RADIOTHERAPY: TECHNOLOGIES AND GLOBAL MARKETS

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1 RADIOTHERAPY: TECHNOLOGIES AND GLOBAL MARKETS HLC176A February 2015 Neha Maliwal Project Analyst ISBN: BCC Research 49 Walnut Park, Building 2 Wellesley, MA USA (toll-free within the USA), or (+1)

2 TABLE OF CONTENTS CHAPTER 1 INTRODUCTION 2 STUDY GOALS AND OBJECTIVES 2 REASONS FOR DOING THE STUDY 2 SCOPE OF REPORT 3 INTENDED AUDIENCE 3 RESEARCH METHODOLOGY 3 ANALYST'S CREDENTIALS 4 RELATED BCC RESEARCH REPORTS 4 BCC RESEARCH WEBSITE 4 DISCLAIMER 5 CHAPTER 2 EXECUTIVE SUMMARY 7 SUMMARY TABLE RADIATION THERAPY MARKET BY TYPE, THROUGH 2019 ($ SUMMARY FIGURE RADIATION THERAPY MARKET BY REGION, THROUGH 2019 ($ 8 8 CHAPTER 3 MARKET OVERVIEW 11 INTRODUCTION 11 INTRODUCTION TO CANCER 11 BENIGN TUMORS 12 MALIGNANT TUMORS 12 Malignant Tumor Categories 12 Carcinomas 12 Sarcomas 12 OTHER TYPES OF CANCER 12 TABLE 1 CHARACTERISTICS OF BENIGN AND MALIGNANT TUMORS 13 CAUSES OF CANCER 13 Internal Factors 13 External Factors 13 CANCER PROTECTIVE FACTORS AND RISK FACTORS 13 TABLE 2 THE IMPACT OF CANCER PROTECTIVE FACTORS AND CANCER RISK FACTORS ON VARIOUS TYPES OF CANCERS INTRODUCTION TO RADIATION 14 FIGURE 1 TYPES OF RADIATION 14 NON-IONIZING RADIATION 15 IONIZING RADIATION 15 PARTICLE RADIATION 16 Electron Beams 16 Proton Beams 16 Neutron Beams 16 Carbon Ions 16 Alpha and Beta Particles 17 Photon Radiations 17 Gamma Rays 17 X-rays 17 14

3 HISTORY OF RADIATION THERAPY 17 The Discovery Period 17 Megavoltage Era ( ) 18 Computer-assisted ERA ( ) 19 MECHANISM OF ACTION 19 CELL GROWTH CYCLE 19 FIGURE 2 CELL GROWTH CYCLE 19 TABLE 3 STEPS INVOLVED IN RADIATION THERAPY 21 RISK MANAGEMENT AND QUALITY ASSURANCE IN RADIATION THERAPY 21 RADIATION THERAPY MARKET SEGMENTATION 22 FIGURE 3 RADIATION THERAPY MARKET SEGMENTATION 22 DRIVERS, RESTRAINTS, OPPORTUNITIES AND TRENDS 23 FIGURE 4 DRIVERS, RESTRAINTS, OPPORTUNITIES AND TRENDS IN THE RADIATION THERAPY MARKET DRIVERS 23 Increasing Incidences of Cancer 23 High Incidence of Cancer in Aging Population 24 FIGURE 5 GLOBAL AGING POPULATION ( 24 FIGURE 6 FACTORS RELATED TO AGING AND THE PROMOTION OF CANCER 25 High Efficiency of Radiotherapy 25 Palliative Radiation Therapy 26 Government Funding 26 Advancement in Technology 26 Reimbursement Boosting Market Growth 27 RESTRAINTS 27 Capital Intensive 27 Lack of Trained Professionals 27 Limited Effectiveness against Metastatic Cancer 27 Side Effects Associated with Radiation Therapy 28 OPPORTUNITY 28 Developing Countries 28 Personalized Treatment 28 TRENDS 28 VMAT 29 Proton Therapy 29 Carbon Ions 29 THREAT 30 Recession Can Restrict the Growth of Radiation Therapy Market 30 MARKET SHARE ANALYSIS 30 FIGURE 7 MARKET SHARE ANALYSIS OF THE RADIATION THERAPY MARKET, 2013 (%) VARIOUS CANCER TREATMENTS 31 TABLE 4 ADVANTAGES AND DISADVANTAGES OF VARIOUS CANCER TREATMENTS 31 STEREOTACTIC RADIOSURGERY (SRS) AND FRACTIONATED STEREOTACTIC RADIATION THERAPY CHAPTER 4 RADIATION THERAPY MARKET BY PRODUCTS 34

4 TABLE 5 COMPARISON OF EXTERNAL BEAM RADIATION THERAPY AND BRACHYTHERAPY EXTERNAL BEAM RADIATION THERAPY 34 TREATMENT PLANNING FOR EXTERNAL BEAM RADIATION 35 Dosing and Treatment with External Beam Radiation 35 TABLE 6 EXTERNAL BEAM RADIATION THERAPY MARKET BY TYPE THROUGH 2019 ($ TABLE 7 EXTERNAL BEAM RADIATION THERAPY BY REGION, THROUGH 2019 ($ GAMMA KNIFE 37 MECHANISM OF ACTION 38 TABLE 8 GAMMA KNIFE MARKET BY REGION, THROUGH 2019 ($ 39 LINEAR ACCELERATORS (LINACS) 39 Structure of Linear Accelerators 40 Electron Guns 40 The Buncher 40 The LINACS 41 Magnetrons 41 Klystrons 42 Beam Collimation and Monitoring 42 TABLE 9 ELECTRON EMITTING HIGH ENERGY LINEAR ACCELERATORS BY REGION, THROUGH 2019 ($ TABLE 10 LINACS MARKET BY TECHNIQUES, THROUGH 2019 ($ 43 TYPES OF LINACS BY TECHNIQUES 44 Three-dimensional Conformal Radiation Therapy (3D-CRT) 44 TABLE 11 THREE-DIMENSIONAL CONFORMAL RADIATION THERAPY BY REGION, THROUGH 2019 ($ Intensity-modulated Radiation Therapy (IMRT) 45 High Cost Restricts the Use 46 TABLE 12 INTENSITY-MODULATED RADIATION THERAPY MARKET BY REGION, THROUGH 2019 ($ Image-guided Radiation Therapy (IGRT) 47 TABLE 13 IMAGE-GUIDED RADIATION THERAPY MARKET BY REGION, THROUGH 2019 ($ Other LINACS 48 TABLE 14 OTHER LINACS MARKET BY REGION, THROUGH 2019 ($ 48 PARTICLE THERAPY 48 TABLE 15 COMPARISON OF PROTON BEAM THERAPY AND CARBON ION THERAPY 50 TABLE 16 PARTICLE THERAPY SYSTEM BY TYPE, THROUGH 2019 ($ 51 TABLE 17 PARTICLE THERAPY SYSTEM MARKET BY REGION, THROUGH 2019 ($ TABLE 18 PROTON SYSTEMS MARKET BY REGION, THROUGH 2019 ($ 52 Carbon Ions 52 TABLE 19 CARBON ION THERAPY MARKET BY REGION, THROUGH 2019 ($ 52 BRACHYTHERAPY 53 TABLE 20 COMMONLY USED RADIONUCLIDES (RADIATION SOURCES) FOR BRACHYTHERAPY TABLE 21 ADVANTAGES AND DISADVANTAGES OF BRACHYTHERAPY 54 TABLE 22 VARIOUS TYPES OF BRACHYTHERAPY IMPLANTS

5 TABLE 23 BRACHYTHERAPY TREATMENT DURATION 55 TABLE 24 BRACHYTHERAPY TREATMENT DOSE RATE 56 TABLE 25 BRACHYTHERAPY TREATMENT SOURCE LOADING 56 PDR BRACHYTHERAPY 56 TABLE 26 COMPARISON OF LOW DOSE AND HIGH DOSE RADIATION THERAPY 57 TABLE 27 GLOBAL BRACHYTHERAPY MARKET BY PRODUCT, THROUGH 2019 ($ TABLE 28 GLOBAL BRACHYTHERAPY MARKET BY REGION, THROUGH 2019 ($ LDR BRACHYTHERAPY MARKET 58 TABLE 29 GLOBAL LDR BRACHYTHERAPY MARKET BY PRODUCT, THROUGH 2019 ($ TABLE 30 GLOBAL LDR BRACHYTHERAPY MARKET BY REGION, THROUGH 2019 ($ LDR Brachytherapy Seeds 59 TABLE 31 MARKET FOR LDR BRACHYTHERAPY SEEDS BY REGION, THROUGH 2019 ($ Brachytherapy Seeds Market by Type of Radioisotope 61 TABLE 32 GLOBAL BRACHYTHERAPY SEEDS MARKET BY TYPE, THROUGH 2019 ($ Iodine TABLE 33 GLOBAL I-125 SEEDS MARKET BY REGION, THROUGH 2019 ($ 62 Palladium TABLE 34 GLOBAL PD-103 SEEDS MARKET BY REGION, THROUGH 2019 ($ Other Seeds 63 TABLE 35 GLOBAL OTHER LDR BRACHYTHERAPY SEEDS MARKET BY REGION, THROUGH 2019 ($ TABLE 36 LDR AFTERLOADER AND APPLICATOR MARKET BY GEOGRAPHY THROUGH 2019 ($ HDR BRACHYTHERAPY MARKET 64 TABLE 37 HDR BRACHYTHERAPY MARKET BY PRODUCT, THROUGH 2019 ($ TABLE 38 HDR BRACHYTHERAPY MARKET BY REGION, THROUGH 2019 ($ 65 HDR Brachytherapy Seed Market 66 TABLE 39 HDR SEEDS MARKET BY PRODUCT, THROUGH 2019 ($ 67 TABLE 40 HDR SEEDS MARKET BY REGION, THROUGH 2019 ($ 67 Iridium-192 seeds 67 TABLE 41 IR-192 SEEDS MARKET BY REGION, THROUGH 2019 ($ 68 Other HDR Seeds 68 TABLE 42 OTHER HDR SEEDS MARKET BY REGION, THROUGH 2019 ($ 69 TABLE 43 HDR AFTERLOADER AND APPLICATOR MARKET BY REGION, THROUGH 2019 ($ ELECTRONIC BRACHYTHERAPY 69 TABLE 44 COMPARISON BETWEEN RADIONUCLIDES AND ELECTRONIC BRACHYTHERAPY TABLE 45 GLOBAL ELECTRONIC BRACHYTHERAPY MARKET BY GEOGRAPHY THROUGH 2019 ($ THERAPEUTIC RADIOPHARMACEUTICALS BY TYPE 71 TABLE 46 ADVANTAGES AND DISADVANTAGES OF RADIOPHARMACEUTICALS

6 COMPARISON BETWEEN ALPHA AND BETA EMITTERS 72 TABLE 47 COMPARISON OF ALPHA AND BETA PARTICLES 73 SHORTAGE OF RADIONUCLIDES 73 CUMBERSOME REGULATORY REQUIREMENTS 73 TABLE 48 MARKET FOR THERAPEUTIC RADIOPHARMACEUTICALS BY TYPE, THROUGH 2019 ($ TABLE 49 SYSTEMIC RADIATION THERAPY BY REGION, THROUGH 2019 ($ 74 ALPHA EMITTERS 75 TABLE 50 GLOBAL ALPHA EMITTER MARKET BY TYPE, THROUGH 2019 ($ 75 TABLE 51 GLOBAL ALPHA EMITTER MARKET BY REGION, THROUGH 2019 ($ TABLE 52 EXAMPLES OF ALPHA EMITTERS 77 TABLE 53 ADVANTAGES AND DISADVANTAGES OF ALPHA EMITTERS 77 Radium Mechanism of Action 79 BETA EMITTERS 80 TABLE 54 GLOBAL BETA EMITTERS MARKET BY TYPE, THROUGH 2019 ($ 80 TABLE 55 ADVANTAGES AND DISADVANTAGES OF BETA EMITTERS 81 TABLE 56 MARKET FOR BETA EMITTERS BY REGION, THROUGH 2019 ($ 82 Iodine TABLE 57 GLOBAL IODINE-131 MARKET BY REGION, THROUGH 2019 ($ 83 Rhenium (Re-186) 84 TABLE 58 GLOBAL RHENIUM-186 MARKET BY REGION, THROUGH 2019 ($ 84 Samarium (Sm-153) 84 TABLE 59 GLOBAL SAMARIUM-153 MARKET BY REGION, THROUGH 2019 ($ Yttrium-90 (Y-90) 86 TABLE 60 GLOBAL YTTRIUM-90 MARKET BY REGION, THROUGH 2019 ($ 86 Lutetium-177 (Lu-177) 87 TABLE 61 GLOBAL LUTETIUM-177 MARKET BY REGION, THROUGH 2019 ($ Others 87 TABLE 62 GLOBAL OTHER BETA EMITTERS MARKET BY REGION, THROUGH 2019 ($ ROUTE OF ADMINISTRATION 88 Introduction 88 Intravenous Administration 88 Inhalation Administration 88 Peroral Administration 89 Other Routes of Administration 89 TABLE 63 OTHER ROUTES OF ADMINISTRATION 89 PIPELINE PRODUCTS 89 TABLE 64 PIPELINE PRODUCTS IN RADIOPHARMACEUTICALS CHAPTER 5 RADIATION THERAPY MARKET BY APPLICATION 93 EXTERNAL BEAM RADIATION THERAPY MARKET 93 TABLE 65 EXTERNAL BEAM RADIATION THERAPY BY APPLICATION, THROUGH 2019 ($ PROSTATE CANCER 93 93

7 Life Expectancy 94 Overall Health Status 94 Tumor Characteristics 94 Stage I Prostate Cancer 94 Stage II Prostate Cancer 94 Stage III Prostate Cancer 95 Stage IV Prostate Cancer 95 Personal Preferences 96 Advantages of EBRT in Treating Prostate Cancer 97 Side Effects 97 Disadvantages 97 BREAST CANCER 97 LUNG CANCER 98 Types of Lung Cancer 99 Non-Small Cell Lung Cancer 99 Small Cell Lung Cancer 99 Lung Carcinoid Tumor 99 HEAD AND NECK CANCER 99 Conformal Radiation Therapy (CRT) 100 OTHER CANCERS 101 INTERNAL RADIATION THERAPY MARKET BY APPLICATION 101 TABLE 66 INTERNAL BEAM RADIATION THERAPY BY APPLICATION THROUGH 2019 ($ PROSTATE CANCER 101 HEAD AND NECK CANCER 102 GYNECOLOGICAL CANCER 102 Vaginal Cancer 103 BREAST CANCER 103 CERVICAL CANCER 104 SYSTEMIC RADIATION THERAPY 104 TABLE 67 SYSTEMIC RADIATION THERAPY BY APPLICATION, THROUGH 2019 ($ HYPERTHYROIDISM 105 BONE METASTASES 105 LYMPHOMA 106 ENDOCRINE TUMORS CHAPTER 6 RADIATION THERAPY MARKET BY GEOGRAPHY 109 UNITED STATES 109 TABLE 68 U.S. RADIATION THERAPY MARKET BY TYPE, THROUGH 2019 ($ 109 TABLE 69 U.S. INSTALLED BASE AND AGE 109 TABLE 70 NEW CANCER CASES AND ESTIMATED DEATHS IN THE YEAR TABLE 71 AGING U.S. POPULATION, EUROPE 111 TABLE 72 EUROPEAN RADIATION THERAPY MARKET BY TYPE THROUGH 2019 ($ ASIA

8 TABLE 73 ASIAN RADIATION THERAPY MARKET BY TYPE, THROUGH 2019 ($ JAPAN 113 TABLE 74 COMPARISON OF INDIAN AND CHINESE RADIATION THERAPY MARKETS 113 CHINA 113 INDIA 114 REST OF THE WORLD 114 TABLE 75 REST OF THE WORLD RADIATION THERAPY MARKET BY TYPE, THROUGH 2019 ($ LATIN AMERICA 115 MIDDLE EAST 115 AFRICA CHAPTER 7 COMPANY PROFILES 117 ACCURAY INCORPORATED 117 FINANCIALS 117 TABLE 76 ACCURAY REVENUES AND R &D EXPENDITURES, ($ MILLIONS/%) PRODUCTS 117 TABLE 77 ACCURAY PRODUCTS 118 RECENT NEWS 118 TABLE 78 ACCURAY RECENT NEWS 118 ACTINIUM PHARMACEUTICALS INC. 119 AUSTRALIAN NUCLEAR ASSOCIATION AND TECHNOLOGY ORGANIZATION (ANSTO) C. R. BARD INC. 120 FINANCIALS 120 TABLE 79 C.R. BARD REVENUES AND R &D EXPENDITURES, ($ PRODUCTS 121 ECKERT & ZIEGLER BEBIG S.A 121 FINANCIALS 121 TABLE 80 ECKERT & ZIEGLER REVENUES AND R &D EXPENDITURES, ($ MILLIONS/%) PRODUCTS 122 RECENT NEWS 122 TABLE 81 ECKERT & ZIEGLER RECENT NEWS 122 ELEKTA 123 FINANCIALS 124 TABLE 82 ELEKTA REVENUES AND R &D EXPENDITURES, ($ MILLIONS/%) 124 PRODUCTS 124 RECENT NEWS 124 TABLE 83 ELEKTA RECENT NEWS 125 GE HEALTHCARE 126 GE HEALTHCARE LIFE SCIENCES 126 PRODUCTS 126 IBA MOLECULAR 127 NORDION INC. 127 NTP RADIOISOTOPES (PTY) LTD

9 SIEMENS HEALTHCARE 128 FINANCIALS 129 TABLE 84 SIEMENS REVENUES AND R &D EXPENDITURES, ($ MILLIONS/%) PRODUCTS 129 RECENT NEWS 129 TABLE 85 SIEMENS RECENT NEWS 129 VARIAN MEDICAL SYSTEMS 130 FINANCIALS 130 TABLE 86 VARIAN REVENUES AND R &D EXPENDITURES, ($ MILLIONS/%) 131 PRODUCTS 131 RECENT NEWS 131 TABLE 87 VARIAN RECENT NEWS CHAPTER 8 APPENDIX A LIST OF HUMAN OF CARCINOGENIC AGENTS BY TYPE OF CANCER TABLE 88 LIST OF CARCINOGENIC AGENTS CHAPTER 9 APPENDIX B LIST OF ACRONYMS 137

10 LIST OF TABLES TABLE HEADING SUMMARY TABLE RADIATION THERAPY MARKET BY TYPE, THROUGH 2019 ($ TABLE 1 CHARACTERISTICS OF BENIGN AND MALIGNANT TUMORS 13 TABLE 2 THE IMPACT OF CANCER PROTECTIVE FACTORS AND CANCER RISK FACTORS ON VARIOUS TYPES OF CANCERS TABLE 3 STEPS INVOLVED IN RADIATION THERAPY 21 TABLE 4 ADVANTAGES AND DISADVANTAGES OF VARIOUS CANCER TREATMENTS 31 TABLE 5 COMPARISON OF EXTERNAL BEAM RADIATION THERAPY AND BRACHYTHERAPY TABLE 6 EXTERNAL BEAM RADIATION THERAPY MARKET BY TYPE THROUGH 2019 ($ TABLE 7 EXTERNAL BEAM RADIATION THERAPY BY REGION, THROUGH 2019 ($ TABLE 8 GAMMA KNIFE MARKET BY REGION, THROUGH 2019 ($ 39 TABLE 9 ELECTRON EMITTING HIGH ENERGY LINEAR ACCELERATORS BY REGION, THROUGH 2019 ($ TABLE 10 LINACS MARKET BY TECHNIQUES, THROUGH 2019 ($ 43 TABLE 11 THREE-DIMENSIONAL CONFORMAL RADIATION THERAPY BY REGION, THROUGH 2019 ($ TABLE 12 INTENSITY-MODULATED RADIATION THERAPY MARKET BY REGION, THROUGH 2019 ($ TABLE 13 IMAGE-GUIDED RADIATION THERAPY MARKET BY REGION, THROUGH 2019 ($ TABLE 14 OTHER LINACS MARKET BY REGION, THROUGH 2019 ($ 48 TABLE 15 COMPARISON OF PROTON BEAM THERAPY AND CARBON ION THERAPY 50 TABLE 16 PARTICLE THERAPY SYSTEM BY TYPE, THROUGH 2019 ($ 51 TABLE 17 PARTICLE THERAPY SYSTEM MARKET BY REGION, THROUGH 2019 ($ TABLE 18 PROTON SYSTEMS MARKET BY REGION, THROUGH 2019 ($ 52 TABLE 19 CARBON ION THERAPY MARKET BY REGION, THROUGH 2019 ($ 52 TABLE 20 COMMONLY USED RADIONUCLIDES (RADIATION SOURCES) FOR BRACHYTHERAPY TABLE 21 ADVANTAGES AND DISADVANTAGES OF BRACHYTHERAPY 54 TABLE 22 VARIOUS TYPES OF BRACHYTHERAPY IMPLANTS 55 TABLE 23 BRACHYTHERAPY TREATMENT DURATION 55 TABLE 24 BRACHYTHERAPY TREATMENT DOSE RATE 56 TABLE 25 BRACHYTHERAPY TREATMENT SOURCE LOADING 56 TABLE 26 COMPARISON OF LOW DOSE AND HIGH DOSE RADIATION THERAPY 57 TABLE 27 GLOBAL BRACHYTHERAPY MARKET BY PRODUCT, THROUGH 2019 ($ TABLE 28 GLOBAL BRACHYTHERAPY MARKET BY REGION, THROUGH 2019 ($ TABLE 29 GLOBAL LDR BRACHYTHERAPY MARKET BY PRODUCT, THROUGH 2019 ($ TABLE 30 GLOBAL LDR BRACHYTHERAPY MARKET BY REGION, THROUGH 2019 ($ TABLE 31 MARKET FOR LDR BRACHYTHERAPY SEEDS BY REGION, THROUGH 2019 ($ TABLE 32 GLOBAL BRACHYTHERAPY SEEDS MARKET BY TYPE, THROUGH 2019 ($

11 TABLE HEADING TABLE 33 GLOBAL I-125 SEEDS MARKET BY REGION, THROUGH 2019 ($ 62 TABLE 34 GLOBAL PD-103 SEEDS MARKET BY REGION, THROUGH 2019 ($ 62 TABLE 35 GLOBAL OTHER LDR BRACHYTHERAPY SEEDS MARKET BY REGION, THROUGH 2019 ($ TABLE 36 LDR AFTERLOADER AND APPLICATOR MARKET BY GEOGRAPHY THROUGH 2019 ($ TABLE 37 HDR BRACHYTHERAPY MARKET BY PRODUCT, THROUGH 2019 ($ TABLE 38 HDR BRACHYTHERAPY MARKET BY REGION, THROUGH 2019 ($ 65 TABLE 39 HDR SEEDS MARKET BY PRODUCT, THROUGH 2019 ($ 67 TABLE 40 HDR SEEDS MARKET BY REGION, THROUGH 2019 ($ 67 TABLE 41 IR-192 SEEDS MARKET BY REGION, THROUGH 2019 ($ 68 TABLE 42 OTHER HDR SEEDS MARKET BY REGION, THROUGH 2019 ($ 69 TABLE 43 HDR AFTERLOADER AND APPLICATOR MARKET BY REGION, THROUGH 2019 ($ TABLE 44 COMPARISON BETWEEN RADIONUCLIDES AND ELECTRONIC BRACHYTHERAPY TABLE 45 GLOBAL ELECTRONIC BRACHYTHERAPY MARKET BY GEOGRAPHY THROUGH 2019 ($ TABLE 46 ADVANTAGES AND DISADVANTAGES OF RADIOPHARMACEUTICALS 72 TABLE 47 COMPARISON OF ALPHA AND BETA PARTICLES 73 TABLE 48 MARKET FOR THERAPEUTIC RADIOPHARMACEUTICALS BY TYPE, THROUGH 2019 ($ TABLE 49 SYSTEMIC RADIATION THERAPY BY REGION, THROUGH 2019 ($ 74 TABLE 50 GLOBAL ALPHA EMITTER MARKET BY TYPE, THROUGH 2019 ($ 75 TABLE 51 GLOBAL ALPHA EMITTER MARKET BY REGION, THROUGH 2019 ($ TABLE 52 EXAMPLES OF ALPHA EMITTERS 77 TABLE 53 ADVANTAGES AND DISADVANTAGES OF ALPHA EMITTERS 77 TABLE 54 GLOBAL BETA EMITTERS MARKET BY TYPE, THROUGH 2019 ($ 80 TABLE 55 ADVANTAGES AND DISADVANTAGES OF BETA EMITTERS 81 TABLE 56 MARKET FOR BETA EMITTERS BY REGION, THROUGH 2019 ($ 82 TABLE 57 GLOBAL IODINE-131 MARKET BY REGION, THROUGH 2019 ($ 83 TABLE 58 GLOBAL RHENIUM-186 MARKET BY REGION, THROUGH 2019 ($ 84 TABLE 59 GLOBAL SAMARIUM-153 MARKET BY REGION, THROUGH 2019 ($ 85 TABLE 60 GLOBAL YTTRIUM-90 MARKET BY REGION, THROUGH 2019 ($ 86 TABLE 61 GLOBAL LUTETIUM-177 MARKET BY REGION, THROUGH 2019 ($ 87 TABLE 62 GLOBAL OTHER BETA EMITTERS MARKET BY REGION, THROUGH 2019 ($ TABLE 63 OTHER ROUTES OF ADMINISTRATION 89 TABLE 64 PIPELINE PRODUCTS IN RADIOPHARMACEUTICALS 90 TABLE 65 EXTERNAL BEAM RADIATION THERAPY BY APPLICATION, THROUGH 2019 ($ TABLE 66 INTERNAL BEAM RADIATION THERAPY BY APPLICATION THROUGH 2019 ($ TABLE 67 SYSTEMIC RADIATION THERAPY BY APPLICATION, THROUGH 2019 ($ TABLE 68 U.S. RADIATION THERAPY MARKET BY TYPE, THROUGH 2019 ($ 109 TABLE 69 U.S. INSTALLED BASE AND AGE 109 TABLE 70 NEW CANCER CASES AND ESTIMATED DEATHS IN THE YEAR

12 TABLE HEADING TABLE 71 AGING U.S. POPULATION, TABLE 72 EUROPEAN RADIATION THERAPY MARKET BY TYPE THROUGH 2019 ($ TABLE 73 ASIAN RADIATION THERAPY MARKET BY TYPE, THROUGH 2019 ($ TABLE 74 COMPARISON OF INDIAN AND CHINESE RADIATION THERAPY MARKETS 113 TABLE 75 REST OF THE WORLD RADIATION THERAPY MARKET BY TYPE, THROUGH 2019 ($ TABLE 76 ACCURAY REVENUES AND R &D EXPENDITURES, ($ MILLIONS/%) TABLE 77 ACCURAY PRODUCTS 118 TABLE 78 ACCURAY RECENT NEWS 118 TABLE 79 C.R. BARD REVENUES AND R &D EXPENDITURES, ($ 120 TABLE 80 ECKERT & ZIEGLER REVENUES AND R &D EXPENDITURES, ($ MILLIONS/%) TABLE 81 ECKERT & ZIEGLER RECENT NEWS 122 TABLE 82 ELEKTA REVENUES AND R &D EXPENDITURES, ($ MILLIONS/%) 124 TABLE 83 ELEKTA RECENT NEWS 125 TABLE 84 SIEMENS REVENUES AND R &D EXPENDITURES, ($ MILLIONS/%) 129 TABLE 85 SIEMENS RECENT NEWS 129 TABLE 86 VARIAN REVENUES AND R &D EXPENDITURES, ($ MILLIONS/%) 131 TABLE 87 VARIAN RECENT NEWS 131 TABLE 88 LIST OF CARCINOGENIC AGENTS

13 LIST OF FIGURES FIGURE TITLE SUMMARY FIGURE RADIATION THERAPY MARKET BY REGION, THROUGH 2019 ($ FIGURE 1 TYPES OF RADIATION 14 FIGURE 2 CELL GROWTH CYCLE 19 FIGURE 3 RADIATION THERAPY MARKET SEGMENTATION 22 FIGURE 4 DRIVERS, RESTRAINTS, OPPORTUNITIES AND TRENDS IN THE RADIATION THERAPY MARKET FIGURE 5 GLOBAL AGING POPULATION ( 24 FIGURE 6 FACTORS RELATED TO AGING AND THE PROMOTION OF CANCER 25 FIGURE 7 MARKET SHARE ANALYSIS OF THE RADIATION THERAPY MARKET, 2013 (%)

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