The Story of Radiotherapy

Professor Michele Saunders: If you look at the whole journey of a cancer patient, over 50 per cent of patients will receive radiotherapy; 40 per cent of people who are cured receive radiotherapy

David Jenkins: The actual business of it was to be taken in, take your top off, lain down on a very sort of ritzy fancy futuristic machine; you’re alone in this big room, you feel it moving around a bit, odd jolts, the odd voice says ‘don’t move’ … and you may see the odd light, or something like that; you feel nothing – or I felt nothing – and then you disappear, and you come back the next day, and you come back the next day…

Professor Michele Saunders: Well radiotherapy is a way of treating patients with cancer using high-energy x-rays, and these x-rays are generated in ‘linear accelerators’, and we are able now to focus our radiotherapy onto tumours, avoiding surrounding normal tissues. So by understanding the biology of the tumour, and the differences to the normal tissues, we’ve been able to develop strategies to lessen the effects on the normal tissues, and thus on the patients. And the enormous technological advances… I mean, when I started radiotherapy we localised the tumour by looking at an x-ray – now we look at a CT scan and we see a three-dimensional picture…

Well Cancer Research UK has been absolutely vital in the development of radiotherapy. Back in the 1940s and 50s, Cancer Research UK funded the Gray Laboratory at Mount Vernon, and now Cancer Research UK is funding the Gray at Oxford - because we’ve moved - and its funding the molecular biology research that I’m sure will take forward radiotherapy treatment in future.

Professor Gillies McKenna: The Gray Institute is an institute that was set up by the MRC and Cancer Research UK when they decided to make a major investment in radiation biology.

So there are some kinds of cancer that we can treat with radiation and reliably cure the patients – for some of them we can cure more than 90 per cent of the patients… and then there are others where we give the same doses of radiation, the same kinds of treatment, and yet we cure very few patients – and that’s really been one of the central mysteries: why some tumours are sensitive to treatment and why others are resistant to treatment.
So this institute represents the largest single investment by those two organisations in this aspect of radiation oncology.

I think you’re really just seeing the tip of the iceberg of what is happening in this form of treatment. The drug temozolomide, which was a drug developed by scientists working for Cancer Research UK, is the first drug that’s been shown to be more effective than radiation alone in treating malignant brain tumours. In the pipeline there are many many more of these strategies that are currently in development.

Professor Michele Saunders: Well in five years time, I hope we’re able to cure patients more effectively and more of them, and I hope we’re able to achieve palliation more easily for the patients.

But I also hope that the molecular biology research which is being done at the Gray particularly, in Oxford, I hope we’ll be able to combine that with radiotherapy and increase its effectiveness, and thus be able to have more individual patient treatment plans, rather than just giving the same to all patients with a particular disease.

Professor Gillies McKenna: Intensity-modulated radiotherapy – which is also known as IMRT – and image-guided radiotherapy, IGRT, are the two kinds of radiotherapy which have developed in response to the advances in cancer imaging that have occurred in the last 10-15 years. With IMRT and IGRT we can vastly reduce the toxicity – we can make the treatment much safer, much more tolerable to the patient, much less likely to cause long-term complications. It takes much more time, you have to deliver the radiation much more carefully and more precisely, but the benefits to the patient at the end of the day are really very clear.

David Jenkins: The role of research is absolutely crucial. In my case Cancer Research UK funded this research – without that I might not have had the luck I’ve had.

Professor Gillies McKenna: This is one of the most exciting times in the field of radiation oncology that I’ve ever seen in my career. Because now we’ve got the technology to deliver radiation with significantly less toxicity than we had ten or twenty years ago, and we now have new techniques coming along that will allow us to make the treatment so much more effective, so we’ll not only produce less toxicity but we’ll be curing more patients and, at the end of the day, that’s the standard we have to look up to – we want to cure patients.