Radiotherapy in UK is feared and underused
BMJ 2011; 342 doi: https://doi.org/10.1136/bmj.d616 (Published 28 January 2011) Cite this as: BMJ 2011;342:d616All rapid responses
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Sir,
The finding, highlighted by the UK National Radiotherapy Advisory Group,
that only 7% of patients are treated with one of the most advanced forms
of radiotherapy (intensity modulated ) compared to 20% in Europe is of
concern to many clinical oncologists. Of equal concern is the public
perception from the recent YouGov poll that radiotherapy is not a modern
treatment (1).
While it is true that there has been a significant investment in new
linear accelerators to catch up with cumulative underinvestment, the UK
still lacks far behind in the adoption of new radiotherapy technologies.
Stereotactic image guided radiotherapy, for example with the Cyberknife,
has the capability to treat moving tumours (eg lung, prostate and breast
cancer) with very focal irradiation. Potential advantages are fewer
radiotherapy treatments and less acute and late toxicity. While the
capital costs of such equipment may be higher than the standard linear
accelerator, the potential for NHS savings from shortening courses of
radiotherapy, for example for prostate cancer from 7 to 1-2 weeks, could
be enormous. Despite wide dissemination of this technology in North
America and continental Europe, there are few installations in the
UK.While some of the indications for stereotactic body radiotherapy (SBRT)
eg small volume inoperable non small cell lung cancer have a well
established evidence base (2), more research is needed to evaluate SBRT in
breast (3) and prostate cancer (4).
There is a need for capital as well as revenue to be ring fenced to
evaluate these new technologies in clinical trials. Partnerships are
needed between NHS Trusts, funding bodies and the voluntary sector to
accelerate access of UK patients to modern radiotherapy techniques. The
misperception of radiotherapy as an outdated specialty would then rapidly
disappear.
1.Watts G. Radiotherapy in UK is feared and underused. BMJ
2011;342:d616.
2.Timmerman R, Paulus R, Galvin J, Stereotactic body radiation therapy for
inoperable early stage lung cancer. JAMA 2010;303:1070-6.
3.Bondiau PY, Bahadoran P, Lallement M et al. Robotic stereotactic
radioablation concomitant with neoadjuvant chemotherapy for breast
tumours. Int J Rad Oncol Biol Phys 2009;75:1041-7.
4.Bolzicco G, Favretto MS, Scremin E et al. Image guided stereotactic body
radiation therapy for clinically localised prostate cancer: preliminary
clinical results. Technol Cancer Res Treat 2010;5:473-
Competing interests: No competing interests
Misperceptions of Radiotherapy
Sir,
we in the radiotherapy community may well have been our own worst enemies,
at least in regard to self-promotion compared to our medical oncology
colleagues.
The judicious use of radiotherapy for palliation in cancer produces
response rates which would be front-page news if the same efficacy was
shown for a chemotherapy agent.
Even more importantly, as Morgan's excellent 2004 review (1) shows
unequivocally, surgery is responsible for most adult cancer cures, closely
followed by radiotherapy, with chemotherapy contributing only 2-3% to the
five year survival figures for the common adult cancers.
Yet ask any lay audience, or even a non-oncologist medical audience, which
treatment modality cures most cancers, and the answer is invariably
"chemotherapy" and that is why we have a massive chemotherapy budget, much
of which is spent on second and third line palliative therapy of
questionable efficacy or benefit, and that is why we have ludicrously
underfunded radiotherapy services in the western world.
(1)Morgan et al. The Contribution of Cytotoxic Chemotherapy to 5-year
Survival in Adult Malignancies
Clinical Oncology (2004) 16: 549-560
Competing interests: No competing interests