Ion-Beam Cancer Therapy, Germany on the Forefront

Treatment of most cancer patients has three components: First the surgical intervention to try an remove the malignant cells, second chemotherapy with aggressive medication to try and eradicate any left-over cancer cells from the body and, third or simultaneously, radiation therapy to kill cancer cells that could not be removed by surgery.
For this radiation therapy, the standard is a focussed and carefully planned application of Gamma or X-rays, radiation that is well known to damage body cells nearly since Conrad Roentgen.
Medical technology has however developed new therapies using other radiation forms. Worldwide, also in Germany, proton radiation has been introduced and found beneficial for many patients with different cancers / types of tumors. The advantage is that the radiated particles are bigger (protons), thus the damage they can cause to the tissue thay are targeted on is more severe. However, the machinery needed to radiate protons are bigger, more sophisticated and more energy consuming than standard gamma-ray machines, consequently only few, big centers have been built and are available for patients.
Along these lines, but with still bigger particles, still bigger and more expensive machines, Ion-Beam Radiation has been developed in recent years and established - up to now at three centers worldwide. Here, heavy ions (carbon) are used to bombard the tumour cells and destroy them. One of these centers is the Heidelberg Ion-Beam Therapy (HIT) Center, associated to the Heidelberg University Hospital and to the German Cancer Research Center, also Heidelberg.
HIT has been chosen as the national reference center for clinical studies on the use of ion beams in cancer treatment, and of course it is also in constant exchange with colleagues at the other centers in Japan and Italy. 
HIT claims to have the following special features:

• The world’s first ion therapy facility with intensity-modulated raster scanning, the world’s most precise radiotherapy method.
• The world’s first heavy ion treatment facility with a 360° rotating beam delivery system (gantry).
• Europe’s first combined treatment facility using protons and heavy ions for radiation therapy.
• The first facility to use cooperating robots for automated imaging and ultrahigh-precision patient positioning.

Patients who are thought to benefit most from this treatment are those who have tumours

• that are located deep inside the body,
• that are extremely resistant to conventional radiation,
• that are surrounded by highly radiation-sensitive healthy tissue, such as the optic nerve or bowel, which should not be damaged during treatment.

Treatments at HIT are still at the level of clinical trials and studies, but it has been shown already that in most cases, the success rate of Heavy Ion Radiation nears 90%, whereas other forms, including proton radiation has rates up to 70%. So it is estimated that in the long run, this therapy could be beneficial for about 10% of all cancer patients.

The costs of such treatments are high, about three times the cost of conventional radiation therapy. However, the center has contracted to get coverage of these costs by most German statutory health insurance companies. Patients who do not have this coverage will have to pay privately, unless they can obtain coverage from their private health insurance. There is no exclusion of international patients.

German Hospital Service will be more than happy to help international patients establish contact to the HIT center. Medical evaluation will be done by the center to ensure that the patient is a good candidate for one of the study programs. Then, a cost estimate can obtained so the patient can decide.

Regional deep hyperthermia could be a treatment for children and adolescents with refractory or recurrent non-testicular malignant germ-cell tumours

Medical researchers at the Paediatric Oncology Clinic, Haematology and Immunology, Centre for Child and Adolescent Health, Medical Faculty, Heinrich- Heine-University Düsseldorf, Düsseldorf, Germany have recently published findings about a study involving 44 patients, aged 7 months to 21 years, where regional deep hypothermia was successfully used to treat malignant germ cell tumours.

In recent years, the survival of children and adolescents with malignant germ-cell tumours has improved substantially. However, the outcome remains poor for patients with refractory or recurrent malignant germ-cell tumours. The Düsseldorf researchers could show that PEI-regional deep hyperthermia can achieve objective tumour response in a study that followed the patients over more than 7 years after treatment. (The median follow-up of surviving patients was 82 months (range 9—195)).

“Of the 35 patients who had sufficient clinical and radiographical data available for response assessment, 30 (86%) had an objective response to treatment (16 patients had complete remission and 14 had partial remission).” However, granulocytopenic fever, which required intercurrent hospital admission, was noted in 29 (66%) of 44 patients and five patients experienced treatment-related grade-3 acute renal toxic effects.

Nevertheless, researchers conclude: “A multimodal strategy integrating PEI-regional deep hyperthermia and tumour resection with or without radiation can successfully treat children and adolescents with refractory or recurrent malignant non-testicular germ-cell tumours. The long-term prognosis of patients with poor response or after first relapse was almost similar to those receiving first-line treatment. This strategy merits further investigation.”

Obviously, this treatment is still in a study phase and not available as standard treatment. But the results are promising and show the high level of expertise regarding child oncology at this big university hospital. German Hospital Service will be happy to assist international patients if they need treatment in Germany for such severe conditions.

Citation:
The Lancet. July 1, 2013
Dr Rüdiger Wessalowski MD , Prof Dominik T. Schneider MD et al
http://www.thelancet.com/journals/lanonc/article/PIIS1470-2045%2813%2970271-7/fulltext

What is the standard of Cancer treatment in Germany?

For international patients who need treatment regarding specific cancer conditions, German clinics offer a wide range of medical treatments and institutions.

For the rather frequent types of cancer, like colon, breast and prostate, the approach is usually a combination of surgery, radiation therapy and chemo-therapy. Hospitals are developing institutions called "centers", which combine the efforts of the different departments and ensure a treatment scheme which is carried out along agreed procedures, based on the consensus of all the faculties that have joined. Regular joint conferences discuss all the patients and define the medical strategy according to the guidelines of evidence-based medicine. A few of these centers, like "breast centers" or "intestine centers" qualify to undergo a special peer review process, for example by an institution called Onkozert, which awards them the label "Certified Center".

In these cases, if the condition is diagnosed early enough, the chances of completely curing the disease are frequently very good.

For the more rare types of the disease, special units in the big university hospitals have been established, where, for example, bone marrow transplants or special neuro-surgical operation techniques like the "Gamma knife" are a regular mode of treatment. Other clinics provide hypothermia treatment, special laser treatments for liver metastases or any other up-to-date therapy.

For all these big centers it is important to know, that they participate in the research for new cancer treatments by taking part in studies. So, if the patient agrees, it is possible to benefit from the latest developments, especially on the cancer drug sector.

Before this background, with the help of a qualified referral organisation like German Hospital Service Ltd., patients can be sure to find the best possible treatment for their cancer condition.

However, it must be understood. Even the best treatment procedure cannot promise to provide a cure to a cancer patient.

Especially, when the treatment starts too late, doctors will only be able to prolong the lifespan of the patient, while improving the conditions of life during that final stage.