Intensity-Modulated Radiotherapy (IMRT) is effective but can have debilitating side effects. To address this, the team at the Royal Marsden Hospital, in collaboration with the Institute of Cancer Research (ICR), significantly refined the technique.
The modified procedure has been rolled out nationally and internationally, and it is now being used to treat an estimated 300,000 patients worldwide. The most significant impact has been reducing the risk of patients suffering xerostomia (dry mouth) and trials show that the risk was reduced to approximately 20 per cent compared with patients who had an 80 per cent risk from traditional radiotherapy.
IMRT is now used to treat head and neck cancer patients in all UK cancer networks and the technology has also been adopted around the world as a treatment for tumours in many other parts of the body including breast, prostate, paediatrics, CNS and pancreas.
Head and neck cancer affects 7,500 people a year in the UK and approximately 600,000 individuals worldwide. While treatment with chemotherapy and radiation is often curative, it can produce long-term permanent and sometimes severe affects on the patient’s quality of life.
Traditionally radiotherapy treatment for a number of head and neck cancers such as mouth, pharynx, larynx or oesophagus has involved targeting the tumour side-on with radiation. While this is effective against the tumour, it can damage nearby healthy tissue or organs. One of the most notable side-effects is xerostomia or dry mouth – a lack of saliva caused by radiotherapy damage to the saliva glands that can permanently affect speaking, eating and oral health.
With eight out of ten head and neck cancer patients at risk from this condition, improved techniques for delivering radiotherapy have been the focus of considerable concern and research.
The team’s work in refining Intensity-Modulated Radiotherapy (IMRT), shapes the beams to fit the outline of the tumour more precisely, taking advantage of advances in computer software and accelerator hardware. This coincided with similar work undertaken at other centres in Europe and North America.
The objective of the programme was first of all to develop IMRT that was safe and which could be effectively applied to patients. There was then a need to evaluate the benefits or drawbacks of this treatment in terms of reduced long-term side effects and quality of life, and compare outcomes with results that could be obtained using traditional radiotherapy techniques.
We also needed to evaluate the effects of IMRT on tumour control for more advanced, and potentially more problematic to treat head and neck cancers. We therefore set out to establish a treatment technique that could be replicated and rolled out nationally for all head and neck cancer patients.
Furthermore, we wanted to contribute to the possibility of this technique being implemented internationally. This we aimed to achieve by disseminating the results of our research, teaching and publication in leading medical and oncology journals. The IMRT treatment underwent Phase I and II trials and secured funding for a larger-scale Phase III trial, sponsored by Cancer Research UK (CRUK).
Three randomised phase III trials were established with each trial designed to test for outcomes in relation to a specific side effect.
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