A Guide to External Radiation Therapy

Radiation therapy (radiotherapy) is a cancer treatment that uses high doses of radiation to kill cancer cells and stop them from spreading. At low doses, radiation is used as an x-ray to see inside your body and take images.

Radiation therapy does not kill cancer cells immediately. It takes days or weeks of treatment before cancer cells start to die. After that, cancer cells keep dying for weeks or months after radiation therapy end.

Radiation therapy can be external beam (when a machine outside your body aims radiation at cancer cells) or internal (when radiation is put inside your body, in or near the cancer cells).

Brain Perfusion Scan x SPECT-CT

A guide to the brain perfusion scan, a procedure often used to diagnose diseases affecting blood flow. Read this to discover how the scan is performed, what to expect before, during and after the procedure, as well as understand its potential risks.

Behavioural Health

Behavioural Health Centre advocates a holistic approach to healthcare by nurturing the psychosocial aspects of physical illness. We believe that health is a state of body and mind WELLNESS. It is essential to nourish our THOUGHTS, EMOTIONS AND BEHAVIOURS to produce better physical and mental health. We will help you to thrive and lead a healthier, fuller life.

Bladder & Bowel Preparation for Radiotherapy to the Pelvis

To ensure that the irradiation area is in the same position during treatment as it was in the CT scan, you will be advised to have an empty bowel and a comfortably full bladder for each appointment.

Bowel Preparation

This preparation is crucial for reducing the risk of long-term side effects on the bowels and ensuring treatment efficacy. It includes dietary guidelines to reduce gas and bloating, such as consuming small meals, avoiding gas-forming foods, and staying active to promote regular bowel movements.

Cancer Treatment: Brachytherapy

Brachytherapy is a type of radiotherapy treatment which uses a radioactive source placed close to the tumour. It can deliver high doses of radiation to specific sites quickly.

Cancer Treatment: TrueBeam™ STx

The advanced radiotherapy system offers sophisticated imaging and motion management, sub-milimitre dosage delivery accuracy, and rotating ability to give fast and powerful treatments that often last only a few minutes.

Cervical Cancer Screening Guide

Cervical cancer is caused largely by the Human papillomavirus (HPV). Find out how you can get screened and protected today.

Colorectal Cancer Screening Guide

Colorectal cancer is the 2nd most common canceer in Malaysia. It is also highly treatable if caught early. Learn more about the risk factors, signs, symptoms and how you get screened.

Da Vinci Surgical System

The da Vinci Surgical System allows surgeons to perform complex minimally-invasive surgical procedures with precision and accuracy.

FDG PET/CT Scan

The FDG PET/CT scan is an imaging test often used in the detection of cancers. Read the guide for a list of general instructions that patients should adhere to as well as what to expect before, during and after the procedure.

Gamma Knife

More than 80,000 patients undergo Gamma Knife surgery every year.

Regarded as the Gold Standard in intracranial radiosurgery, it is preferred for its extreme accuracy, efficiency and outstanding therapeutic response.

2 to 4 times better sparing of normal brain tissue compared with other stereotactic platforms.

Up to 130 times lower dose to the rest of the body compared with traditional linear accelerates.

A Comprehensive Introduction to Haematopoietic Stem Cell Transplantation

Bone marrow is found in the center of most bones and has many blood vessels. There are two types of bone marrow: red and yellow. Red marrow contains blood stem cells that can become red blood cells, white blood cells and platelets. Yellow marrow is made mostly of fat.

Hyperthyroidism

The thyroid is a small gland in your neck, in front of your windpipe. It produces a hormone called thyroxine which regulates the body's metabolism. Hyperthyroidism is a medical condition of overactive thyroid gland, which leads to excessive thyroxine hormone secretion.

Common causes of hyperthyroidism are autoimmune condition known as Graves' disease (when your body immunity acts against your own body) and benign single or multi nodular goiter.

IORT

IORT stands for Intraoperative Radiotherapy. IORT is a technique of delivering radiotherapy directly to the tissues surrounding the cancer (also known as tumour bed) during surgery. This new technique will greatly reduce radiation exposure and the length of treatment time

INTRABEAM IORT is delivered during breast conservation surgery (also known as lumpectomy) in the operating room while the patient is still asleep. After the tumour is removed, a miniaturised radiation device is inserted into the lumpectomy cavity. Therapeutic radiation is then directed immediately and precisely where it is needed most – the location where the cancer was removed. Localising the radiation inside the breast is effective because this is where the cancer is most likely to recur. INTRABEAM IORT is delivered as a 30-45 minute treatment during surgery.

Kidney Cancer Treatment with da Vinci Surgical System

There are many different types of kidney cancer. The most common type is renal cell carcinoma which accounts for more than 80% of all kidney cancers. The good news is that most of kidney cancers are found before they spread (metastasise) to other organs. Cancers that are detected early can be treated with better success rate.

Living with Head and Neck Cancers

When someone mentions cancer, head and neck cancers rarely come to mind. Despite that, head and neck cancers are very common in Malaysia. This type of cancer generally forms in the squamous cells (cells that line the moist mucosal areas in the head and neck).

LU177-PSMA Therapy

LU177-PSMA Therapy is a type of molecular therapy that is used to treat metastatic prostate cancer. Lu177-PSMA therapy is also known as radionuclide therapy or radioisotope therapy.

Managing Cancer

Among the many contributions of innovation and technology is the ability to provide better treatment options in the healthcare industry. One of the key areas technology has made an impact in is the treatment of cancer.

Although the cause of cancer is uncertain, with technology today, managing cancer has become less challenging.

Read more about the different areas involved in healthcare that supports the management of cancer in the link below.

Myocardial Perfusion Scan

A guide to the myocardial perfusion scan, a procedure often used to assess the sufficiency of blood flow to the heart tissue and aid in the detection of coronary artery disease. Read this to learn how the scan is performed, what to expect before, during and after the procedure, as well as understand its potential risks.

Peptide Receptor Radionuclide Therapy (PRRT)

PRRT is a molecular therapy used to treat metastatic neuroendocrine tumours (NETs). PRRT is also known as radionuclide therapy or radioisotope therapy.

PET/CT Scan

FDG PET/CT (Positron Emission Tomography/Computed Tomography) is a powerful imaging technique that combines both CT scan and PET scan using radioactive sugar (FDG – 18F-fluorodeoxyglucose) as the tracer.

It provides comprehensive information on the abnormal activity and function of cells (obtained by PET) as well as the precise location of these abnormalities in the body (obtained by CT).

This leads to more accurate assessment of your current medical condition especially cancer, brain disorder, heart disease and infective/ inflammatory disease.

Prostate Cancer Treatment with da Vinci Surgical System

Prostate cancer occurs in the prostate gland when abnormal cells develop in the prostate. It is one of the more common cancers globally and usually affects men aged 50 and above. Prostate cancer is generally a slow growing disease and often has no early symptoms.

Selective Internal Radiation Therapy

SIRT is known as Selective Internal Radiation Therapy. It is a targeted treatment for liver tumours that delivers millions of tiny radioactive beads called SIR-Spheres Y-90 resin microspheres directly to the liver tumours. It involved two stages, namely planning stage and treatment stage.

The Reality of Cancer

Our cells are the building blocks of our body and when the growth process of these cells go wrong, it forms a mass called a tumour. A malignant tumour is cancerous and there are more than a hundred types of cancer with symptoms that vary depending on the type.

In Malaysia, cancer is considered the most lethal killer disease among all, with several types of cancer being the main contributors to the high mortality rate each year.

Tomotherapy Radixact-X9

Tomotherapy is a new way of treating cancer with radiation. It combines three elements into one integrated system.

Tomotherapy is both a treatment delivery machine and a CT scanner that allows experts to take a CT scan right before each cancer treatment.

Tomotherapy Radixact-X9 is an emerging modality or radiotherapy which controls and destroys malignant cells with high intensity radiation.

Efficacy and Safety of Peptide Receptor Radionuclide Therapy in Metastatic Neuroendocrine Tumour: Malaysian Single Institution Retrospective Analysis

Peptide Receptor Radionuclide Therapy (PRRT) has been recommended as a treatment option in metastatic somatostatin receptor (SSTR) positive gastroenteropancreatic-neuroendocrine tumours (GEP-NETs), thoracic-NETs and pheochromocytomas/paragangliomas.

Gamma Knife Radiosurgery

Treating large brain metastases with radiosurgery has been a challenging task compared with smaller metastases, mainly due to the need of reducing the toxicity risk to the adjacent tissues and improving the local tumour control at the same time.

Cleveland Clinic, which pioneering in two-stage Gamma Knife (GK) Stereotactic Radiosurgery (SRS) has reported a dramatically improvement of the local control rate when doses were divided into two fractions in about a month apart, while minimising the adverse radiation effects (Angelov L et al., 2017) [1].

Nurse Lead Grade Based Radiotherapy Side Effect Management

Radiotherapy is an important modality in the management of cancer treatment. All patients receiving external radiotherapy are at potential risk of developing radiation toxicities within the treatment field but there was inconsistency in side effects recording due to the the free text format and there was no standard in side effects management as each Oncologists had their own preferred methods.

Hence, it is crucial to introduce a standard for scoring and managing radiotherapy side effects for consistent and accurate analysis of the radiation toxicities.

Optical Surface Monitoring System

Radiotherapy set up during CT Simulation requires permanent tattoos on patient skin for reproducibility and daily setup Several studies report that these marks can cause anxiety and body confidence issues and needle prick incidence might be occurred.

The purpose of this study to assess the feasibility and accuracy of using Optical Surface Monitoring System (Vision RT) as an surface guided radiotherapy OSMS is a technique that using non ionizing camera technology to track patients’ surface in 3 D for both daily setup and motion management during radiotherapy treatment delivery.

PET/CT Simulation

Positron Emission Tomography Computed Tomography (PET CT) scan, which combines the benefit of metabolic PET data and anatomical CT data, has been clinically proven to provide valuable information which could improve the accuracy of the target volume delineation.

However, the process of co registration of an existing PET CT images with CT simulation images could hinder the accuracy of co registration due to the fact that the patient’s position during PET CT scan is different from the patient's position during CT simulation.

Phantom Validation Of Geometric Accuracies of 3T MRI

Increasing the MRI field strength may enhance visualization and resolution of small brain lesions, in turn improving the accuracy of GKRS delivery.

However, concerns remain regarding the influence on geometric distortion caused by the metallic stereotactic skull frame, posts and fixation screws in a frame based Gamma Knife Radiosurgery.

Radioactive Iodine (RAI)

Radioactive iodine (RAI), also known as I-131, is used following surgery for certain types of thyroid cancer; specifically, follicular and papillary and hyperthyroidism.

The physical properties of iodine as well as its beta particle emission makes it an ideal agent that is specifically absorbed by the thyroidal cell and subsequently results in radiation-induced cellular apoptosis.

Stereotactic Body Radiation Therapy in Lung Tumour

Stereotactic body radiotherapy (SBRT) is the treatment of choice for patients with primary or metastatic lung tumor, who are medically inoperable or refuse surgical resection.

XSpect Bone Scan

Prostate cancer is one of the most common cancers affecting men worldwide, and a bone scan is part of the staging modality used to evaluate asymptomatic bone metastasis.

A bone scan with diffusely increased skeletal tracer uptake relative to soft tissue in association with absent or faint renal activity is known as a superscan (Manohar et. al., 2016).

Y-90 bremsstrahlung SPECT/CT

Y-90 is effectively a pure beta emitter, i.e., it lacks discrete energy photon emissions, such as gamma rays and/or characteristics fluorescence x-rays. The x-ray photon emitted by Y-90 are very low in both yield and energy (<< 18 keV), and the gamma photons emitted by Y-90 have an insignificant yield and very high energy (~2 MeV).

Y-90 activity distribution in vivo is traditionally assessed by imaging the bremsstrahlung photon, which is produced from interactions of energetic beta particles with soft tissue, using planar and/or SPECT/CT imaging.

Analysis of Genetic Variants in Myeloproliferative Neoplasms Using a 22-Gene Next‑Generation Sequencing Panel

The Philadelphia (Ph)-negative myeloproliferative neoplasms (MPNs), namely essential thrombocythaemia (ET), polycythaemia vera (PV) and primary myelofibrosis (PMF), are a group of chronic clonal haematopoietic disorders that have the propensity to advance into bone marrow failure or acute myeloid leukaemia; often resulting in fatality. Although driver mutations have been identified in these MPNs, subtype-specific markers of the disease have yet to be discovered. Next-generation sequencing (NGS) technology can potentially improve the clinical management of MPNs by allowing for the simultaneous screening of many disease-associated genes.

Enhancing Voxel-Based Dosimetry Accuracy with an Unsupervised Deep Learning Approach for Hybrid Medical Image Registration

In this study, we introduce CoRX-NET, a novel unsupervised deep learning network designed for deformable registration of hybrid medical images. The CoRX-NET structure is based on the Swin-transformer (ST), allowing for the representation of complex spatial connections in images. Its self -attention mechanism aids in the effective exchange and integration of information across diverse image regions. To augment the amalgamation of SPECT and CT features, cross-stitch layers have been integrated into the network.

From Driver Mutations to Genomic Classification: Current & Future Perspectives on Myeloproliferative Neoplasms

Myeloproliferative neoplasms (MPNs) encompass a heterogeneous group of chronic, clonal haematopoietic stem cell neoplasms that harbour the propensity to undergo leukaemic transformation.

In this review, we focus on the classical Philadelphia chromosome (Ph)-negative MPNs – polycythaemia vera (PV), essential thrombocythaemia (ET), and primary myelofibrosis (PMF); providing an overview of the current understanding of the disease at a clinical and molecular standpoint while discussing the present challenges and future opportunities in the management of MPNs.

Management of Classical Philadelphia Chromosome‑Negative Myeloproliferative Neoplasms in Asia: Consensus of the Asian Myeloid Working Group

Myeloproliferative neoplasms (MPN) are a heterogeneous group of clonal hematopoietic stem cell disorders characterized clinically by the proliferation of one or more hematopoietic lineage(s). The classical Philadelphia-chromosome (Ph)-negative MPNs include polycythemia vera (PV), essential thrombocythemia (ET) and primary myelofibrosis (PMF).

This consensus from the AMWG aims to review the current evidence in the risk stratification and treatment of Ph-negative MPN, to identify management gaps for future improvement, and to offer pragmatic approaches for treatment commensurate with different levels of resources, drug availabilities and reimbursement policies in its constituent regions.

Managing and Treating COVID‑19 in Patients with Hematological Malignancies: A Narrative Review and Expert Insights

Patients with hematologic malignancies (HMs) are at a significantly higher risk of contracting COVID-19 and experiencing severe outcomes compared to individuals without HMs. In this review, we aim to summarize the current evidence to enhance our understanding of the impact of HMs on COVID-19 risks and outcomes, identify particularly vulnerable individuals, and emphasize the need for specialized clinical attention and management.

MicroRNAs That Affect the Fanconi Anemia/ BRCA Pathway are Downregulated in Imatinib-Resistant Chronic Myeloid Leukemia Patients Without Detectable BCR-ABL Kinase Domain Mutations

Chronic myeloid leukaemia (CML) patients who do not achieve landmark responses following treatment with imatinib mesylate (IM) are considered IM-resistant. Although IM-resistance can be due to BCR-ABL kinase domain (KD) mutations, many IM-resistant patients do not have detectable BCR-ABL KD mutations.

To investigate the role of miRNAs in IM-resistance, we recruited 8 chronic phase CML patients with IM-resistance who tested negative for BCR-ABL KD mutations and 2 healthy normal controls.

Primary imatinib resistance in chronic myeloid leukaemia patients in a developing country

Imatinib (IM) is a BCR-ABL-targeted agent that acts as a tyrosine kinase inhibitor (TKI), the use of which has significantly altered the treatment landscape and improved the prognosis of this disease. Point mutations in the BCR-ABL kinase domain (KD) are known to be responsible for most cases of clinical resistance to IM.

In this study, we retrospectively analyzed the clinical behaviour of 22 IM-resistant CML patients with and without BCR-ABL KD mutations.

P493 Oral-ATO/ ATRA/ Ascorbic Acid (AAA)-Based Induction or Maintenance of First Complete Remission Improved Outcomes in Newly Diagnosed APL

Pure oral arsenic trioxide (oral-ATO) solution (Arsenol ®) was first formulated in Hong Kong. It achieves a bioavailability comparable to that of intravenous ATO (i.v.-ATO). Oral-ATO, used in combination with all trans retinoic acid (ATRA) and ascorbic acid (the AAA regimen) has been shown to be highly effective in the re-induction of relapsed acute promyelocytic leukaemia (APL), and in the frontline induction, consolidation and maintenance of newly-diagnosed APL.

Ga-PSMA PET/CT and F-FDG PET/CT

Recent case reports and series have demonstrated the usefulness of 68Ga/18F-PSMA PET/CT in restaging recurrent renal cancer after nephrectomy. We presented a case of a patient with renal mass who had undergone both 18F-FDG and 68Ga-PSMA PET/CT for diagnosis and staging.

Concordant tracer uptake in the primary tumor and metastatic lesions was demonstrated by both radiotracers. Final histopathological reports revealed clear cell renal cell carcinoma. Furthermore, unusual left metacarpal bone metastasis was also detected.

Morphine use for cancer pain

The incidence of pain has been reported to be over 50% in cancer patients in general and more than 90% in those with advanced cancer. Additionally, undertreated cancer pain occurs in 43% of cancer patients, with greater patient-perceived barriers to cancer pain management in Asian patients.

Suboptimal pain control affects the daily activities of cancer patients and their caregivers and changes the focus of their relationship. This can further result in psychological and emotional distress.

Quantitative analysis of xQuant reconstruction algorithm in SPECT/CT

OSEM is an iterative algorithm that has been traditionally used as a standard imaging reconstruction method on account of its reliability due to its good reconstruction quality and ideal convergence rate.

A reconstruction algorithm developed by Siemens Healthcare, xQuant, uses a variant of iterative reconstruction named OSCGM that allows for higher resolution reconstructed SPECT/CT images and ultimately the ability to quantify them.

This study compares the accuracy of the novel xQuant reconstruction algorithm against the current standard OSEM.

Superscan: Superiority of xSPECT/CT over OSEM SPECT/CT in bone scans of prostate cancer patients.

Prostate cancer is one of the most common cancers affecting men. Bone scan is part of the staging modality commonly used to evaluate bone metastasis. A bone scan with diffused increased skeletal tracer uptake relative to soft tissue, combined with faint renal activity is known as a superscan.

The Journal for Radiation Physics, Radiation Chemistry and Radiation Processing

Radiation Physics and Chemistry is a multidisciplinary journal that provides a medium for publication of substantial and original papers, reviews, and short communications which focus on research and developments involving ionizing radiation in radiation physics, radiation chemistry and radiation processing.

Breast Cancer: The No.1 Killer in Women

Breast Cancer: The No.1 Killer in Women

Cancer: A Time Bomb

Cancer was not a common disease but today, various cancers are leading patients to their end. This situation is influenced by financial constraints among the low income groups (B40), allowing them to only seek treatment when they are already at Stage 3 or 4 of the disease.

Cancer in Children

Cancer in children is rare, but parents cannot afford to take this disease lightly. In the United States, as many as 15,600 new cases involve cancer among children and adolescents between the ages of 0 and 19.

Cancer | Illustrations | Sunway Medical Centre

People tend to have a negative perception on hospitals – indifferent white treatment rooms, the pungent smell of antiseptic and unsettling emotions of fear, anxiety and sadness.

Combining Eastern and Western approaches

Sunway Group Healthcare has opened its first traditional and complementary medicine (TCM) centre at Sunway Geo Avenue in Bandar Sunway. Representing a holistic approach to medicine and health, Sunway TCM Centre aims to pair the traditional and cultural practices of the East with the modern, technology-driven approach of the West.

Does Avoiding Screenings Mean You're Safe? Your "Ostrich" Mentality Lets Cancer Get Ahead

Cancer is quite common and its lethality cannot be underestimated, so it is an issue that no one should take lightly. However, many people delay seeking medical treatment because they avoid screening for various reasons, resulting in irreparable deficiencies. In fact, early detection of cancer through screening has a very high survival rate.

High incidence of cancer in an ageing society

High incidence of cancer in an ageing society

Introduction of an anti-cancer weapon

According to the World Health Organization (WHO), cancer is the second leading cause of death worldwide causing an estimated 9.6 million deaths in 2018 – that makes one out of every six deaths occurring from cancer.

Leukaemia, Lymphoma & Brain Tumour: 3 Common Cancers in Children

The most common cancers in children are leukaemia, lymphoma and brain tumours. There has been no definitive research on the causes of cancer in children. Cancer symptoms are almost identical to those of childhood illnesses, and it is often difficult to tell the difference. However, we can still find signs of cancer in children's abnormal health behaviour.

Medical Research and Drugs Abound: Say Goodbye to Breast Cancer

Do not be alarmed if you find a breast tumour because breast tumours are classified as benign or malignant.

Neoadjuvant Chemotherapy | Chemotherapy | Breast Cancer | Sunway Medical Centre

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Precision Medicine: Tailoring Cancer Treatments to the Individual

In this article, our Clinical Oncologist, Dr Ivan Shew, discusses about precision medicine, the future of cancer treatment. It combines a series of basic treatments such as surgery, radiotherapy and chemotherapy with advanced technology to provide individualised and targeted treatments to help achieve better therapeutic effects, minimise treatment side effects, as well as improve patients' quality of life.

Preventing Cervical Cancer

In Malaysia, only 22.2% of women aged between 20 and 65 have their cervical cancer screening every one to three years, while the rest fail to do so.

Radiotherapy masks transformed into hero masks

Radiotherapy is mandatory for many cancer patients and for patients with head and neck cancer, they are required to have a thermoplastic mask securely attached to their head while undergoing radiotherapy.

Stem Cell Transplant: A Non-Surgical Procedure Using Matched Stem Cells

Are bone marrow transplants and haematopoietic stem cell transplants the same?

Both terms are often used interchangeably to describe the same treatment to replace damaged or abnormal bone marrow stem cells and restore normal blood and immune system function. Our Consultant Haematologist, Transplant Physician and Internal Medicine Specialist, Dr Ho Kim Wah, explains more in this article.

Taking steps to up cancer fight

Cancer is the fourth most common cause of death in Malaysia, with approximately 37,000 cases reported every year. It is estimated that this number will rise to more than 55,000 newly-diagnosed cases by 2030.