Re-engineering radiotherapy

The annual number of cancer cases is expected to rise by more than 40% by 2040, with the vast majority of the associated deaths expected to occur in low- and middle-income countries (LMICs). More than 15,000 electron linear accelerators (linacs) are used worldwide to treat tumours with beams of X rays, but only a fraction of patients in LMICs who would benefit from radiotherapy treatment have access to it. In African countries, for example, there is approximately one radiotherapy device for every 3.5 million people, compared with one for every 80 000 to 100 000 people in the US and in many European countries. LMICs also face challenges such as the ageing of devices, delays in obtaining spare parts, frequent power shortages that affect the lifetime of equipment, a lack of of certified and qualified personnel to operate and maintain the linacs and continued reliance on Cobalt-60 external-beam radiotherapy machines.

The Smart Technologies to Extend Lives with Linear Accelerators (STELLA) project seeks to shift the paradigm in global cancer care. Initiated at a CERN workshop in 2016 by the International Cancer Expert Corps (ICEC) in collaboration with the UK Science and Technology Facilities Council, UK universities and partners in African countries, the project aims not only to design and prototype a radiotherapy treatment system tailored to challenging environments but also to significantly change how industry addresses the needs of people with cancer located anywhere in the world. Central to this effort is the development of integrated software that accurately predicts faults, streamlines maintenance and guides physicians, along with the use of creative approaches to training and servicing that strengthen local expertise and reduce the downtime of radiotherapy facilities.

“While the linac is a central element of STELLA, the fastest developing aspects of radiotherapy are imaging systems and data analysis for diagnostics and the use of AI and machine learning for treatment planning,” explains CERN’s Steinar Stapnes, who is responsible for the design studies for the STELLA radiotherapy system. “CERN has expertise in all these areas, not least in integrating accelerator and detector systems, which use open hardware and software solutions, with clean interfaces such that maintenance can be done and future improvements can be incorporated.”

From 29 to 30 May 2024, members of the multidisciplinary STELLA alliance returned to CERN to kick off the next phase of the project. Thanks to 1.75 MUSD of funding awarded to the ICEC by the US Department of Energy, CERN and the ICEC have signed an agreement to carry out an 18-month “pre-design” study in collaboration with the UK universities of Oxford, Cambridge and Lancaster and a network of 28 LMICs. The goal is to develop the specifications for a radiotherapy machine to such a level that the collaboration can enter into discussions with industry partners, foundations, non-governmental organisations and governments interested in investing in lower-cost and more robust solutions.

“Propelled by a newly signed agreement between CERN and ICEC and by funding from the US Department of Eenergy, the STELLA project continues to move forward with great enthusiasm and purpose,” says Manjit Dosanjh, project leader for the ICEC and visiting professor at the University of Oxford. “STELLA is a great opportunity for CERN and the particle physics community to demonstrate that their ingenuity, skills and know-how can contribute to solving global health challenges.”

Further information can be found at:

https://www.iceccancer.org/innovative-radiotherapy-technologies/

https://cerncourier.com/a/linacs-to-narrow-radiotherapy-gap/

https://cerncourier.com/how-to-democratise-radiation-therapy/

https://cerncourier.com/a/developing-medical-linacs-for-challenging-regions/