Clinical Review

Advances in radiotherapy

BMJ 2012; 345 doi: http://dx.doi.org/10.1136/bmj.e7765 (Published 04 December 2012) Cite this as: BMJ 2012;345:e7765
  1. Saif S Ahmad, specialist registrar in clinical oncology1,
  2. Simon Duke, senior house officer in clinical oncology1,
  3. Rajesh Jena, consultant clinical oncologist1,
  4. Michael V Williams, consultant clinical oncologist1,
  5. Neil G Burnet, professor of radiation oncology and honorary consultant clinical oncologist2
  1. 1Clinical Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK
  2. 2University of Cambridge, Cambridge
  1. Correspondence to: S S Ahmad saif.ahmad{at}nhs.net
  • Accepted 8 November 2012

Summary points

  • Radiotherapy forms part of the management of 40% of patients who are cured of cancer

  • Advances in technology mean that more patients now receive efficacious treatment with less toxicity

  • Newer technologies are increasingly available in the UK

  • These technologies include intensity modulated radiotherapy, image guided radiotherapy, stereotactic radiotherapy, stereotactic ablative radiotherapy, and proton beam therapy

  • Toxicity can develop early or late, and non-specialist clinicians should be aware of the more common side effects, which typically relate to the anatomical site treated

Radiotherapy plays an important role in the care of patients with cancer and forms part of the management of 40% of patients cured of their disease.1 Advances have been made in the past two decades, as improvements in engineering and computing have enabled technologies such as intensity modulated radiotherapy (IMRT), image guided radiotherapy (IGRT), and stereotactic radiotherapy (SRT) to be used in routine clinical practice.

This article explains newer radiotherapy techniques and aims to enable general practitioners and non-specialist clinicians to advise patients who come to them with questions. It will focus on external beam radiotherapy (EBRT), which is the most common form of treatment, delivered to 125 000 patients a year in England.2

Sources and selection criteria

This article is an evidence based review of clinical radiotherapy. We searched PubMed and the Cochrane databases between 1990 and 2012 using the search terms radiotherapy, intensity modulated radiotherapy, image guided radiotherapy, stereotactic radiotherapy, and proton beam therapy to identify observational studies, randomised trials, meta-analyses, and systematic reviews.

How does radiotherapy work?

X rays are a form of electromagnetic radiation that deliver their energy through waves called photons. These photons are produced by accelerating a stream of electrons and colliding them with a metal target. High energy photons produce secondary electrons in human tissue. Electrons cause DNA damage which, if not repaired, proves fatal at cell division. Absorbed …

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