International Patient Services

Radiotherapy uses high-energy rays to destroy cancerous cells in the treatment area. It can damage the ability of cancer cells to proliferate without harming the surrounding normal cells. 

There are unprecedented advances in radiotherapy technologies and techniques these years, many of which incorporate new concepts and skills to precisely locate tumours, instantly tailor the shape of X-ray beams and accurately deliver doses of radiation to moving tumours. 

The HKSH introduced the Radixact X9 - next generation of helical radiation therapy technology and installed Asia’s first Unity MR Linac in HKSH Eastern Medical Centre, which is an important innovation allowing radiation to be aimed at tumours with extreme precision.

Systemic chemotherapy has been extensively used in cancer management. In highly chemo-sensitive cancers, such as lymphoma, leukaemia, and germ cell tumours, chemotherapy alone can be curative, whereas in other solid tumours chemotherapy can effectively reduce the chance of recurrence when used in conjunction with other therapies. 

In advanced disease setting, chemotherapy often delays disease progression, controls symptoms, and improves quality of life. 

The HKSH Medical Group provides two venues of Chemotherapy Day Centres and inpatient treatment if required; we strive to provide a reassuring, private and comfortable environment to patients and their family members during treatment. Every possible need will be catered to the best of our abilities by our professional oncology nurses to ensure a smooth and optimal patient journey. 

Chemotherapy drugs are usually used in combination to maximise tumour cells killing through different mechanisms of action. They can be administered either before or after surgery or radiotherapy, and sometimes be given concurrent with radiotherapy. Most of these drugs are delivered to the body via intravenous route, but some drugs can be taken orally or even administered into the arteries, pleural cavity or peritoneal cavity, or directly into the surgical bed. 

Since cytotoxic agents unselectively inhibit both normal and tumour cells, they do share some common toxicities, in particular to those fast-growing normal cells. General toxicities include bone marrow suppression leading to anaemia and increased infection risk, hair loss, and gastrointestinal side effects such as nausea, vomiting and diarrhoea. Some classes of drugs may demonstrate specific class effects, such as nerve toxicity, kidney toxicity, liver toxicity, or heart toxicity. Doctors will closely monitor the toxicity profile of each patient and employ various methods to effectively minimise these side effects.

Radionuclide therapy treats abnormal cells by radioisotopes emitting high-energy alpha and beta radiation. The radioisotopes are tagged with biochemical molecules in radiopharmacy laboratory as “therapeutic agent”. The compound follows metabolic pathway as an in-vivo carrier and brings the radioisotope to specific treatment targets. The high energy radiation maximises treatment effect at molecular distance. The role of this treatment modality has been well established for thyroid diseases, and it has emerged as an effective option for neuroendocrine tumours and prostate cancers in recent years. 

Theranostics is a new concept in strategic treatment of cancer based on quantitative and longitudinal targeted molecular imaging, using the same biochemical molecules as imaging and therapeutic agents. Firstly, tracers with diagnostic radioisotopes (F-18, C-11, Ga-68, Tc-99m, I-123, etc.) are used for tomographic imaging with PET/CT and NM SPECT/CT to perform cancer staging, trace metastases, simulate treatment and predict effectiveness. Subsequently, tracers with therapeutic radioisotopes (I-131, Lu-177, Y-90, Ra-223 and Sr-89, etc.) emitting high energy radiation are applied to deliver highly specific treatment and their biodistribution inside body during therapy are captured for evaluation. Cancer therapy can thus be personalized and effectively monitored to improve survival and quality of life. 

To ensure radiopharmaceutical quality and safety, a series of stringent tests are performed in our Quality Control Laboratory before patient use. Under the care by nuclear medicine specialists, radiographers and nurses in our private radiation isolation rooms, the safety and well-being of patients during treatment can be maximized. 

With a comprehensive clinical setting, we are the only NMPET centre in Hong Kong capable of providing a one-stop full spectrum service of radionuclide therapy for different cancers and other metabolic diseases. The current scope of treatment services includes Lutetium-177 DOTATATE and Iodine-131 MIBG for neuroendocrine tumour, Lutetium-177 PSMA for prostate cancer, Iodine-131 for thyrotoxicosis and thyroid cancer, Yttrium-90 Microspheres for liver cancer, Ytrrium-90 Zevalin radioimmunotherapy for non-Hodgkin's lymphoma, Radium-223 Dichloride for bone metastases of prostate cancer and Strontium-89 Chloride for bone metastases palliation.

Molecular targeted agents are currently the focus of active cancer research. With better understanding of the molecular mechanisms of tumourogenesis of various cancers, drugs can be developed to interfere with specific molecular targets that are involved in the growth and spread of cancer. 

For a specific targeted therapy to work, the corresponding molecular target must be present in the tumour cell, and this is usually verified by tumour biopsy or blood test. The drugs are either in the form of small molecular oral tablets (inhibitor) or given intravenously (monoclonal antibody). 

In contrast to chemotherapy which makes no distinction between normal and cancer cells in its attack, targeted therapy causes less damage to normal cells and is therefore associated with less treatment side effects; a wide variety of targeted drugs have been approved for the treatment of: 

• Breast Cancer (e.g.Herceptin, Pertuzumab, Olaparib)
• Cervical cancer
• Colorectal cancer (e.g. Bevacizumab, Cetuximab and Panitumumab)
• Glioblastoma
• Kidney Cancer (e.g. Cabozantinib, Sunitinib, Pazopanib, Axitinib, Lenvatinib, Sorafenib)
• Leukaemia (e.g. Imatinib)
• Liver Cancer (e.g. Sorafenib, Lenvatinib, Regorafenib)
• Lung Cancer (e.g. Erlotinib, Gefinitib, Afatinib, Decomitinib and Osimertinib)
• Lymphoma (e.g. Mabther/Rituximab)
• Multiple Myeloma
• Ovarian Cancer

Under normal circumstances, an immune response is triggered when cancer cells are identified by the immune system. However, certain types of cancer may interfere with this mechanism and suppress immune responses, making one prone to cancer attack. 

There are several forms of immunotherapy on the market. They can either help the immune system to recognise the cancer, or stimulate the immune system in various ways. Checkpoint inhibitor is a class of drugs (e.g. Pembrolizumab, Nivolumab, Atezolizumab, Durvalumab, Avelumab) that can successfully treat cancers such as: 

• Bladder cancer
• Kidney Cancer
• Lung Cancer
• Lymphoma

Hormone therapy, also called endocrine therapy, is a cancer treatment that slows or stops the growth of cancer that is dependent on hormones to grow. Hence, hormone therapy is commonly used to treat breast cancers and prostate cancers. It may be given in different ways, such as oral route, injection, or surgery to remove the hormone-producing organs (ovaries or testes). 

70-80% of breast cancer patients belong to the hormone-receptor positive category. Hormone-receptor positive patients will derive benefits from hormone therapy in the adjuvant setting after breast surgery (Tamoxifen with or without Gonadotrophin releasing hormone analogue for premenopausal patients, and aromatase inhibitors for postmenopausal patients). The duration of hormone therapy in this situation is usually 5 years or longer. Hormone therapy is also an effective treatment in metastatic hormone-sensitive breast cancer, and provides substantial tumour control with relatively less toxic side effects when compared to systemic chemotherapy. At the time of development of endocrine resistance, further hormone therapy, such as Fulvestrant or Exemestane, may be used alone or in combination with other targeted therapies, such as the Cyclin-dependent kinases 4/6 inhibitors or the mTOR inhibitors, to overcome endocrine resistance. 

Almost all prostate cancer cells rely on male sex hormone (androgens) to grow. Androgen deprivation therapy (ADT) can thus effectively suppress prostate cancer by eliminating testosterone production from the testes. In intermediate- to high-risk non-metastatic prostate cancer, ADT can be used before and after radiotherapy to enhance tumour control and reduce tumour recurrence, whereas in metastatic prostate cancer, ADT can be used alone or in combination with chemotherapy to palliate symptom and delay disease progression. ADT can be achieved by surgical removal of testes or regular injection of Luteinizing-releasing hormone analogue. 

At the time of acquired endocrine resistance, also called castration resistance, additional hormone therapy, such as antiandrogens or androgen synthesis inhibitors, may be used in combination with ADT to overcome endocrine resistance. Enzulutamide is a new antiandrogen that binds to the androgen receptors of tumour cells to reduce signal transduction and cell proliferation. Abiraterone Acetate is a new androgen synthesis inhibitor that inhibits androgen production from the adrenal glands, tumour cells, and the testes more comprehensively.