Cancer boost: New radiotherapy is more effective, with fewer side-effects

By Paul Dinsdale
Updated: 03:15 EST, 29 September 2009

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There's no doubt that radiotherapy is one of the most important tools in fighting cancer - almost half of all cancer patients in the UK are treated with it at some stage.

The good news is that there's now a safer and more effective version - a new machine that will not only cut the number of sessions patients need, but is more accurate than the conventional treatment.

As a result, patients are less likely to experience the unpleasant and sometimes debilitating side- effects of radiotherapy, such as damage to the skin or to healthy internal tissue (which can lead, among other problems, to incontinence).

Effective: The new version of radiotherapy is more accurate than the conventional treatment

The new machine will also mean that more patients can be treated, reducing waiting lists.

Unfortunately, only patients in the North-West of England or private patients will be receiving this 'revolutionary' form of radiotherapy in the short term. It's not only another example of the postcode lottery, but highlights the inadequate provision of treatment in the UK generally.

At the end of last year, patients at the Clatterbridge NHS Centre for Oncology in the Wirral became the first in the UK to have treatment using the new machine. The London Clinic in Harley Street will also provide the treatment from December this year.

RapidArc, as it is known, delivers the radiation in a 360-degree arc around the patient, rather than from one direction as with conventional treatment.

What this means is that the beam can follow the contours of the tumour, targeting all sides of it. Furthermore, the beam itself can be more concentrated because it is hitting the tumour, rather than healthy tissue around it, so the patient can receive a full dose at every session, reducing the number of sessions they need.

Another advantage is that patients undergoing the more accurate RapidArc treatment only have to remain still for four or five minutes, making radiotherapy a far more comfortable experience.

But perhaps more important is the precision and speed of the treatment. RapidArc is basically a new way of providing what is known as intensity-modulated radiation therapy, or IMRT.

This is a sophisticated form of radiotherapy; it uses 3D scans of the patient and computer technology to determine the dose needed - and then precisely deliver that dose to the tumour itself.

Such precision is important-as it helps prevent the damage of healthy tissue. Currently, every year thousands of cancer survivors suffer side-effects as a result of radiotherapy to save their lives.

Up to 10 per cent of breast cancer patients suffer radiation damage to their heart, lungs or arms, while thousands of the patients who've had pelvic radiotherapy for conditions such as bowel cancer suffer incontinence or heavy bleeding.

The advantage of RapidArc is that it can deliver a complete IMRT treatment in a single sweep - or arc - of the machine around the patient, making it up to eight times faster.
Studies show it also matches or exceeds the precision of conventional intensity-moduation radiotherapy.

Rapid Arc is already being used in Denmark and the Netherlands. While the arrival of the state-of the-art treatment at Clatterbridge is to be welcomed, it belies a much gloomier picture of the standard of radiotherapy in Britain.

Radiotherapy is delivered by expensive machines called linear accelerators, or linacs, and the UK has the lowest ratio of these machines per 100,000 population of all countries in Europe.

Furthermore, our shortage of radiographers means that few centres have the staffing or expertise to use IMRT routinely.

These inadequacies are important because radiotherapy is an extremely successful way of treating cancer.

Cancer specialists generally agree that around half of cancers are cured by surgery, around 40 per cent by radiotherapy, and only 5 per cent through the use of cancer drugs.

The National Radiotherapy Advisory Group, set up by the Department of Health, in 2007 found that there was a shortfall of 63 per cent between current levels of radiotherapy treatment and the amount that could be given to all who might benefit from it.

The group says the situation will only get worse - an ageing population means more cancer cases.

The good news is that the Government recently made £200 million available for local health authorities to spend on improving radiotherapy treatment.

Dr Michael Williams, a radiologist and chair of the national advisory group, says the situation and waiting times are improving.

He adds more needs to be done to ensure everyone who might benefit from radiotherapy receives it.

'We are continually being told that machines are expensive, but if you compare radiotherapy to the cost of surgery, it is very cost-effective,' he says.