A report for the NHS in England, examining the benefits of a precise form of radiotherapy, called Stereotactic Body Radiotherapy (SBRT) has issued guidance for NHS commissioners and providers and clinicians.
Dr Peter Kirkbride, co-author of the report, explains the benefits of this advanced treatment.
Radiotherapy has been in use as a cancer treatment for more than 100 years, with its earliest roots traced from the discovery of x-rays in 1895.
The field of radiotherapy began to grow in the early 1900s – largely due to the groundbreaking work of Nobel Prize-winning scientist Marie Curie, who discovered the radioactive elements polonium and radium.
In the early days, radiotherapy was a rather blunt form of treatment and could lead to quite severe side effects due to healthy tissue, as well as the cancer, being damaged.
However, as with other areas of science and medicine, radiotherapy treatment has become incredibly sophisticated in recent years.
Stereotactic Body Radiotherapy (SBRT) has the potential to treat tumours with radiation using far fewer treatments (know as fractions). This not only allows long courses to become much shorter, it also offers the possibility that SBRT could be used as an alternative to surgery and, because of its precision, to treat and possibly cure cancers which otherwise might not be treatable.
SBRT is an established treatment for early-stage lung cancer and has been shown in non-randomised studies to be better than conventional radiotherapy at controlling the disease in the lungs, and at extending survival.
For selected lung cancer patients, whose tumours are near the edge of their lungs, and who can’t be operated on (either because they have other diseases, because they decide they don’t want surgery, or for technical reasons), it offers a good option to control the disease with relatively few side-effects. It should therefore be available as an alternative to conventional radiotherapy or radical surgery in these patients.
The technique may also have a role in treating other cancers – but the evidence for this is less developed, and so can only currently be recommended as part of a clinical trial. However, this is a rapidly evolving area of medical practice, and the number of types of cancer that SBRT is suitable for is likely to expand as more evidence emerges.
A further benefit of SBRT, particularly in these uncertain economic times, is that the treatment can often be delivered using standard radiotherapy machines, called linear accelerators. While SBRT is more resource-intensive than conventional radiotherapy in terms of additional planning procedures, delivery in only a few high-dose fractions provides the opportunity for savings within the NHS.
In addition SBRT has potential to be used – under certain circumstances – as an alternative to radical surgery, avoiding the need for costly in-patient admissions.
However, an informal survey of the English radiotherapy centres showed that the majority of them were not offering SBRT in 2010. Therefore, our report (pdf) has made a number of recommendations. The main one is that SBRT should made available to all suitable cancer patients in England, particularly those with early lung cancer who are unable to undergo surgery.
We have also recommended that SBRT should be made available preferentially to patients as part of clinical trials.
Putting these recommendations into place cannot be rushed. The welfare of patients is paramount and it’s essential that everyone in the NHS works together to meets the needs of their local patients, while making sure staff have time to be thoroughly trained in new radiotherapy techniques.
In this country, there has been a long history of exploring the use of radiotherapy in fewer fractions than have been conventionally used elsewhere. Now, there is a great opportunity for us build upon this work, and to make the UK a world leader in SBRT, as part of our commitment to ensure the development of a world-class radiotherapy system.
I hope everyone in the NHS will work together to make it a reality for our patients.
Dr Peter Kirkbride is chief cancer clinician and clinical director in radiology for Sheffield Teaching Hospitals Trust, and England’s national clinical advisor for radiotherapy
- Cancer Research UK is campaigning for an action plan for radiotherapy to make sure that the best treatments are available to everyone who needs them. Find our more and sign our petition.