Zosia Chustecka

May 10, 2011

May 10, 2011 — Four new radiotherapy centers have opened in the United Kingdom, expanding capacity so that more cancer patients can now be offered this form of treatment.

The United Kingdom has lagged behind other western European countries in providing radiotherapy for cancer patients, and the lack of facilities has meant that last year only about 10% of cancer patients who were candidates for intensity-modulated radiation therapy (IMRT) received this treatment.

Dr. Tim Maughan

"For a number of years, radiotherapy was the Cinderella service among cancer treatments. The focus was all around cancer drugs, despite the fact that radiotherapy cures more people," said Tim Maughan, MD, professor of clinical oncology and clinical director of the Gray Institute for Radiation Oncology and Biology at the University of Oxford, United Kingdom.

Dr. Maughan was speaking at a press conference held during the European Society for Therapeutic Radiology and Oncology (ESTRO) 11th Biennial Conference in London, United Kingdom.

An example of the focus on cancer drugs that Dr. Maughan referred to was last year's initiative to set up a Cancer Drug Fund, worth some £250 million, designed specifically to pay for some of the expensive cancer drugs that the National Institute of Clinical Excellence decreed were not allowed for use on the National Health Service. This was a direct reaction to a report that showed the United Kingdom was lagging far behind many other countries in its use of new anticancer drugs.

Other reports comparing cancer care across Europe have also highlighted the lack of radiotherapy provision in the United Kingdom.

Dr. Maughan illustrated the problem by citing the number of patients who were undergoing IMRT. It is not appropriate for every cancer patient, but "about 30% of radical radiotherapy, where the intent is curative, needs to be delivered by IMRT," he said.

About 23,000 cancer patients in the United Kingdom each year are candidates for IMRT, but only 1,200 patients received this treatment in 2009, and only 2,300 patients received it in 2010, he said. With the new radiotherapy centers, the hope is that 8,500 patients will undergo IMRT in 2011, and that this number will rise to 22,800 in 2012.

"By next year, nearly every patient who is a candidate for this therapy should have access to it," he said.

IMRT directs a more accurate beam of radiation than conventional radiotherapy and reduces the damage to surrounding healthy tissue, Dr. Maughan explained. It reduces the adverse effects of radiotherapy, but there is also early evidence that it might improve the chances of a cure, he added.

"It's great news that investment in this effective form of treatment is regaining momentum," he added.

Dr. Jane Barrett

"Radiotherapy plays a vital part in treating a wide range of cancers and helps to cure around 40% of patients," said Jane Barrett, MD, president of the Royal College of Radiologists, chair of the ESTRO National Organizing Committee, and consultant clinical oncologist at the Royal Berkshire Hospital in the United Kingdom.

Radiotherapy is also very effective in palliation, she added: "For a patient suffering back pain from metastases to the spine, a single radiotherapy treatment can be dramatic and can save the patient from chronic use of analgesics."

"Radiotherapy is curative, cost effective, and cutting edge," she concluded.

New Centers Funded Locally

The state-of-the art radiotherapy centers have been built at Peterborough City Hospital in Bracknell, and at 2 locations in Manchester (Salford and Oldham), as part of the Christie Hospital complex. The funding for each unit has been raised locally by each individual hospital.

Carl Rowbottom, PhD, head of radiotherapy physics at the Christie Hospital, explained that the hospital made savings in other areas and received some funding from cancer charities. The new facility at Salford cost about £14 million, he said. It is due to open officially in July 2011, and has 2 linear accelerators, which can deliver both IMRT and image-guided radiotherapy. It will also be equipped to deliver stereotactic radiosurgery for brain tumors, making it one of only a handful of such centers in the United Kingdom.

Although the new facilities were funded individually at a local level, there was some coordination nationwide under a National Radiotherapy Implementation Group, which is acting on the problems that were identified by the National Radiotherapy Advisory Group in its 2007 report.

David Scott, from Varian Medical Systems, who is chair of the Radiotherapy Manufacturers Association, noted that unlike Scotland, which does have a national plan for radiotherapy, there has been no nationwide policy in England since 2007.

There was a program before then, he explained in an interview. The New Opportunities Fund, which included lottery funding, ran from 1999 to 2003; this was followed by a capital investment program for radiotherapy from 2003 to 2007. He estimates that around £350 million was spent during both of these phases to purchase new machines and to replace aging equipment.

"The problem is that many of these machines are more than 10 years old and are becoming obsolete," he explained. There is a need for more both machines and for more trained staff to operate the equipment, he added.

"We don't have enough staff," agreed Dr. Barrett; in particular, she noted that there is a lack of radiographers and medical physicists. There is now a drive to improve recruitment and retention of these professionals, she said.

European Society for Therapeutic Radiology and Oncology (ESTRO) 11th Biennial Conference


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