Radiotherapy has been used to treat cancer for over a century and in this time we have seen phenomenal advances in how this technique is used and the benefits it can have for patients. To find out more about the latest research being carried out in this field we spoke to Dr Charlotte Coles, a specialist in breast radiotherapy at Addenbrookes’ Hospital in Cambridge.
How far we've come...
Radiotherapy was first introduced as a means to treat cancer at the turn of the 20th century, however the dangers of radiation were not widely understood. Treatments often involved high doses of radioactive material being placed in close proximity to the tumour; the cancer was rarely cured and extensive damage to the surrounding tissue often occurred.
We’ve come a long way from the days of crude exposure to high dose radiation, but modern radiotherapy still carries a risk of side effects. As Dr Coles describes, “This ranges from temporary changes in the skin and fatigue during the early stages of treatment, to rarer but more permanent changes to the shape and size of the breast and damage to other organs such as the heart and lungs, which can occur months or years after treatment”.
It is therefore not surprising that doctors like Dr Coles want to minimise the impact that radiotherapy has on patient wellbeing; “Our aim with breast radiotherapy is to give the best chance of cure, but with fewer side effects”.
…and where we’re at now
Over the past 25 years we have seen major advances in the way radiotherapy is used to treat breast cancer, which Dr Coles attributes to “the engagement of the whole research community in radiotherapy trials”. Collaboration between a wide range of medical professionals and cancer patients has led to clinical trials which have provided the evidence needed to make changes to radiotherapy practice, ensuring patients receive higher quality treatment.
One of the key changes in radiotherapy for breast cancer has been the introduction of intensity modulated radiotherapy (IMRT), where the radiation beam is closely shaped to the area of the tumour and allows variation in the intensity of the radiation delivered - smoothing out the dose across the breast and reducing radiation-induced damage to other organs and tissues.
For Dr Coles, the Breast Cancer Now funded Cambridge IMRT trial was crucial in ensuring that this technique became available for breast cancer patients. “IMRT was not standard treatment before the trial, but the results helped drive this forward so that all patients could receive it if needed”. Over 1,000 women participated in the study, which found that IMRT reduced long-term side effects of radiotherapy, in particular reducing changes to the physical appearance of the breast.
Where we’re heading
Doctors are constantly looking for ways to optimise the radiotherapy procedure and reduce the impact of this treatment on quality of life for patients. Across the UK, many clinical trials are currently underway, with the aim to improve the way patients are treated. This includes the FAST-forward study, led by Professors Murray Brunt and John Yarnold and co-ordinated by the Institute of Cancer Research Clinical Trials and Statistics Unit, which is investigating whether whole breast radiotherapy delivered over a single week can prevent cancer returning and avoid long-term side effects as successfully as the current standard procedure, where patients are treated over three weeks.
A further means of reducing the impact of radiotherapy on patients’ quality of life is preventing unnecessary overtreatment. In collaboration with Professor Judith Bliss, Dr Coles is leading a new Cancer Research UK funded study, which aims to identify whether patients at very low risk of their cancer returning can avoid radiotherapy, and the associated side effects, completely.
Looking to the future
So what does the future have in store for breast cancer patients and radiotherapy? For Dr Coles, the key to improving outcomes for patients lies in the development of ‘personalised’ treatments. With the help of research into new tests to predict the risk of cancer returning, she believes that radiotherapy can be tailored according to breast cancer type and prognosis, and that ultimately this will “give the best chance of survival with the fewest side effects”.
As we reach the end of our series on the cornerstone treatments for breast cancer, it is clear that current research – from chemotherapy and surgery to radiotherapy, is intent on minimising the impact that breast cancer and its therapies can have on patients and their quality of life.
Overall, we want to be able to predict which patients will benefit from treatments and develop new, highly specific therapies – avoiding side-effects and unnecessary overtreatment. Ultimately, making the treatment for a devastating diagnosis of cancer more bearable.