Cancer, the emperor of maladies, is a frightful hunter of humans. Across the world in 2012, 14.1 million cases were diagnosed, 8.2 million people died and 32.5 million people are living with cancer. By 2030 the number of victims is expected to rise to 24.6 million. Less developed countries such as India can expect a two-fold increase in the next 20 years. The cost that the world had to bear in 2010 is $ 2 trillion ~ a crippling burden for less developed countries.
Where does India stand in the fight against the scourge? On September 18, if noticed by only a few, the biggest cyclotron for exclusive medical application became operational in India. The cyclotron is housed in a specially designed state-of-the-art building in Salt Lake and next to the Peerless Hospital. This establishment is one of the most important research and development centres of the Variable Energy Cyclotron Centre (VECC) in Kolkata. Scientists and engineers of VECC, a unit of the Department of Atomic Energy achieved this tremendous feat.
This cyclotron is called Cyclone-30, bought from a company in Belgium called IBA. How did the cyclotron arrive in Kolkata? First, the Department of Atomic Energy, the nodal Government department, wanted it to be built by VECC indigenously. As VECC Director at that time, I argued against such an idea. As this machine is used for medical application, supply of radio isotopes at reliable and regular intervals is essential. IBA has achieved that consistency and reliability after almost 25 years of research and development. The second factor is that its current must be large enough |for optimum utility. Fortunately, this idea was eventually abandoned.
We wanted to use the soft loan option from the Belgium Government to India. Mr. P. Chidambaram, then the Union finance minister, was not keen on obtaining a loan from another country. So, this idea was also abandoned. Finally, I approached Mr RP Goenka for a purely private enterprise. The negotiations, as expected, received wide publicity but in effect ended up with no result. RPG group backed out.
Eventually, one managed to persuade the Department of Atomic Energy to purchase the machine. The convoluted drama of Government funding had ended with checks and balances, clothed with suspicions and doubts raised by the bureaucracy. All this happened in the late 1990s and the early years of the 21st century. The machine was delivered along with its accessories in huge crates from IBA. But there was no building to accommodate them. The crates were kept safely at VECC premises in an air-conditioned environment.
It took a fairly long time to get the building ready and obtain necessary clearance from various regulatory bodies, ensuring radiation safety in particular. The government of West Bengal was extremely generous and gracious. Chief Minister Buddhadeb Bhattacharjee arranged for five acres ~ free of charge. Mr. Bhattacharjee was impressed by the machine’s public utility. It tooks almost five years for the building to come up. Some months ago, the crates were shifted from the VECC premises to the site of the medical cyclotron, quite an operation given the weight of the machine. IBA must be complimented; after all the years, the machine once energised reached the fixed energy, as per the design, of 30 million electron volts without any hitch whatsoever. Also, It reached the designed current of 350 microamperes, a huge current by any standard.
What is the function of Cyclone- 30? It produces the all-important SPECT radioactive isotopes for cardiological and cancer diagnosis, imaging and even therapy. Iodine (123) is used for oncology, Iodine (124) for imaging and therapy, Gallium (67), diagnosis for soft tissue tumour, Broncogenic carcinoma, Thallium (201) for myocardial perfusion, Fluorine (18) for oncology and Paladium (103) for Prostate therapy. For the first time in India, Cyclone-30 is operational. Palladium radioisotopes are available for therapy, especially for cancer. Thallium is used extensively for myocardial perfusion, usually imported, costing a fair amount and losing out on radiation in transit. Relatively poor people can now have access to such treatment.
Particularly relevant is the use of Palladium for prostate therapy. One plugs in Palladium in the prostate region and the radiation destroys the cancer tumours; if used early when the cancer is in the first stage, it is almost a sure cure of cancer of the prostate. In the United States there are dedicated cyclotrons which produce only Palladium.
In India there are about 20 medical cyclotrons with beam energy up to 18 MeV, but most of the isotopes are used for diagnosis of tumours. The 30 MeV Cyclotron is the first of its kind in India. It is an extraordinary diagnosis. One can ascertain the tumour’s location fairly accurately and there are by now a large number of diagnostic centres in India. But therapy is restricted to radiotherapy and chemotherapy. Radiotherapy has the disadvantage of burning out “good” cells since the profile of the radiation used for radiotherapy is broad, not just directly focused only on the cancer tumour. For a very narrow profile, focused just on the tumour, proton beam therapy is more effective. Apollo hospital in Chennai has procured a proton machine, the only one of its kind in India. Across the world, there are about 65 proton therapy accelerators.
Proton therapy has yet another important role ~ therapy for brain tumours. Of all places, the 250 MeV Cyclotron at Cape Town, South Africa, has been the first to take the plunge in this direction. The accelerator is used for brain tumour therapy during the week and only over weekends is it used for research in nuclear physics. The Cape Town accelerator is a wonderful synthesis of public service and fundamental research. Carbon ions are also used for therapy, the advantage being its relative dose, which is higher than protons.
I am not suggesting that radiotherapy is obsolete. The latest development of MRI-guided radiotherapy is a great improvement over traditional radiotherapy. It is the very basis of all therapies, but that is not enough. At the end of 2007, an estimated 61,855 patients were treated by ion therapy worldwide, 53,188 by protons and 4,450 by carbon ions. As expected, by 2016 the number of patients had risen to 168,000. Proton therapy, it seems, is becoming more acceptable and oncologists across the world prefer to use it against some kind of cancer.
It is quite amazing that a physicist way back in 1946, the man who built the Fermi Laboratory in USA, Richard Wilson, introduced the idea of proton therapy for the first time in human history. The story goes that he was asked by the then President of the United States ~ “What good is this lab going to be for the defence of America”? Wilson retorted: “Well Sir, it is the Fermi Lab, that will be worth defending”. Now, it is again the Fermi Lab that conceived proton therapy when the great war had just ended.
Another very exciting development is the use of newly discovered radioactive isotopes, using accelerators to be used for diagnosis and therapy effectively, for special kinds of cancer. This is an entirely new area and has achieved major breakthroughs thanks to intense collaboration between physicists and oncologists. Finally, there has been phenomenal progress on a very fundamental level.
This year’s Nobel winners have made a significant discovery on the immune system. James P. A Allison and Tasuki Hanjo discovered checkpoint molecules which inhibit the Tcells of the immune system from attacking cancer tumours. They also discovered antibodies which eventually will be able to attack cancerous tumours. Such antibodies have already been converted into a member of immune therapeutic drugs, already approved.
Professor Harold Eliot Varmus, Nobel Laureate from Meyer Cancer Centre, USA, visited Kolkata recently. On a genetic level, he has made a pioneering contribution on the why and wherefore of cancer. It took many years since the early days of radiotherapy to come to Linear Accelerator (LINAC), from Linac to proton therapy. We are still sluggish in terms of our progress graph. The process can be accelerated by working with other countries. Cancer is not just a local tragedy, it is a global tragedy.
In my life 18 September 2018 is a day for celebration, a long cherished dream has come true. We can now reach out to people who remained beyond reach for so long and try to alleviate the misery of so many. Through these columns, I would like to congratulate my young friends at the Variable Energy Cyclotron Centre.
The writer is former Homi Bhabha Professor, Department of Atomic Energy, former Director VECC and SINP.