According to new research by Omdia, the global market for radiotherapy and proton therapy equipment will continue to grow given the need to deploy more cancer equipment to battle the disease in the years to come.
Worldwide revenue this year for radiotherapy and proton therapy equipment is forecast to grow 6 per cent and reach US$6.6bn, replicating the pace of expansion set in 2019 when the market rose to US$6.3bn.
Last year, radiotherapy accounted for approximately 85 per cent share of market revenue, with proton therapy taking up the remaining 15 per cent. From a products-versus-services split, hardware and software products combined represented an estimated 57 per cent share of revenue, with services accounting for the balance of 43 per cent share.
More than 18 million new cases of cancer were diagnosed in 2018 alone, according to the World Health Organization (WHO), with the figure anticipated to rise by 63 per cent by 2040. But while an estimated 60 per cent of new cancer patients will need as part of their treatment plan some form of radiation therapy or radiotherapy, only 25 per cent will receive treatment because the equipment is not available or because treatment is too costly.
Therapies defined
Most types of cancer radiotherapy use ionizing photon (X-ray or gamma-ray) beams for the local or regional treatment of disease. However, ionizing radiation damages the DNA of both tumour and healthy cells, causing biochemical reactions that eventually result in prolonged abnormal cell function and cellular death. For this regimen, the capability to focus treatment on only the malignancy would be optimal.
An alternative treatment modality to radiotherapy is proton therapy, also known as charged particle radiotherapy. Instead of photons, proton therapy uses beams of protons or other charged particles, such as helium, carbon, or other ions. Charged particles possess different depth-dose distributions compared to photons, depositing most of their energy in the last final millimetres of their trajectory when their speed slows. This results in a sharp and localised peak of dose, known as the Bragg peak. Proton therapy is still an emerging type of external radiation therapy in part due to its high cost, which involves the use of a particle accelerator, which directs proton particles in the form of a beam at the tumour. The beam is generated by using a cyclotron or synchrotron, instead of a linear accelerator.
The third type of treatment is brachytherapy, or the treatment of cancer, especially of the prostate, liver, and breast. The procedure involves the insertion of radioactive implants directly into the tissue. (Note: revenue from brachytherapy is not included in this insight.)
With proton therapy, long a limiting factor in making the therapy more commonly available was the capital cost entailed in developing a proton centre. However, options are now available to reduce start-up costs and help build more proton therapy centres, including one-room centres.
Overall, the upgrading of equipment is becoming increasingly important, especially as current radiotherapy or proton therapy gear continue to age out. Systems featuring a modular design also are candidates for upgrading because they do not require full system replacement.
Breakdown of equipment types
A variety of equipment is used in both radiotherapy and proton therapy. The device most often used in the external radiation treatment of cancer is the medical linear accelerator, or LINAC, which customises high-energy X-rays or electrons to conform to a tumour’s shape and destroys cancer cells while avoiding the surrounding healthy tissue. Featuring several built-in safety measures to ensure delivery of a dose as prescribed, the equipment is routinely checked by a medical physicist to ensure it is operating properly.
While LINACs are widely available in the U.S. and Western Europe, significant demand exists in the rest of the world, deposit cost constraints create a shortfall in availability. Based on demand from patients that could benefit from this therapy, the shortage of LINACs is expected to increase through the next decade. Approximately 14,400 LINACs and proton systems worldwide are installed at present, with the number forecast to reach 18,950 units in 2023, Omdia estimates.
LINAC machines deliver several types of radiation therapy, including the following:
- Intensity-modulated radiation therapy, or LINAC IMRT, can be controlled to target more precisely the size and shape of the tumour, allowing a higher radiation dose while minimising radiation to surrounding healthy tissue. A variation or advancement of IMRT is volumetric modulated arc therapy (VMAT), which allows the clinician to control three parameters: the radiation beam, or beam-shaping aperture; dose rate; and speed of rotation around the patient. Tomotherapy is a radiation therapy modality in which the patient is scanned across a modulated strip-beam so that only one “slice” of the target is exposed at any one time by the LINAC beam.
- Image-guided radiation therapy, or LINAC IGRT, complements LINAC-IMRT in allowing clinicians to improve treatment accuracy by accounting for small tumour movements, changes in tumour size or tumour shrinking.
- Stereotactic radiosurgery, or LINAC SRS, is an advanced ablative radiation treatment used to treat tumours and other disorders in the brain. It involves the delivery of a single, highly precise, high dose of ionizing radiation to small and critically located targets in the brain with minimal damage to surrounding tissue in a small number of treatment sessions.
- Stereotactic body radiation therapy, or LINAC SBRT, resembles LINAC SRS in being an advanced ablative radiation treatment as well as a hypofractionation regimen—or radiotherapy that allows higher doses of radiation and fewer treatment sessions. With SBRT, small- and medium-sized tumours can be removed with minimal damage to surrounding tissue. But while SRS targets brain lesions, SBRT is used to treat body tumours and tumours outside the brain.
- Three-dimensional conformal radiotherapy, or 3D CRT, delivers a conformal dose distribution to tumours while sparing surrounding normal structures. The use of patient-specific 3D images in the treatment-planning process distinguishes 3D CRT from conventional treatment techniques.
Market winners
Among regions, the Americas—primarily the U.S.—held the largest share of revenue in 2019, with 42 per cent of the total market. In second place was EMEA, with 35 per cent; followed by Asia Pacific, with 23 per cent.
The world’s top three suppliers of radiotherapy and proton therapy equipment include two based in California’s Silicon Valley—Varian Medical Systems in Palo Alto, the market leader; and Accuray Inc., headquartered in Sunnyvale, in third place. Occupying the No. 2 slot is Elekta AB from Stockholm, Sweden.