UCLH clinical oncologist Professor Jeffrey Tobias has predicted that radiotherapy, the “unsung hero” of the major types of cancer treatment, will assume an even greater importance in the management of cancer over the next decade.
Professor Tobias spoke to a large audience ranging from schoolchildren to senior medical colleagues, at a prestigious Royal Society of Medicine public lecture on curing cancer with radiotherapy.
Prof Tobias said: “With the advent of much more powerful and precise radiotherapy beams, our approach to cancer treatment has undergone a genuine revolution over the past 25 years. We now recognise, for example, that higher doses – and therefore higher cure rates – can routinely be achieved to a level unimaginable to early radiation specialists, because we can now avoid the normal structures around the deep-seated cancer by using complex shaped multi-beam techniques.”
X-rays were discovered in the late 1890s, and rapidly used for X-ray diagnosis, that is to create an internal image of organs hidden deep within the body. In the case of more powerful radiation beams, radiotherapy became a remarkably effective treatment for cancer.
“Nowadays more than half of all patients with cancer are treated with radiotherapy at some point during the illness, quite often with the expectation of total cure. Many people simply don’t realise that radiotherapy is sometimes capable of curing cancer patients in whom surgery is impossible. It is also used as a wonderfully powerful palliative tool, where relief of symptoms is the goal. In the latter case, for example, patients with secondary cancer spread into the skeleton will gain remarkable relief from severe cancer pain.”
Prof Tobias spoke at the lecture timed to coincide with the Year of Radiotherapy chosen also because 2011 marks the centenary of Marie Curie's Nobel Prize for her pioneering work in the discovery of radium.
He added: “In many cases, radiotherapy is supplemented by chemotherapy at moderate doses, given alongside the radical radiotherapy, to enhance its effectiveness still further.
Radiotherapy can also be used in conjunction with surgery. Perhaps the best example of this would be breast cancer, where the radical mastectomy of the past has largely been replaced by a much less fearsome operation: wide local excision with full preservation of the breast which means a simple removal of the tumour and just a few millimetres of normal tissue around it. In all cases, this has to be followed by radiotherapy to the breast in order to avoid local recurrence. This has now become the standard treatment of the most common cancer in women.
“Just recently, we published a large international comparison study, led by a UCL/UCLH team, which demonstrated that for many patients, it is unnecessary to insist on a lengthy one-month (daily) radiotherapy programme. Instead we started to employ a radiation probe which inserts deep into the surgical cavity of the breast directly after the cancer has been lifted away. This looks like yet another revolution in cancer care since the patient awakes from the anaesthetic with both the surgery and radiotherapy completed, and the radiotherapist has the satisfaction of knowing that the all-important radiation has been delivered with both immediacy and absolute precision, to a level previously unachievable.
“The future of radiotherapy is bright. 30 years ago it looked as though the rapid development of chemotherapy might render radiation therapy no longer necessary, or even obsolete, but the reverse has turned out to be the case. Certain types of tumour, previously very difficult to treat by radiotherapy, because of their location close to highly sensitive organs, or for other reasons, may be treatable by proton beam therapy, a fascinating new area of research, which has garnered government-backed funding for at least one brand new centre to be built at UCLH in London.”
Prof Tobias also made it a point to emphasise that radiotherapy was all down to team work. “A great team is required to deliver radiotherapy, from radiographers, to nursing staff, physicists, engineers, medics, speech therapists, physiotherapists and dieticians, not to mention the essential clerical staff and many others besides.”