A Detailed Guide To Radiotherapy Treatments In Singapore

Medically reviewed by Dr Johann Tang, Senior Consultant Radiation Oncologist

Part 1: The Importance Of Radiotherapy

1.1 Introducing Radiotherapy

Cancer is an increasingly common condition that affects people across the globe. In Singapore alone, cancer affects approximately 1 in 4 people in their lifetime, and comes in many forms such as breast, prostate, lung, cervical, and brain cancer, amongst others. With the lethality of cancer, it is always essential for early detection and diagnosis, which facilitates effective treatments such as radiotherapy, also known as radiation therapy.

Radiotherapy treatment uses radiation to kill cancer cells in the body by damaging their DNA, preventing them from growing and dividing. Radiation therapy in Singapore is a key method in treating cancer, utilising various means to deliver high-energy radiation, including X-rays, gamma rays, protons or electrons, into the body to destroy or damage cancer cells while minimising damage to nearby healthy tissue. While healthy cells nearby may also be affected, many are able to repair themselves over time.

The radiotherapy treatment prescribed differs from patient to patient depending on the type of cancer and where it is in the body. For some patients in Singapore, radiation therapy is the only required cancer treatment in the form of curative radiotherapy, and delivers effective results for selected early-stage cancers such as nasopharyngeal (nose) and prostate cancer, as well as certain breast cancers. In many cases, it is also used in conjunction with other treatments such as chemotherapy and surgery to increase the likelihood of a successful treatment.

Radiotherapy is also utilised in preparation for surgery, such as neo-adjuvant radiotherapy where it is used to shrink the size of the tumour to make it easier for surgical removal; or adjuvant radiotherapy that follows up after surgery to kill any remaining cancer cells and reduce the likelihood of the tumour returning. For situations where the cancer has metastasised and spread through the body, radiotherapy may be used to ease symptoms, in the case of palliative treatments. It can help by shrinking tumours to reduce pain and other related symptoms, such as breathing issues or loss of bowel and bladder control, helping improve one’s quality of life.

The main types of radiotherapy treatment in Singapore include external beam radiotherapy (EBRT) and brachytherapy, with proton therapy being a specialised form of external beam radiotherapy. The most common is external beam radiotherapy (EBRT), where a machine is utilised to carefully direct and focus beams of radiation at the cancer. Another treatment option is utilising radiotherapy implants, also known as brachytherapy; where small pieces of radioactive material are temporarily or permanently placed inside one’s body near the cancer. The type of radiation therapy recommended for patients depends on various factors, such as the type of cancer being presented, tumour location, as well as potential side effects. Another form of brachytherapy is the use of high dose rate brachytherapy (HDR) often used in the treatment of cervix, endometrial, prostate, and breast cancer.

A specialised alternative to conventional X-ray-based EBRT, proton therapy utilises a stream of positively-charged protons instead to treat cancerous tumours. The main advantage of using proton particles is that they can be planned to deposit most of their radiation energy at a targeted depth, potentially reducing radiation exposure beyond the tumour. This allows for precise targeting and may reduce radiation exposure to nearby healthy tissue in selected patients. However, proton therapy is not necessarily more effective or associated with fewer side effects for every cancer type. Proton therapy may be useful for selected tumours which have not spread and are near important parts of the body, such as the brain and spinal cord. It is also utilised in treating other cancers, such as sarcomas, head, neck, lung, and prostate cancer, amongst others, depending on clinical suitability and in accordance with MOH approved guidelines.

Learn more about the various types of radiation therapy treatments in Singapore in Part 2 below.

1.2 Radiologists & Radiation Oncologists

Radiologists and radiation oncologists in Singapore play different roles in helping to treat patients. Radiologists specialise in utilising a variety of medical imaging techniques to diagnose and treat conditions, of which cancer is amongst them. Radiologists often play an important role in staging the cancer and evaluating the extend of spread of the cancer. Various tools at their disposal such as computed tomography (CT) scans, X-rays, ultrasound, magnetic resonance imaging (MRI) scans, positron emission tomography (PET) scans, and mammograms are used to evaluate the extend of cancer spread. After examining the medical images, radiologists interpret the results to provide their diagnosis, and work closely with other physicians such as surgeons, medical oncologist and radiation oncologist to recommend an individualised treatment plan.

Radiation oncologists refer to physicians who specialise in treating cancer, and are in charge of determining the delivery method as well as dosage of radiation therapy to be delivered to a patient. With their speciality in various types of cancer, radiation oncologists oversee patients’ individualised radiation treatment plans, as well as effectively carrying out the treatment process and reviewing patients’ response and overall health across the entire duration.

With over 25 years of experience, Dr Johann Tang is a highly experienced radiation oncologist based in Singapore. He underwent additional fellowships in both breast and prostate brachytherapy, as well as skin and paediatric care. Dr Tang was also a board member of various international oncology boards and societies, as well as a mentor to resident radiation doctors and authoring various publications. In addition to being frequently invited to give talks abroad, Dr Tang has also won several research prizes and held various research grants.

Dr Tang adopts an evidence-based and individualised approach to treating his patients at his clinic, which works in conjunction with advanced medical technology to minimise side effects and maximise treatment outcomes. Dr Tang and his team of experienced medical staff are fully committed to patient-centered care, reassuring patients by fully attending to their clinical needs and journeying with them from diagnosis to treatment completion.

Patients seeking radiotherapy treatment in Singapore can arrange a consultation with Dr Johann Tang from ME Novena Specialist Group, which is located at Mt Elizabeth Novena Hospital, Mt Alvernia Hospital or Farrer Park Hospital, to discuss suitable radiation therapy trreatment options.

Part 2: Various Radiotherapy Treatments

In this section, we will cover more about the various radiotherapy treatments that are carried out by radiation oncologists in Singapore, as well as their effectiveness in treating a wide range of cancers, such as prostate, cervical, breast, and lung, amongst others. These include external beam radiation therapy, brachytherapy and proton therapy, each of which uses a different approach to deliver radiation to cancer cells.

2.1 External Beam Radiation Therapy

External Beam Radiation Therapy (EBRT) is the most commonly used type of radiation therapy in Singapore, which focuses a beam of high-energy radiation into the target region using a machine. There are many types of EBRT treatments available, such as 3D CRT, IMRT, VMAT, IGRT, stereotactic radiotherapy (SBRT), stereotactic radiosurgery (SRS), as well as proton therapy. Each of these treatments is designed for different clinical situations and different cancer type. External beam radiation treatment delivery is generally painless. Treatment duration and radiation dosage vary from 5-15 minutes depending on the cancer type and site of disease and type of radiation treatment.

3D Conformal External Beam Radiotherapy, also known as 3D CRT, is one of the most common forms of EBRT used by radiation oncologists in Singapore. As per its name, the radiation beams utilised in this treatment are generated by a linear accelerator, and customised to conform to the precise shape of the malignant tumour. The usage of imaging technologies such as CT scans, sometimes supplemented by MRI and PET scans, helps to create a three-dimensional image of the tumour and nearby organs and tissues, allowing for a refined treatment plan and an effective dose of radiation to be administered. 3D CRT is routinely utilised in breast cancer treatment in Singapore, as well as treating lung cancer and brain tumours.

Intensity Modulated Radiation Therapy, or IMRT for short, utilises multiple smaller beams from different angles to deliver varying intensities of radiation to the affected region. Similarly to 3D CRT, IMRT utilises careful planning via imaging technologies to effectively determine the ideal dosage. The main goal of IMRT is to conform the radiation dosage strictly to the targeted tumour or area while reducing the exposure of radiation to healthy tissue. IMRT is frequently used in prostate cancer radiation treatment, as well as for head and neck cancers and pelvic tumours; and is useful in reducing treatment toxicity.

Volumetric Modulated Arc Therapy, or VMAT, builds upon IMRT by directing the high-energy beams in a series of arcs or angles via a rotating treatment machine. These arced beams allow radiation to precisely target tumours in difficult locations, such as those wrapped around organs. The main advantage of VMAT is its significantly shorter duration, with radiation delivery often completed within a few minutes. It is used in the treatment of prostate and lung cancers, along with head and neck cancers; and is also utilised for patients who may feel discomfort or pain when lying down for prolonged periods.

Image Guided Radiation Therapy (IGRT) utilises detailed scans using imaging technologies such as CT, X-ray or MRI that are taken before or during the treatment session. It allows for highly precise delivery of high-powered beams of radiation onto the tumour, maximising effectiveness and reducing damage to nearby healthy tissue. It is useful in treating cancers located close to sensitive structures or organs, or for tumours that move with respiration, such as head, neck, abdominal, pelvic, and lung cancers, amongst others.

Stereotactic Body Radiation Therapy, or SBRT, delivers extremely precise and intense doses of radiation to treat both primary and metastatic tumours instead of surgery. It uses high quality imaging technology to locate tumours accurately. It is often used as a radiation treatment for lung cancer, prostate, liver and spinal cancers. An advantage of SBRT is the larger doses of radiation delivered during a single session, allowing for a greatly reduced overall treatment timeline, often requiring only one to five sessions. SBRT is generally non-invasive, although its suitability and potential side effects depend on the tumour’s location and the patient’s condition.

Stereotactic Radiosurgery (SRS), is similar to SBRT in its delivery of highly precise and intense doses of radiation to treat small and localised brain tumours. It concentrates many small radiation beams onto the region where the tumour is, having minimal effect on the tissue it passes through while delivering its effectiveness at the area where the beams intersect. Unlike gamma knife which involves screwing the frame to the skull or invasive brain surgery, LINAC based SRS avoids incisions to the skull  and many of the risks associated with conventional surgery. LINAC Based SRS is a Frameless SRS which iis non-invasive and uses a thermoplastic mask to secure onto the patient’s head, which provides greater comfort to the patient while maintaining effective treatment outcomes.

2.2 Brachytherapy

In contrast to EBRT which delivers radiation therapy via an external source, brachytherapy does so by inserting radioactive sources inside the patient’s body. Brachytherapy allows a higher total dose of radiation over a shorter time, and it is often used in conjunction with EBRT to increase the likelihood of fully destroying cancerous cells. It also features a shorter treatment timeline and reduced side effects, as well as the option for outpatient treatment to allow patients to go about their daily lives.

Brachytherapy also plays a key role in cervical cancer treatment in Singapore. Cervical cancer is an important women’s health concern, and brachytherapy is a key component of treatment for many patients with locally advanced cervical cancer. Brachytherapy works alongside EBRT and chemotherapy for effective treatment. Intracavitary brachytherapy is most often utilised, whereby a radioactive applicator is positioned in the vagina and uterus, sometimes with additional needles, to deliver radiation close to the tumour. The treatment duration depends on the prescribed brachytherapy technique.

Brachytherapy also helps to treat breast and endometrial cancer, also known as uterine cancer. Brachytherapy plays an important role for selected patients who have undergone hysterectomy surgery to remove the uterus, particularly when radiation is recommended to reduce the risk of recurrence. Vaginal Vault brachytherapy is a commonly used HDR procedure, with an applicator being inserted into the vagina to deliver radiation to the upper vaginal region. Treatment duration and the number of sessions depend on the individual treatment plan.

Arrange a consultation with us today to find out more about our brachytherapy treatments in Singapore, and how we can best help you.

2.3 Proton Therapy

Proton therapy, also known as proton beam therapy, is an advanced type of external beam radiotherapy that uses positively charged proton particles instead of conventional X-rays to target and destroy cancer cells. It allows radiation to be delivered precisely to the tumour while potentially reducing exposure to surrounding healthy tissues and sensitive organs.

Proton therapy may be considered for selected cancers, including brain, head and neck, prostate and certain paediatric cancers, particularly when tumours are located near critical structures. Its suitability depends on the patient’s diagnosis, tumour location and individual treatment needs.

Learn more about proton therapy treatment in Singapore and whether it may be a suitable option for you.

Part 3: Visiting A Radiation Oncologist

The treatment process is naturally daunting for cancer patients. Read on to learn more on preparing for a visit to a radiation oncologist in Singapore, as well as what to expect for subsequent treatment sessions, including the different types of radiation options, radiotherapy treatment course, common side effects and available financial support.

3.1 Preparing For Your First Visit

The radiation therapy treatment process begins with an initial consultation with a radiation oncologist in Singapore, who will review the patient’s medical reports, pathology reports, and radiology images before conducting a physical examination. Some factors that radiation oncologist consider for the appropriate treatment to use include:

• Type of cancer
• Size of tumour and location in body
• Proximity of tumour to healthy tissues
• Patient’s general health and medical history
• Patient undergoing other cancer treatments
• Age and existing medical conditions

From there, the radiation oncologist will arrange for a simulation process which involves the taking of X-rays or diagnostic imaging scans, and allows them to define the exact location and configuration of treatment for the cancer or tumour. The treatment setup will also be simulated, with patients being positioned and immobilised to reproduce the treatment process as thoroughly and accurately as possible.

Once the radiation oncologist has discussed with other staff such as therapists, nurses, medical physicists, and dosimetrists, they will design a tailor-made treatment plan that aims to deliver maximum radiation to the tumour within safe limits while limiting the dosage to nearby tissue, as well as reducing side effects. Once planning is complete, radiation therapy treatment can commence.

Your radiation oncologist will require you to sign a consent form informing on the benefits of treatment, possible risks, type of radiation therapy to be utilised, as well as other treatment options. Do take this opportunity to ask all relevant questions that you may be concerned about, such as your ability to handle work or leisure while undergoing treatment, expected side effects, as well as any possible long-term effects that may affect your overall wellbeing.

Here are some tips to best prepare for your first radiation therapy session:

• Find ways to relax and reduce stress
• Seek family or friends’ help to handle errands
• Arrange for transport to and from the clinic
• Share your concerns with staff and friends
• Consider your future fertility plans

The actual treatment session generally does not last long, with patients often spending no more than 20 minutes in the treatment room. Once done, patients will be brought to an examination room, where they can discuss issues regarding radiation, skin care, and nutrition.

What Are the Common Side Effects of Radiotherapy Treatment?

Radiation therapy may cause side effects depending on the area of the body being treated, the radiation dose and the patient’s overall health. Common side effects of radiotherapy treatment include fatigue, skin irritation, hair loss in the treated area, nausea, and urinary or bowel changes. Many short-term side effects improve within a few weeks after treatment, although some may persist or develop later. Patients should consult their radiation oncologist about managing side effects during and after radiotherapy.

3.2 Subsequent Treatment Sessions

Across the treatment schedule, the radiation oncologist and assigned nurses at your Singapore clinic will follow up regularly with you to check on your progress, degree of side effects and recommend treatments for them if necessary, as well as addressing any concerns you may have.

What Is the Radiotherapy Treatment Course in Singapore?

With patients each responding differently to radiation therapy, radiation oncologists will plan out individualised treatment timelines that vary based on the type of treatment used and the patient’s diagnosis and treatment goals.

Treatment for different patients varies from one day to a few weeks. For example, Stereotactic Radiosurgery (SRS) may be completed in a single session, while Stereotactic Body Radiation Therapy (SBRT) often requires one to five sessions. Conventional external beam radiotherapy may be delivered over several weeks, while brachytherapy and proton therapy follow treatment schedules tailored to each patient’s condition. Some longer treatment courses may extend beyond several weeks.

The number of sessions and overall treatment duration depend on the cancer type, tumour location, prescribed radiation dose and the patient’s response to treatment. Any changes to the schedule will be assessed by the radiation oncologist to ensure that treatment remains safe and effective.

During this period, it is important to get plenty of rest, consume a balanced and nutritious diet, stay hydrated, avoid exposing affected skin to sunlight, as well as seek emotional support from loved ones. Once treatment is fully completed, your radiation oncologist will also schedule follow-up appointments to ensure your recovery proceeds normally, as well as to monitor the tumour response. They may also order additional diagnostic tests if necessary to check the response to treatment and monitor for possible recurrence.

Is MediSave or Financial Support Available for Radiotherapy Treatment in Singapore?

At our radiotherapy clinic in Singapore, we believe that health should not come at the expense of being unable to afford radiation therapy sessions. Patients may be able to use MediSave, MediShield Life, Integrated Shield Plans or other eligible insurance arrangements to help manage radiotherapy treatment costs in Singapore, subject to the applicable eligibility requirements and coverage limits.

MediSave can be used for approved outpatient radiotherapy treatments, including certain types of external beam radiotherapy, brachytherapy, stereotactic radiotherapy and proton beam therapy. The amount claimable depends on the treatment type and prevailing MediSave withdrawal limits.

Patients with Integrated Shield Plans or private medical insurance may also be eligible for partial or full coverage of certain treatment expenses, depending on their policy terms, deductibles, co-payments and insurer approval.

Dr Johann Tang’s practice assists patients with insurance-related enquiries, including Integrated Shield Plans, corporate and personal insurance, and Letters of Guarantee from participating insurers. International patients may also enquire about insurance arrangements and direct billing where applicable.

For more information about radiotherapy treatment costs, MediSave claims, insurance coverage and payment options, visit our Billing and Payments page or contact our clinic staff for assistance. Patients are encouraged to clarify their estimated treatment costs and insurance eligibility before starting radiotherapy.

Part 4: Conclusion

Radiation therapy is invaluable in treating Singaporeans with cancer, and with early detection and expert treatment and care, radiotherapy clinics provide patients with treatment options that may control cancer, reduce symptoms and, in suitable cases, achieve a cure. Dr Tang and his experienced team of staff are committed to providing the utmost in patient-centered care, supporting them and their families from start to end.

Looking for radiotherapy treatment in Singapore? Consult Dr Johann Tang, a radiation oncologist from ME Novena Specialist Group located either at Mt Elizabeth Novena Hospital, Mt Alvernia Hospital or Farrer Park Hospital, to learn more about suitable radiation therapy options, including external beam radiotherapy, brachytherapy and proton therapy. His team can also assist with enquiries about the treatment course, MediSave and insurance arrangements.

Get in touch with Dr Johann Tang’s practice to arrange a consultation and discuss an individualised radiotherapy treatment plan.