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A child receiving radiotherapy in 1957

Radiotherapy has come a long way since this picture was taken in 1957

If you could travel back in time to 1911 you would see, hear and smell a world that is vastly different from today. Horse drawn carriages dominate the roads; the streets and most homes are still lit by gas; and the only option for treating cancer involves surgeons cutting out the tumour and hoping for the best.

Fortunately, the options and outlook for cancer patients have hugely improved since then.

One hundred years ago this year Marie Curie won a second Nobel Prize for her research into radium, establishing her position as a pioneer in the field of radiotherapy. To mark this, 2011 has been designated the Year of Radiotherapy, celebrating a century of advances.

Around four in ten patients who are cured of cancer have received radiotherapy as part of their treatment, but public understanding and appreciation of this vital technique hasn’t kept pace with the scientific advances made over the last century.

Fewer than one in ten members of the public think that radiotherapy is a modern, cutting-edge treatment. And people still fear the treatment, with 40 per cent of people describing radiotherapy as “frightening”.

Doctors too are often unaware of how far radiotherapy has come. Currently around four in ten cancer patients get radiotherapy but studies suggest that this figure should be closer to five in ten, suggesting that some patients may be missing out on the opportunity to benefit from a treatment could help save their life. We’re working to tackle this through our Voice For Radiotherapy campaign, which you can join today.

On Monday the National Cancer Director Professor Sir Mike Richards joined radiotherapy experts, including Cancer Research UK’s Professor Tim Maughan, at the Royal Marsden Hospital to discuss how to ensure that all patients who could benefit from radiotherapy are getting access to the most up to date treatments.

You can watch a video of the whole round-table discussion on the Royal Marsden’s website, but we’ve pulled out some of the highlights below.

Increasing awareness among doctors

As well as calling for more money to be spent on radiotherapy, Professor Richards believes the medical profession needs to be more aware of the huge advances that have been made in radiotherapy in the last 15 years.

This view was echoed by Dr Amit Bhargava, GP and Chair of the Crawley Commissioning Consortium, who noted that radiotherapy was still “shrouded in mystery” for primary care professionals. The government is giving more say to GPs on buying services and much of the NHS budget through Clinical Commissioning Groups, but unless GPs learn the value of radiotherapy this could mean that patients continue to miss out.

Dr Bhargava believes that we need to explain to GPs the difference that new radiotherapy treatments can make for patients in terms they can understand. Using a military metaphor, he suggested that “No one would opt for carpet-bombing of their cancer if they knew that laser-targeted missiles could be used instead.”

New technology for all

Professor Tim Maughan, Clinical Director of Cancer Research UK’s Gray Institute for Radiation Oncology and Biology in Oxford, supported the call for improved access to more advanced radiotherapy treatments. He noted how intensity modulated radiotherapy (IMRT, which shapes the radiotherapy beams to better match the tumour) and image guided radiotherapy (IGRT) – which allows the location of the tumour to be tracked so that doctors can ensure they are hitting the target every time – can mean better treatment with fewer side effects.

Experts believe that a third of all patients who are treated with radiotherapy could benefit from IMRT. But while 97 per cent of radiation equipment in England is able to deliver IMRT, only around 35 of the 50 radiotherapy centres across England have staff trained in how to use this new technique. As a result, only a limited number are offering IMRT to all patients who might benefit.

Professor David Dearnaley of the Royal Marsden Hospital explained:

“Radiotherapy has come a long way in the last 10 years. Older radiotherapy used to add rectangular radiotherapy beams together, and where those beams overlap, you get your high dose. But if you use rectangular beams you end up with something that looks like a shoebox and, of course, cancers aren’t shaped like shoeboxes.

“Modern radiotherapy means we have much more directed and precise treatment with reduced side effects, which allows us to actually increase the dose which controls the cancer even further. Putting all that together we’ve got a safer treatment which is more effective, so it’s a win-win situation.”

Counting the costs

While introducing these newer treatments will require investment, this is small compared to the benefits it could bring, particularly compared with the overall NHS spend. Cancer commands about six per cent of the NHS budget, accounting for £6bn per year. Of this, the radiotherapy budget is a snip at around £300m, or just five per cent of the total spend on cancer.

Adding IMRT to conventional cancer treatment could cost as little as £500 per patient – costs that could be saved further down the line through reduced side effects. This is an investment well worth making, argues Professor Richards, who says that “An increase in the radiotherapy budget could be offset by a whole lot of reductions in other areas”.

Reducing the numbers of non-surgical hospital admissions for cancer may be one way of doing this. And these savings could be used to help to ensure all patients who could benefit are getting access to IMRT.

Into the future

Just as we’ve moved on from horse drawn carriages and gas lamps to hybrid cars and halogen bulbs, radiotherapy has continued to develop into an ever more powerful and technological tool in the fight against cancer.

Progress is being made. Radiotherapy can cure cancer, it is cost effective and it is cutting edge.

By getting the funding right, and ensuring that there are incentives within the NHS which encourage providers to invest in new techniques and technology, experts believe we could soon be delivering the best radiotherapy to all patients who could benefit. As Professor Richards puts it:

“We’ve got to get the message across that radiotherapy really is one of the major treatments for cancer, and can be curative. This is a priority. We now need to make sure that all patients in the country can benefit.”

You can help to get radiotherapy up the political agenda and bring more benefits to cancer patients by joining our campaign, A Voice For Radiotherapy, today.

Paul Thorne (press officer) and Hilary Tovey (policy manager)

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Comments

flora pool September 11, 2011

KEEP UP THE GOOD WORK
I TRY TO HELP AS MUCH AS I CAN BUT BEING NINTY YEARS OLD I CANT DO VERY MUCH BUT MANY THANKS FOR ALL YOUR GOOD WORK

Nicola Nissen September 8, 2011

I have had this treatment and found the worse part was having the tiny black tatoo’s.But that is only because I have never had anything permanant put on or in me. E G taoo’s pirced ears or any other part that could be pirced. So that said, nasty little black tat’s were a small price to pay for recovery.
Well done reserchers.x

Heather Goodare August 24, 2011

It is good that radiotherapy is being discussed more widely. We need too to discuss the problems that can arise with hypofractionation, such as was used (NB to save money!) many years ago, with disastrous long-term consequences for some (including me and many members of RAGE, 25 years after treatment). Unfortunately it is still being used and even advocated in the current START trial, for which only five-year results are yet available. Our experience is that serious problems only arise AFTER five years. We need to make sure that the long-term sequelae are followed up: this is money that has to be spent if we are to gather the evidence about the progressive damage that can result from hypofractionation. There is no point in cutting corners: it will be more expensive in the long term.

Yes to better radiotherapy, but no to short-term solutions.