Hi-tech radiotherapy 'not only answer'

Radiotherapy has wrongly been "in the shadows" of cancer drugs and chemotherapy, say those who use it to treat patients.

In this week's Scrubbing Up, Richard Evans, CEO of the Society and College of Radiographers, says this is beginning to change - but that there has been too much focus on one hi-tech version, which won't be right for all.

Amongst the radiotherapy community, there has long been the view that the pharmaceutical companies are enviably effective in publicising and marketing their cancer drugs, even those with marginal benefit.

There is also concern that this has had a restraining effect on the ability of radiotherapy to achieve the prominence it deserves, both within the public perception and in terms of political focus.

However, all of this seems to have changed with the emergence of new technology known as Sterotactic Ablative Radiotherapy (SABR) and of one specific device to deliver it: the Cyberknife.

'Righteous indignation'

The goal of all radiotherapy is to deliver a lethal dose of radiation to the cancer cells, whilst minimising damage to normal, healthy body tissues.

What SABR can do is to achieve this in some parts of the body that previously would have presented too much risk to those healthy organs. Hard to treat cancers can, in some cases, now be effectively treated.

There are several excellent machines capable of giving SABR treatments.

The particular success of the Cyberknife is that its promoters have overcome the constraints of poor perception of radiotherapy and have succeeded in making the product known to politicians, the media and public alike.

This has been so successfully done that the Cyberknife phenomenon is beginning to take on characteristics similar to a pharmaceutical campaign.

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No one believes that you need to have a heart surgeon to operate on your bunions”

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There have been on-line petitions demanding access to Cyberknife for all cancer patients; politicians apparently believing that they have a duty to see Cyberknife installed in their local cancer centre; the media carrying pages of righteous indignation over the lack of "life-saving Cyberknife treatment" and consequently people fighting cancer and their families caught up in the frenzy.

Just as radiotherapy receives something approaching appropriate publicity, there are real worries that it is the "wrong type" of publicity.

The fact is that, despite its brilliance, Cyberknife is simply not the best machine to treat the vast majority of people that need radiotherapy.

No one believes that you need to have a heart surgeon to operate on your bunions.

In the same way, SABR (including Cyberknife) is best employed in specialist centres where there is appropriate expertise and support.

'Genuine danger'

Of course, every patient that may benefit from SABR should be able to receive it. However, this does not mean that there has to be a grossly under-used expensive Cyberknife in every radiotherapy centre.

With many radiotherapy machines reaching the end of their useful lives, it has to be folly to believe that replacement should be with anything other than the best equipment to treat the largest numbers of people.

It has been estimated that, in the UK, up to two people in every six who need radiotherapy still do not receive it.

There is a genuine danger that the focus on Cyberknife is causing a distraction that may slow the progress that is being made to close the gap.

Nevertheless, it is not too late to see the enthusiasm in Cyberknife as an opportunity rather than a threat.

After all, it should not be too far-fetched to believe that everyone really wants the same things.

Clinicians, patients, policy makers, carers, equipment manufacturers, pressure groups, charities, councillors. All want to see people with cancer receive the best possible care.

We must be able to agree what is best practice, separate from commercial interest.

This means ensuring wide access to radiotherapy for all those currently missing out and SABR for those who would benefit. It does not mean SABR in every radiotherapy department.

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