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The Department of Health has announced new guidance for treating patients using stereotactic body radiotherapy (SBRT). In SBRT radiation is given in fewer sessions and at higher doses than conventional radiotherapy, with a high precision that helps to spare healthy tissue. The DoH is recommending its routine use in medically inoperable Stage I lung cancer, whilst recognising it is a clinical option that may be suitable for other cancer types. It also encourages further development of the therapy through clinical trials in a number of cancer sites.

On Monday 25th July, The Royal Marsden hosted a round-table discussion about radiotherapy. The panel included Professor Mike Richards, the National Clinical Director for Cancer and End of Life Care. A key point raised in the discussion is that whilst radiotherapy is a very important treatment with great clinical utility, it has a low profile and is poorly understood by both the public and some healthcare professionals, and this situation should be rectified. A video of the discussion is available on the Royal Marsden website.

A recent publication in Lancet Oncology has confirmed that IMRT, if used carefully, can reduce the unpleasant symptoms of dry mouth after curative radiotherapy for cancers arising in the mouth and throat regions. This is because IMRT is a form of x-ray treatment where radiation dose can be selectively reduced to an organ of interest, in this case the salivary glands, which produce most of our saliva flow. 47 patients were treated with conventional radiotherapy and 47 with IMRT. The only adverse effect with IMRT was that patient fatigue was more sever during treatment; this is understandable because the dose taken away from the parotid gland has then to be delivered to a wider range of tissues, albeit at a far lower dose.

This large study – involving over 50,000 persons from the USA - has used modified ‘low dose’ CT scans or standard chest x-rays to screen for lung cancer. The calculated relative reduction in mortality due to lung cancer was 20% in the CT screened group, presumably due to the finding of earlier, smaller sized tumours which could be treated more effectively by surgery and/or radiotherapy, before the cancer had a greater chance of spreading. This study shows the importance of early detection using the best available diagnostic technique and has implications for the challenges of treating more patients with smaller sized cancers and enhanced prospects of cure.

Intensity Modulated Radiation Therapy (IMRT) is a highly conformal radiotherapy technique that uses some of the most advanced treatment technology available and has been shown to significantly reduce toxicity. Despite 97% of linear accelerators in England being IMRT enabled, very few centres offer the technique to more than a handful of patients per month. In 2009 the National Radiotherapy Advisory Group (NRAG) published a series of guidelines regarding the IMRT service provision in England. One of the targets in these guidelines was that by 2012 at least one centre in each cancer network should offer IMRT. The guidelines also suggested it should be available to patients who would benefit from it and estimated this equated to approximately 30% of radical treatments.