Radiotherapy update

Radiation oncology: physics advances that minimize morbidity

ABSTRACT 

Radiation therapy has become an ever more successful treatment for many cancer patients. This is due in large part from advances in physics including the expanded use of imaging protocols combined with ever more precise therapy devices such as linear and particle beam accelerators, all contributing to treatments with far fewer side effects. This paper will review current state-of-the-art physics maneuvers that minimize morbidity, such as intensity-modulated radiation therapy, volummetric arc therapy, image-guided radiation, radiosurgery and particle beam treatment. We will also highlight future physics enhancements on the horizon such as MRI during treatment and intensity-modulated hadron therapy, all with the continued goal of improved clinical outcomes.

Travel times and radiotherapy uptake in two English counties

OBJECTIVES

To examine whether longer travel times for radiotherapy are associated with reduced overall uptake of radiotherapy treatment, or with reduced uptake of palliative as opposed to radical radiotherapy.

DESIGN

Correlations of weighted average travel times for radiotherapy with overall radiotherapy uptake, and of travel times to one cancer centre with the ratio of palliative to radical radiotherapy at that centre.

SETTING

The fourteen local authority (county) Districts of Bedfordshire and Hertfordshire.

SUBJECTS

Residents of Bedfordshire and Hertfordshire registered by the Cancer Registries as attending hospital with a diagnosis of cancer, and registered as receiving radiotherapy treatment. Residents recorded by single cancer centre as receiving radical or palliative radiotherapy at that centre.

RESULTS

There was no significant correlation between travel times for treatment and overall radiotherapy uptake (r = 0.40, P = 0.18), or with the ratio of palliative to radical radiotherapy at a single centre (r = -0.29, P = 0.34). Both measures of uptake showed considerable variability. Longest travel times were about one hour.

CONCLUSIONS

Travel times up to one hour do not appear to reduce radiotherapy uptake, and the variability observed is likely to be due to other factors. The recommendation of the Chief Medical Officer's expert advisory group on cancers, that radiotherapy should be provided in larger cancer centres, is unlikely to result in lower radiotherapy uptake with travel times of this order.

Development of clinical radiotherapy since 1896

From the discovery of x-rays in November 1895 and the first publication in December 1985 it did not take long for the first x-ray therapy of cancer in January 1896. The first 25 years in the history of radiotherapy was not a very flattering period for the discipline. During the following 25 years, however, important developments in clinical radiotherapy occurred and in some countries the speciality of radiotherapy was established in the 1930s. In the last 50 years gradual changes have taken place and now modern radiotherapy is an established curative method in the treatment of cancer. The scientific background of radiotherapy is solid, and the understanding of cancer biology and radiobiology has improved drastically. The radiotherapists of today are cancer specialists, oncologists. The technical development has been enormous. The future of radiation oncology looks very promising, with local cancer treatment being shown to be most effective.