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06 September 2023 | Story André Damons | Photo Supplied
radiation dose distribution
The patient is still under anaesthesia, the placement of the brachytherapy applicators is completed, and they are connected to the Iridium source for the radiation to be given.

Medical personnel at the Universitas Academic Hospital and the University of the Free State (UFS) in Bloemfontein became the first in Southern Africa to use Interstitial brachytherapy as a method for treating cervical cancer. 

A multidisciplinary team, consisting of an anaesthetist, clinical oncologists, application specialists, medical physicists, radiation therapy radiographers and professional nurses, completed the first interstitial cervical cancer brachytherapy in Southern Africa at Universitas Academic Complex in June this year.

Prof Alicia Sherriff, Head of the UFS Department of Oncology and a clinical oncologist, explained: “Brachytherapy is a method of internal radiation therapy, where a source of radiation is placed inside or near the cancer. This type of radiation travels only a short distance and makes it possible to deliver curative doses to the cancer while staying within the tolerance of the surrounding bladder, rectum, and small bowel.” 

She further emphasised that intracavitary brachytherapy has been an essential component of the curative management of cervical cancer since 1938.

According to her, feasibility studies were published for the use of applicators that combine intracavitary and interstitial brachytherapy in 2006. In 2014 prospective clinical trials started reflecting on the clinical value to improve local control for the locally advanced cervical cancers with combining intracavitary and interstitial brachytherapy to get higher doses of radiation where the cancer has grown outside of the cervix. Interstitial brachytherapy where the applicators are placed into the tissue with cancer are also used in prostate and breast cancer. 

Second-most common cancer in South African women

As per the Catalan Institute of Oncology (ICO) and the International Agency for Research on Cancer (IARC) information Centre on Human Papilloma Virus and cancer publication of March 2023, the current new diagnoses of cervical cancer annually in South Africa are 10,702 with 5,870 patients passing away annually due to cervical cancer. It is the second-most common cancer in women in South Africa and the most common among women between 15 and 44. Due to late/delayed presentation and diagnoses most cervical cancer patients seen have more advanced stages where the cancer has infiltrated outside of the cervix into the surrounding tissue.

“At the Universitas Academic Complex we have been approaching cervical brachytherapy with CT (Computer Tomography)-based image guidance for more than a decade already and the past five years we have been doing Adaptive CT-based image guided brachytherapy. 

“This means that with each brachytherapy treatment the cancer and all the surrounding normal organs are delineated based on a new CT image to ensure that we consider how the cancer has shrunk from one brachytherapy to the next and to see how we can limit the dose to the surrounding organs but at the same time achieve the highest possible dose of radiation with each treatment,” says Prof Sherriff. 

Planning to expand the use to other cancers

The intracavitary brachytherapy applicators which are used most frequently are placed within the cervix and uterus and deliver high doses there but cannot address the infiltration into the surrounding tissue adequately, she continued. “That is where these additional needles that are placed via the Venezia applicator into the surrounding tissue give the ability to also reach those areas with high-dose radiation while sparing the organs.”

Prof Sherriff explained that the interstitial brachytherapy does add additional time, expertise and logistical planning to the management and would not be utilised for all cervical cancer patients, but for those patients with locally advanced disease whose general health would support a more aggressive approach. The other academic training institutions are aiming to add interstitial brachytherapy to their platforms as well as at the UFS which is also planning to expand the use to other cancers. 

Save more lives

The MEC for Health in the Free State province, Mathabo Leeto, has congratulated medical professionals on this groundbreaking medical intervention. 

She said this breakthrough is in line with goals set by the United Nations in not only the provision of quality health services, but also and importantly, saving lives.

“This milestone is responsive to our targets for improvement of women’s health and reducing mortality. It is responsive also to Goal 3 of the United Nations’ Sustainable Development Goals which seeks to reduce global maternal mortality ratio, ensure universal access to sexual and reproductive health-care services, including for family planning, information and education, and the integration of reproductive health into national strategies and programmes,” she said.

“Hopefully this breakthrough will help us save many more lives. I wish to congratulate everyone who contributed to this innovative way of cancer treatment and assure you that your province and the people are indebted to you,” concluded Leeto.

 


The medical staff who were involved in the first interstitial cervical cancer brachytherapy in Southern Africa were, from left: Dr Marnus Booyens (Anaesthetist); Dr Karin Vorster (Head Clinical unit and Clinical Oncologist); Dr Willie Shaw (Head of Medical Physics for the division of Radiation Oncology); Khalil Ben Fredj (Application Specialist ELEKTA for the TIMEA region and medical physicist); Prof Alicia Sherriff (HOD Oncology and clinical oncologist); Dr Dedri O’Reilly(medical physicist); Chantel Stroebel (Radiation therapy radiographer at brachytherapy); Dr Lourens Strauss (Medical physicist); Karl Sachse (Medical physicist); Sr Angelique Engelbrecht (professional nurse); Marga Claassen (Clinical and Commercial Account Specialist, SA for Elekta and Medical physicist).

News Archive

Researcher part of project aimed at producing third-generation biofuels from microalgae in Germany
2016-05-09

Description: Novagreen bioreactor  Tags: Novagreen bioreactor

Some of the researchers and technicians among the tubes of the Novagreen bioreactor (Prof Grobbelaar on left)

A researcher from the University of the Free State (UFS), Prof Johan Grobbelaar, was invited to join a group of scientists recently at the Institute for Bio- and Geo-Sciences of the Research Centre Jülich, in Germany, where microalgae are used for lipid (oil) production, and then converted to kerosene for the aviation industry.

The project is probably the first of its kind to address bio-fuel production from microalgae on such a large scale.  

“The potential of algae as a fuel source is undisputed, because it was these photoautotrophic micro-organisms that were fixing sunlight energy into lipids for millions of years, generating the petroleum reserves that modern human civilisation uses today.  However, these reserves are finite, so the challenge is marrying biology with technology to produce economically-competitive fuels without harming the environment and compromising our food security.  The fundamental ability that microalgae have to produce energy-rich biomass from CO2, nutrients, and sunlight through photosynthesis for biofuels, is commonly referred to as the Third-Generation Biofuels (3G),” said Prof Grobbelaar.

The key compounds used for bio-diesel and kerosene production are the lipids and, more particularly, the triacylglyserols commonly referred to as TAGs.  These lipids, once extracted, need to be trans-esterified for biodiesel, while a further “cracking” step is required to produce kerosene.  Microalgae can store energy as lipids and/or carbohydrates. However, for biofuels, microalgae with high TAG contents are required.  A number of such algae have been isolated, and lipid contents of up to 60% have been achieved.

According to Prof Grobbelaar, the challenge is large-scale, high-volume production, since it is easy to manipulate growth conditions in the laboratory for experimental purposes.  

The AUFWIND project (AUFWIND, a German term for up-current, or new impetus) in Germany consists of three different commercially-available photobioreactor types, which are being compared for lipid production.

Description: Lipid rich chlorella Tags: Lipid rich chlorella

Manipulated Chlorella with high lipid contents (yellow) in the Novagreen bioreactor

The photobioreactors each occupies 500 m2 of land surface area, are situated next to one another, and can be monitored continuously.  The three systems are from Novagreen, IGV, and Phytolutions.  The Novagreen photobioreactor is housed in a glass house, and consist of interconnected vertical plastic tubes roughly 150 mm in diameter. The Phytolutions system is outdoors, and consists of curtains of vertical plastic tubes with a diameter of about 90 mm.  The most ambitious photobioreactor is from IGV, and consists of horizontally-layered nets housed in a plastic growth hall, where the algae are sprayed over the nets, and allowed to grow while dripping from one net to the next.

Prof Grobbelaar’s main task was to manipulate growth conditions in such a way that the microalgae converted their stored energy into lipids, and to establish protocols to run the various photobioreactors. This was accomplished in just over two months of intensive experimentation, and included modifications to the designs of the photobioreactors, the microalgal strain selection, and the replacement of the nutrient broth with a so-called balanced one.

Prof Grobbelaar has no illusions regarding the economic feasibility of the project.  However, with continued research, optimisation, and utilisation of waste resources, it is highly likely that the first long-haul flights using microalgal-derived kerosene will be possible in the not-too-distant future.

Prof Grobbelaar from the Department of Plant Sciences, although partly retired, still serves on the editorial boards of several journals. He is also involved with the examining of PhDs, many of them from abroad.  In addition, he assisted the Technology Innovation Agency of South Africa in the formulation of an algae-biotechnology and training centre.  “The chances are good that such a centre will be established in Upington, in the Northern Cape,” Prof Grobbelaar said.

 

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