To use condoms while having sex,

• To get HPV test and pap smear done every 5 years.

To conclude, HPV infection is a common infection. 70-80% of sexually active partners get it. Majority of them clear this infection with their immunity. Persistent infections cause problems of cancer. There are vaccines available and ways to prevent this cancer.

Let us be wise and choose prevention to cure!

And for us Indians, there is a long way to go in preventing these cancers and saving the women and men of our country!

The article is part of Cervical Cancer Awareness Month (January).

Written by:

Dr Annapurna V

Dr Annapurna V, Sr. Consultant Gynaec Oncologist and HoD (Gynaec Oncology) - Sri Shankara Cancer Hospital and Research Centre, Bangalore

Senior Consultant & HoD - Gynaec Oncology

Sri Shankara Cancer Hospital and Research Centre, Bangalore

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