Updated: 01/08/14 : 04:39:12
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Cancer: Winning the Battle

By Jim O'Sullivan

The advances in the treatment of most cancers have been rapid: the latest radiotherapy technique looks like a game-changer with particular benefits for the people of this region.

Thousands of breast cancer sufferers could benefit in future from an “innovative” new type of radiotherapy which can be delivered during surgery instead of the current regime whereby the patient must undertake multiple visits to receive the treatment afterwards.

The new treatment, Intrabeam Radiotherapy System (Intrabeam), has this last week been given the go-ahead in the UK by the National Institute of Health and Care Excellence (NICE) making it available to all patients being treated by the NHS.

In their deliberations documentation NICE describe “Intrabeam” as a “mobile irradiation system designed to deliver a single dose of targeted low energy radiation (X-rays) directly to the tumour bed while limiting healthy tissue exposure to radiation”

Because it delivers low energy radiation, it can be used in an ordinary operating theatre at the time of surgery. The applicator is attached to the tumour bed so that breast tissue at risk of local recurrence receives the prescribed dose while skin and deeper structures are protected.

As the radiation is delivered over 20 to 30 minutes in a single dose this means much less travel and stress for patients. A typical treatment at present is one session a day for 3 weeks, from Monday to Friday, with a rest at the weekend. This means the need to travel to the hospital every weekday over that period. The latest treatment, administered during breast surgery, would eradicate all the disruption, stress and inconvenience involved in the current long drawn out process.  Also regular radiotherapy is typically performed some time after surgery or chemotherapy which greatly prolongs the overall treatment cycle.

In this context the new treatment would be a godsend to the people of this region. Even when breast cancer services were available at Sligo Regional, following surgery, patients from the North West still had to traipse the highways and byways to access radiotherapy. The development will also remove the argument that was often thrown in the faces of campaigners trying to save the cancer services by Mary Harney that “patients would have to travel anyway”----that red herring would well and truly be rendered moot.

The initial roll out of “Intrabeam” must give priority to those hospitals catering for large geographical areas where patients are faced with having to travel very long distances---University Hospital Galway must have a very strong case to be first in line on this basis. It would be profoundly unfair if such services where to be made available first in areas where hospitals are within easy reach for the majority living in its catchment area.

NICE has cautioned that “Intrabeam” is “still a new treatment” and recommended its roll out be undertaken in a “carefully controlled way” to ensure patients are fully aware of the risks and benefits before choosing which treatment to have and allow doctors to gather more information about the treatment. Clinicians must, “fully explain the treatment options available to patients including their associated risks and benefits, so that patients can make an informed choice about their treatment”, according to the NICE statement.

Every year, around 41,500 women and 300 men in England alone are diagnosed with breast cancer and the NICE spokesperson said that around 86% of these patients, or 35,970 people each year, could potentially benefit from the treatment.

There is also likely to be significant cash savings for health services. A typical radiotherapy department will spend around 30% of its time dealing with breast cancer and estimates suggest a shift to “Intrabeam” would free up significant  resources that could be employed elsewhere.

The equipment is expensive to start with---each probe costs about €500,000 and this has seen some hesitancy in deploying the technique. There are only 6 centres in the whole of the UK at present equipped to deliver the treatment but roll out elsewhere in Europe has been much more rapid with Germany leading the way with 60 centres already fully equipped.

To add to this development, in the US, findings from 4 phase III clinical trials in breast, prostate, and colorectal cancers were released in June last by the American Society of Clinical Oncology. These pivotal studies reveal new ways to optimise commonly used chemotherapy, hormone therapies, and newer targeted drugs, and according to Clifford A. Hudis, MD, FACP chief of the Breast Cancer Medicine Service at Memorial Sloan-Kettering Cancer Centre, “Today’s results answer critical questions faced by people with cancer and their doctors every day.  There is no doubt that patients will live longer and better because of these studies.”

“We may not be able to direct the wind but we can adjust the sails.”