For many Malaysians, a cancer diagnosis still comes late. The National Cancer Registry Report 2017–2021 revealed that 65.1 per cent of cases are detected at Stage 3 or 4, with lung cancer recording more than 90 per cent late-stage diagnosis in both men and women.
Early detection remains the gold standard, but when cancers are discovered late or located near vital organs, treatment becomes much more complex.
This is where precision radiotherapy steps in.
Globally, newer image-guided systems have already been changing the way doctors treat cancer.
Now, Malaysia is beginning to adopt the same technology, delivering radiation beams with sub-millimetric accuracy while accounting for something as simple yet disruptive as a patient’s breath.
Traditional radiotherapy often stretches over weeks. By contrast, stereotactic radiosurgery (SRS) and stereotactic body radiotherapy (SBRT) allow doctors to deliver highly targeted, higher doses of radiation in just one to five sessions.
These approaches are already well-established in Europe, the US and Japan, where they have shown strong results in controlling tumours and easing symptoms.
What makes the new generation of systems stand out is their ability to track even the tiniest body movements, whether it’s a patient shifting slightly or simply breathing—using a mix of surface scanning, thermal imaging and X-ray verification.
The machine automatically pauses or adjusts if the tumour moves out of range, keeping the radiation exactly where it should be.
This means doctors can safely target cancers that were once considered too risky to treat, including tumours in the lung, liver, prostate, breast and spine, on top of complex brain cases.
Non-cancer conditions like arteriovenous malformations (AVMs), or tangled blood vessels in the brain, can also be treated with the same precision.
Comfort counts too
For patients, cancer treatment is not just about survival, it is also about the journey.
Traditional radiotherapy often required rigid head-to-toe masks and even permanent skin tattoos to ensure precise positioning, which could be uncomfortable and emotionally taxing. Today’s systems have been redesigned with comfort in mind.
Open-face masks now allow patients to breathe more easily and feel less claustrophobic, while tattoo-free alignment eliminates the need for permanent skin markings by using advanced imaging instead.
Treatments are also shorter, meaning less time on the table and fewer hospital visits, helping to ease both the physical and emotional burden of care. These seemingly small changes can make a big difference in reducing anxiety and improving the overall treatment experience.
A timely development in Malaysia
One example of this shift is at Subang Jaya Medical Centre (SJMC), which recently introduced the ExacTrac Dynamic system, the first of its kind in Malaysia. Integrated with the hospital’s TrueBeam Linear Accelerator, the technology combines surface guidance, thermal imaging and X-ray monitoring to track patient movement in real time, even accounting for breathing motion.
SJMC chief operating officer said: "The launch of ExacTrac Dynamic marks another important milestone for SJMC in advancing precision medicine. Every innovation we introduce is made with our patients’ well-being in mind.
"As we celebrate our 40th anniversary this year, we remain steadfast as a trusted one-stop cancer centre and regional referral hub for complex cases, combining medical excellence with compassionate, person-centred care."
Consultant clinical oncologist Dr Winnie Ng explained how the system has changed the way the hospital approaches complex cases.
“This level of accuracy allows us to treat tumours in delicate areas or those that are hard to reach. We can also offer treatment to patients who might not have been suitable for stereotactic radiosurgery in the past.
"For many, this means fewer treatment sessions, faster recovery, reduced hospital visits and less disruption to their daily lives," she said.
International experts who have used the technology in clinical practice have also observed its benefits. Dr Yoshiko Oshiro, chief of radiation oncology at Tsukuba Medical Centre, Japan said the enhanced prepositioning technology has enabled up to 50 patient set-ups a day, streamlining preparation and allowing more patients to be treated without compromising accuracy.
Free University of Brussels (UZ Brussel), Belgium head of medical physics Professor Dr Thierry Gevaert highlighted its value for tumours affected by movement.
“Beyond its established role in brain radiosurgery, it is especially valuable for tumours affected by breathing or other movement, as real-time monitoring allows instant adjustments to maintain precision,” Gevaert said.
For patients, the comfort factor is just as important. Catherine Lee, director of cancer and radiosurgery and imaging services at SJMC, explained that it is not only about delivering precise treatment, but also about making the process less daunting.
“Features like the open mask, quick set-up and short treatment time help patients feel more at ease while we maintain the highest safety standards,” she said.
Looking ahead
Having access to precision radiotherapy at home means fewer patients need to consider costly trips overseas. It also brings local cancer care in line with international standards, offering hope for those with difficult or advanced cases.
Still, experts caution that technology is not a cure-all. Precision radiotherapy may improve outcomes and reduce side effects, but it cannot make up for late detection. Screening, healthier lifestyles and early intervention remain critical in lowering the country’s cancer toll.