Radiotherapy/radiation therapy refers to therapeutic procedures using high-energy radiation from X-rays, gamma rays, neutrons, protons, and other sources to destroy abnormal cancerous cell growths and shrink tumors. Radiotherapy treatment is a minimally invasive alternative to chemotherapy and surgical measures, with lesser damage to normal healthy cells.

The top vendors in the radiotherapy market were evaluated and placed them into four categories based on their performance in each criterion: “Visionary leaders,” “Innovators,” “Emerging Companies,” and “Dynamic Players”.

Vendors who fall into this category receive high scores for most evaluation criteria. They have a strong and established product portfolio and a vast presence. They provide mature, innovative, and reputable radiotherapy devices to end users and maintain customer relationships. These companies also have strong business strategies to support their growth and presence in the market.

The players considered as dynamic are established vendors with very strong business strategies. However, they provide limited offerings and are less innovative in this market. They focus on a specific type of technology related to the product.

Innovators in the Vendor DIVE Matrix are vendors that have demonstrated substantial product innovations compared to their competitors. They have a focused product portfolio, but do not have very strong growth strategies for their overall business.

These vendors have niche product offerings that are starting to gain traction in the market, however, they do not have strong business strategies compared to other established vendors. They might be new entrants in the market and require some more time before achieving significant market growth. On the basis of application, the radiotherapy market is classified into two major segments—external beam radiotherapy (EBRT) and internal beam radiotherapy/brachytherapy. The external beam radiotherapy segment is expected to dominate the radiotherapy applications market mainly due to technological advancements in external beam radiation therapy and increasing research activities to study the application and efficacy of external therapy for new cancer types. Additionally, the absence of associated risks of high radiation exposure to patients in this procedure is driving its demand among both patients as well as healthcare providers. EXTERNAL BEAM RADIATION THERAPY EBRT can be applied solely or in combination with brachytherapy or general surgery, depending upon the physical state of the cancerous tumors and the level of biomarkers present in the patient’s body. The development of newer techniques such as stereotactic radiosurgery and IMRT to deliver radiation externally with high accuracy and precision makes this mode suitable for many types of cancer treatment applications. On the basis of application, the external beam radiation therapy market is segmented into prostate cancer, breast cancer, lung cancer, head & neck cancer, colorectal cancer, and other cancers. The prostate cancer segment is expected to account for major share of the EBRT market. The growing incidence of prostate cancer and high success rates achieved with EBRT are the major factors driving the growth of this market segment. PROSTATE CANCER High incidece of prostate cancer will drive the demand for EBRT. Radiation therapy is a noninvasive treatment alternative to other major therapeutic options available for prostate cancer treatment. EBRT overcomes the limitations associated with invasive procedures, such as issues associated with the patient’s age and physical condition. EBRT poses no risk of radioactivity to the patient or the members in contact with the patient, thus allowing them to lead a normal life. In addition, radiotherapy procedures do not involve post-surgical complications such as bleeding. As a result, radiotherapy is considered the most suitable approach for the treatment of prostate cancer. The growing number of available treatment procedures, increasing incidence of prostate cancer, and advantages offered by external therapy for the treatment of prostate cancer are driving the growth of this market segment. In 2018, in the US, about 164,690 new cases of prostate cancer are expected to be diagnosed (Source: American Cancer Society). An increase in R&D activity in this area (the applications of radiotherapy in prostate cancer therapeutics) will also contribute to market growth. However, the possibility of certain side-effects, such as urinary problems, erectile problems, and lymphedema associated with external radiation for prostate cancer, may pose a challenge to the growth of the market. BREAST CANCER Breast cancer is the most frequently diagnosed cancer in women and is prevalent among women in both developed and developing countries. For the treatment of breast cancer, EBRT is used alone or as a combination therapy along with surgery. EBRT for breast cancer is a more targeted approach as radiation does not circulate throughout the body, unlike chemotherapy and brachytherapy. Radiation therapy after breast-conserving therapy lowers the chances of cancer recurrence near the lymph nodes. The major factors contributing to the growth of this market segment include the adoption of advanced external radiotherapy systems across emerging markets and increasing breast cancer research activities. Furthermore, the development of intraoperative radiotherapy, which offers advantages such as high precision, better cosmetic outcomes, and greater patient comfort, is contributing to the growth prospects of this market segment. The rising number of breast cancer cases across the globe is further fueling the adoption of EBRT. For instance, the number of women diagnosed with breast cancer worldwide is estimated to double from 1.7 million in 2015 to reach around 3.2 million by 2030 (Source: Lancet). The demand for breast cancer EBRT products has prompted manufacturers to focus on product development and enhancement. However, the availability of HDR brachytherapy (with fewer side-effects for the same procedure) and challenges in ensuring correct patient positioning over the course of the treatment are the major restraints for market growth. LUNG CANCER Radiotherapy can be used during various stages of lung cancer treatment—it can be used as a solo option in cases where the patient is not healthy or due to other factors such as the size or position of the tumor, or used in combination with surgery to destroy smaller tumors after the surgical procedure. Limited alternatives for lung cancer treatment and the efficient performance of EBRT are the major factors driving the growth of this market segment. GIRT and SBRT can detect small-body movement and deliver the beam accordingly, thus limiting the hazardous effects of radiation on the surrounding tissues. Other factors supporting market growth include rising research and clinical testing of new EBRT therapies for lung cancer applications and the development of guidelines for the use of EBRT in lung cancer treatment. In radiation therapy, the crucial anatomical position of the organ and the continuous movement of the lungs due to respiratory movement make it difficult to target only the cancerous tissue. However, the development of better patient positioning and dose control systems in radiotherapy has reduced the impact of this factor. HEAD AND NECK CANCER Head and neck cancer treatment is considered a very sensitive procedure, as anatomically it is performed adjacent to important organs such as the spine and brain. This segment includes laryngeal cancer, hypopharyngeal cancer, oropharyngeal cancer, and oral cavity cancer. Head and neck squamous cell carcinoma (HNSCC) accounts for ~6% of all cancer cases, with an estimated 1%–2% of all cancer deaths. Radiation therapy can be chosen as the primary treatment plan or can be given in combination with chemotherapy or as a postoperative measure. In this treatment procedure, optimum care has to be taken in dose precision. 3D CRT and IMRT are the commonly used external radiation therapy techniques, as they offer the highest precision in dose calculation. External radiotherapy is preferred in the treatment of head and neck cancer owing to its noninvasive approach and precise dosage measurement, with minimal hazardous effects on important organs. This is one of the major factors driving the growth of this market segment. Technological advancements in external beam radiotherapy are also supporting the growth of this market segment. However, the treatment of head and neck cancer through external beam radiotherapy can lead to side effects such as xerostomia (dry mouth), hypothyroidism, mucositis, inflammation of the mucous membranes of the mouth or throat, ear pain, and skin reactions. These side-effects may limit the growth potential of this market segment over the coming years. COLORECTAL CANCER Radiation therapy is used for colon cancer when the tumor is attached to an internal organ or the abdomen lining. In the advanced stage of colon cancer, radiation therapy is preferred along with chemotherapy. For rectal cancer, radiation therapy is normally used along with surgery to prevent cancer recurrence. In external radiation therapy, 3D CRT and IMRT techniques are mostly preferred by oncologists. EBRT is preferred for colorectal cancer as it reduces the radiation exposure to the pelvic bones, thereby limiting the risk of osteoporosis. The high incidence of colorectal cancer is the major factor driving the growth of this market segment. According to the BMJ, colorectal cancer is the third-most-commonly diagnosed malignancy in the world, and its burden is estimated to increase to more than 2.2 million new cases by 2030, representing an increase of 60%. The availability of other therapy options (brachytherapy and systemic radiotherapy) for the treatment of colorectal cancer is a major factor restraining the growth of this market segment. INTERNAL BEAM RADIOTHERAPY/BRACHYTHERAPY Internal beam radiotherapy/brachytherapy makes use of radiation sources that offer a highly targeted treatment option, which allows the use of higher doses of radiation and reduces the treatment time. The internal beam radiotherapy/brachytherapy applications market is segmented into prostate cancer, gynecological cancer, breast cancer, cervical cancer, penile cancer, and other cancers. PROSTATE CANCER Prostate brachytherapy is a cutting-edge treatment for prostate cancer. Both LDR and HDR brachytherapy are used for prostate cancer treatment. Moreover, brachytherapy is increasingly being used for the treatment of high-risk prostate cancer, globally. It is applied alone or in combination with hormone therapy or EBRT. LDR brachytherapy is as effective as prostatectomy or EBRT because it delivers low-dose radiation and provides protection to the surrounding healthy tissues. In addition, brachytherapy eliminates the need to monitor the movement of the prostate gland, as the implanted radioactive seeds move with the gland. GYNECOLOGICAL CANCER Gynecological cancer includes gestational trophoblastic disease (GTD), primary peritoneal, ovarian, uterine/endometrial, vaginal, and vulvar cancers. For womb or endometrial cancer, radiotherapy is seldom used as monotherapy but is commonly used as a postoperative measure. For womb cancer treatment, brachytherapy offers the advantage of direct tumor access, as the brachytherapy seeds are placed with the help of an applicator and configured according to the treatment site. The radiation is then directed to the tumors via these applicators. For the treatment of vaginal or vulvar cancer, either LDR or HDR brachytherapy can be used. Gynecological cancer provides a huge market for brachytherapy applications due to advantages such as minimal damage, precise targeting, and fast treatment. Furthermore, the high prevalence of gynecological cancer across the world is adding growth opportunities to this applications market. According to Florida Hospital, in the US 80,000 women are diagnosed with gynecologic cancers, where uterine cancer is the most common, followed by ovarian cancer (about the eighth-most-common cancer overall), with about 22,000 new cases per year. BREAST CANCER Brachytherapy is frequently used as a replacement for the traditional wholebreast external radiation therapy. HDR brachytherapy delivers a precise, highly concentrated radiation dose to the target tumor, with shorter treatment times and limited exposure to healthy breast tissues. Brachytherapy also helps in retaining most healthy breast tissues, thus restoring the cosmetic look of the breast. Owing to all these factors, brachytherapy has become a gold standard for the treatment of breast cancer. Early-stage breast cancer, locally advanced breast cancer with no metastasis, and chest-wall breast cancer (which cannot be treated through surgery) are the major application areas for HDR brachytherapy. CERVICAL CANCER Owing to its high incidence, the cervical cancer application segment is covered separately in this report although it is a part of gynecological cancer. In the developing world, cervical cancer is the second-leading cause of cancer deaths among women. Since the cervix is located close to the rectum and bladder, precise and accurate radiation exposure only to the cervix is of great importance in order to avoid side-effects. One of the most effective treatment procedures for cervical cancer is the combination treatment of brachytherapy and chemotherapy. This combination can be applied for any cancer stage—ranging from stage 1B2 (in which the tumor is less than 40 mm in depth and width) to stage 4A (in which the tumor has spread to the nearby organs). Intracavitary brachytherapy wherein the radiation source is placed using an applicator through the vaginal cavity can treat the upper vagina, cervix, and uterus. The growing number of training programs and symposia to spread awareness about the treatment techniques for cervical cancer is a growth driver for this application segment. In 2017, the Virginia Commonwealth University conducted a symposium on “Proficiency-Based Cervical Cancer Brachytherapy Training: An Effort to Combat Recent Trends in Radiation Oncology That Result in Worse Outcomes for an Underserved Population through Resident Education.” However, side-effects such as tiredness, burning sensation while urinating, and sore skin can negatively affect the growth of the internal beam radiotherapy/brachytherapy market for cervical cancer. PENILE CANCER Penile cancer is rare, with the ACS estimating that only about one in 100,000 men are affected. For the treatment of penile cancer, radiation therapy is considered a better alternative than conventional surgical treatment options, which often results in physical distress and may lead to the loss of both sexual and urinary function. Brachytherapy can be applied to treat tumors with a size of up to 4 cm that are restricted to the glands and have not spread beyond the balano-preputial sulcus. Brachytherapy can be used alone or in combination with EBRT. Both LDR and HDR brachytherapy can be used for the treatment of penile cancer. Plesiobrachytherapy and interstitial brachytherapy are the two types of brachytherapy procedures used in these treatments.