Teaching pack: Devices & Physical Therapies

Devices and physical therapies treat cancer with electric fields, heat, light or sound rather than chemicals. The section groups tumour treating fields, with Optune now approved in pancreatic cancer, hyperthermia, HIFU and histotripsy, photodynamic therapy and photoimmunotherapy, electroporation and intraoperative devices. Technologies linking here include TTFields, focused ultrasound and histotripsy, focused-ultrasound blood-brain barrier opening, irreversible electroporation with NanoKnife, hyperthermia and magnetic nanoparticle hyperthermia, photoimmunotherapy, intravesical therapy and scalp cooling. The companies Novocure, HistoSonics and Insightec also point to this section.

• Accelerator-based BNCT systems (NeuCure, nuBeam, NeuPex): Boron neutron capture therapy used to need a nuclear reactor. These hospital-sized accelerators make the neutron beam instead, and in 2020 Japan approved the first one, with its boron drug, for head and neck cancers that have come back or cannot be removed.
• Biology-guided radiotherapy (RefleXion X1, SCINTIX): A radiotherapy machine with PET detectors built in: the tumour's own radioactive tracer signal tells the beam where to fire, hundreds of times a second, so moving tumours and several metastases can be tracked and treated without external markers.
• C-arm medical linear accelerators (TrueBeam, Versa HD and others): The standard radiotherapy machine: an electron accelerator in a rotating arm that makes high-energy X-rays or electron beams, shapes them with moving metal leaves, and takes a CT of the patient before each dose. Most people who have radiotherapy are treated on one.
• Carbon-ion synchrotrons and facilities: Carbon ions are twelve times heavier than protons, so every clinical facility uses a synchrotron ring tens of metres across and fixed or huge rotating beamlines. Only about a dozen centres exist, in Japan, Germany, Italy, Austria, China, South Korea and Taiwan.
• Closed-system transfer devices for hazardous drugs (PhaSeal, ChemoLock, Equashield): Sealed connectors that let a pharmacist or nurse draw up and give chemotherapy without any drug vapour or droplet escaping, protecting the staff who handle these drugs every day.
• Cryoablation systems: Killing a tumour by freezing it through one or more needles, with the ice ball watched live on CT, ultrasound or MRI. It hurts less than heat, spares nearby nerves and collecting systems better, and is the usual choice for small kidney tumours, painful bone metastases and, in trials, small breast cancers.
• CT, MRI and PET scanner manufacturing: The scanners that find and stage cancer are built by five companies in a dozen factories. Detectors, superconducting magnets and the helium that cools them are the parts that run short.
• CyberKnife robotic radiosurgery: A small accelerator on an industrial robot arm that aims hundreds of pencil-thin beams from any direction and follows the tumour as the patient breathes, so brain, spine, prostate, lung and pancreatic tumours can be treated in one to five sessions without a head frame.
• Electrochemotherapy: Brief electric pulses applied to a tumour open pores in cell membranes so that a tiny dose of bleomycin or cisplatin floods in; used for skin metastases and, increasingly, for deep tumours.
• Electrochemotherapy devices (Cliniporator): A pulse generator and needle electrodes that give a tumour a few brief electric shocks minutes after a small dose of chemotherapy, opening the cells so the drug floods in. Used mostly for cancer nodules in the skin, now also for tumours inside the body.

• Devices and physical therapies roadmap: heat and light → electric fields and focused sound → drug-releasing implants · Radium, heat and light (historic)
• Devices and physical therapies roadmap: heat and light → electric fields and focused sound → drug-releasing implants · Ablation through a needle (historic)
• Devices and physical therapies roadmap: heat and light → electric fields and focused sound → drug-releasing implants · Electric fields become a treatment (current)
• Devices and physical therapies roadmap: heat and light → electric fields and focused sound → drug-releasing implants · Light-activated drugs and drug-releasing implants (current)
• Devices and physical therapies roadmap: heat and light → electric fields and focused sound → drug-releasing implants · Focused sound: destroy, prime, open (emerging)
• Devices and physical therapies roadmap: heat and light → electric fields and focused sound → drug-releasing implants · Devices that make treatment bearable and reachable (current)

• Netherlands Cancer Institute HIPEC trial (phase 3, n=105): Overall survival: 22.3 months vs 12.6 months
• PANOVA-3 (phase 3, n=571): Overall survival: 16.2 months vs 14.2 months, HR 0.82
• Photodynamic therapy against imiquimod against fluorouracil for superficial basal cell carcinoma (phase 3, n=601): Tumour-free survival at 5 years: 80.5% vs 70% vs 62.7%
• EF-14 (phase 3, n=695): Progression-free survival: 6.7 months vs 4 months, HR 0.63
• Photodynamic therapy against cryotherapy for superficial basal cell carcinoma (phase 3, n=118): Lesion recurrence at 5 years: 20% vs 22%
• FOCUS (phase 3, n=102): Objective response rate (independent central review, treated population): 36.3%

1. What was the first approval in nearly thirty years specific to locally advanced pancreatic cancer?
   Answer

   Optune Pax (tumour treating fields) with gemcitabine/nab-paclitaxel, approved Q1 2026 on PANOVA-3.
2. What is tumour treating fields and which cancers is it approved for?
   Answer

   Wearable electrode arrays delivering alternating electric fields that disrupt cell division; approved for glioblastoma, mesothelioma, NSCLC after platinum, and (2026) locally advanced pancreatic cancer.
3. Does scalp cooling prevent hair loss from chemotherapy?
   Answer

   Partly: roughly half of patients on taxane-based regimens keep at least 50% of their hair with DigniCap or Paxman; it is less effective with anthracyclines and reimbursement varies.

• FDA: Medical devices: https://www.fda.gov/medical-devices
• NCI: Hyperthermia to treat cancer: https://www.cancer.gov/about-cancer/treatment/types/hyperthermia