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Proton Therapy Cancer Treatment In Singapore: Singapore Institute Of Advanced Medicine Holdings

Proton Therapy Cancer Treatment In Singapore: Singapore Institute Of Advanced Medicine Holdings

Cancer treatment in Singapore

Health365 is glad to expand our partnership with Singapore Institute Of Advanced Medicine Holdings (SAM) to offer to our readers SAM’s services for diagnostic imaging, health screening and cancer treatment in Singapore.

About Singapore Institute Of Advanced Medicine Holdings

Singapore Institute Of Advanced Medicine Holdings (SAM) comprises three clinics- Asia HealthPartners Pte Ltd, Advanced Medicine Imaging Pte Ltd, and Proton Therapy SG Pte Ltd. Asia HealthPartners offers General Practitioner, Wellness, Aesthetics, Imaging, and Endoscopy services. Advanced Medicine Imaging offers diagnostic imaging, nuclear medicine, as well as theranostic services. Proton Therapy SG is the latest addition to this group and offers radiotherapy services, including proton therapy, which has unique advantages over X-ray radiotherapy. To bolster their services, SAM has recently signed a service level agreement (SLA) with Raffles Hospital to allow access to acute hospital services. SAM’s eventual goal is to develop a comprehensive cancer centre.

Radiation Oncologist At SAM

Dr Looi Wen Shen

Dr Looi Wen Shen graduated from NUS YLL-SOM and completed his specialist training at NCCS. Prior to joining SAM, he was a Consultant at NCCS and a Clinical Assistant Professor at Duke-NUS Medical School. He also practised at the University of Florida Proton Therapy Institute, USA, where he completed formal subspecialty fellowship training in proton therapy and paediatric radiotherapy. He has also received further training at the Taipei Medical University Hospital Proton Centre for regionally endemic diseases such as liver cancer and nasopharyngeal cancer.

The Potential Of Proton Therapy

Proton Therapy

There have been vast developments in the delivery of conventional X- rays. The introduction of intensity-modulated radiation therapy (IMRT) and stereotactic ablative radiotherapy (SABR) have changed the landscape. However, they all still have the same drawback of penetrating the patient completely, leaving an exit dose. This results in more dose splash within the patient. Proton therapy fixes this drawback as the beam can stop within the patient due to its biological properties. This reduces the radiotherapy dose to normal issues and organs. Aside from the more obvious reductions in side effects, this also reduces the risk of second malignancies from radiation exposure.

Proton Therapy Benefit

An example of a situation where proton therapy is beneficial is shown on the left. This child required craniospinal irradiation, i.e. radiotherapy to the whole brain and spine. Using conventional X-rays results in a dose splash to all the organs anterior to the treatment target. Proton therapy allows radiotherapy to be delivered while sparing these organs. This patient will have a lower dose to the oral cavity, thyroid, heart, and abdominal contents. This translates into a lower risk of side effects in these organs. In females, a lower dose to the ovaries can help to preserve fertility. Proton therapy is particularly suitable for children with cancer for a few reasons. Firstly, they are not only growing but also developing. Radiotherapy can affect this growth and development, so minimising exposure to radiotherapy is paramount. Secondly, their bodies are relatively smaller than adults. Therefore for a fixed tumour size, a larger proportion of normal issues receives unwanted radiotherapy. Thirdly, childhood cancer survivors have many years ahead of them to develop late-onset side effects.

Facilities, Equipment, And Services At Proton Therapy SG

General

Located at Amnios at Biopolis, Proton Therapy SG has a Varian ProBeam proton therapy gantry, Halcyon Linac for x-ray radiotherapy, as well as a dual-energy enabled SOMATOM computed tomography (CT) scanner for acquiring planning CT images. Proton Therapy SG’s colocation with Advanced Medicine Imaging allows for seamless access to imaging services such as magnetic resonance imaging (MRI) and positron emission tomography (PET). This is advantageous logistically because imaging is often required as part of radiotherapy planning and may even be performed with immobilisation gadgets that are customised and utilised during the planning CT scan.

Varian ProBeam Compact System (Proton Therapy)

Varian ProBeam™ Compact System (Proton Therapy)

The Varian ProBeam has a cyclotron-powered full 360-degree gantry with a gantry-mounted imaging system that allows precise delivery of pencil beam scanned proton therapy. SAM has a contract with Varian Medical Systems that guarantees an operational up-time of 95% or more. SAM’s ProBeam system is the only proton therapy system in Singapore which can eventually be upgraded to deliver clinically applicable FLASH proton therapy.

SAM’s proton therapy system has some unique advantages over other systems. The full gantry has an important advantage over the half-gantry design seen in some systems such as the IBA Proteus®ONE. While half-gantry systems often require a repositioning of the patient to treat the contralateral side midway through each session, full-gantry systems are able to deliver the full fraction each session without having to reposition the patient. This allows faster delivery of proton therapy that may reduce patient movement and also facilitates techniques such as breath-holding, which is important in proton therapy for liver cancer. The gantry-mounted imaging has an important advantage over the wall-mounted imaging design seen in some systems such as the Hitachi PROBEAT. Wall-mounted imaging systems prohibit imaging from certain angles and can affect the verification of treatment delivery.

Varian Halcyon

Varian Halycon™

The Varian Halcyon system is a unique jawless, double-stack MLC, ring gantry linear accelerator that uses flattening-filter-free beams to deliver x-ray radiotherapy. These unique design features offer the advantage of very fast delivery. From a treatment perspective, this may reduce patient movement and also facilitate techniques such as breath-holding. This integrates seamlessly with the SDX® voluntary breath-hold system, which is important in radiotherapy for breast cancer as it can reduce cardiac doses and subsequent heart disease.

Radiotherapy Techniques Available

Proton Therapy SG is able to deliver proton therapy, intensity-modulated radiation therapy (IMRT), volumetric-modulated arc therapy, stereotactic body radiotherapy, and 3D conformal radiotherapy. They have both free-breathing 4D and breath-hold gating capabilities. They have access to brain stereotactic radiosurgery as well as skin electron radiotherapy through their service level agreement with Raffles Medical Group.

Future Plans

Comprehensive Cancer Centre

SAM’s eventual goal is the development of a comprehensive cancer after the proton therapy service is fully ramped up. Currently, they have general practitioner, imaging, nuclear medicine, theranostic, and radiation oncology services. Their plan is to eventually offer medical oncology services and they have set aside an area for the development of a chemotherapy suite for this.

FLASH Proton Therapy

FLASH proton therapy is an emerging form of radiotherapy. It has the potential to reduce side effects even further compared to proton therapy. The first human phase 1 trial was recently completed, which is the first step to allowing FLASH to transition from an experimental therapy to a standard therapy. SAM expects this transition to be fully realized over the next decade. Importantly, their Varian ProBeam system is the only one in Singapore that can be upgraded to deliver clinically applicable FLASH therapy.

Conclusion

SAM offers a comprehensive range of radiotherapy services and are one of only two private radiotherapy centres that can deliver proton therapy. SAM’s team is confident in delivering a high standard of care. They have a unique colocation with an established imaging service and are also well served with a general practitioner and wellness base.

Location

  • Advanced Medicine Imaging – 1 Biopolis Drive #01-02/03 Amnios Singapore 138622
  • Asia HealthPartners – 304 Orchard Road, #05-06 Lucky Plaza, Singapore 238863
  • Proton Therapy SG – 1 Biopolis Drive #B1 Amnios Singapore 138622

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This article is informative only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment, and should never be relied upon for specific medical advice.