COMPASS Research Report | Page 33

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Current Status of RT

Current practices have seen little technical innovation recently Most RT centres deliver radiation in the form of IMRT which constructs a tumour-specific RT beam or beams using a multi-leaf collimator (“ MLC ”). This technique allows rapid shaping of the beam to conform to the shape of the tumour and spare healthy tissue , although toxicity is still significant . Volumetric modulated arc therapy (“ VMAT ”) is the most recent iteration of IMRT that delivers a precisely sculpted 3D dose distribution with a 360-degree rotation of the gantry in a single or multi-arc treatment . This reduces treatment time to 2 minutes from 8 - 10 minutes which potentially reduces the risk of secondary malignancies .

TPS are constantly improving as technology evolves

Photons have typically been the standard way to deliver radiation to tumour sites

Treatment planning systems are at the forefront of current RT innovation Linear accelerators (“ LINACS ”) are used to accelerate photons for RT , and innovation of hardware is slow due to the improvements in delivery by IMRT . Advances in software however have continually improved IMRT approaches with TPS and oncology information systems (“ OIS ”) undergoing major advancement thus generating interest and profits for companies providing these products . The major trend in this space is seeing the integration of AI and machine learning (“ ML ”) to allow superior analysis and automation of RT . Companies such as RaySearch and Elekta are market leaders in this space , with new systems allowing more meticulous , patient-specific construction of beam line routes , optimising dosage , navigating critical structures , and minimising tissue damage .

Photon-based technology and its limitations Photons have classically been the standard form of RT treatment for prostate , lung , and breast tumours . Having neither mass nor charge , photons can travel easily through to target material , often as x-rays , accumulating at the tumour . Generated by LINACs , there is an initial increase of energy as they interact with the electrons in the target material , which enhances the radiation effect . As a result of this , their peak dose is reached within a few centimetres from the entrance surface – the so-called “ dose accumulation effect ”. The radiation decreases as the photons travel through and exit the body . However , the delivery of a lethal dose of radiation to the target area will also result in low to moderate dose accumulation to surrounding tissue , resulting in tissue damage . Possible side effects include gastrointestinal (“ GI ”) and genitourinary (" GU ”) problems depending on tumour location as well as a slightly higher potential risk for secondary malignancies . This has been somewhat mitigated by the emergence of advanced TPS implemented for IMRT such as VMAT that improve dose delivery precision , however , there remains a risk and photon therapy is not optimal to treat organs located deep within the body .

Please see analyst certifications , important disclosure information , and information regarding the status of analysts on pages 91-94 of this research report .