New horizons in radiotherapy for older people

Radiotherapy is an effective, albeit underutilised, treatment for cancer in older adults, especially for those who are surgically inoperable or for whom chemotherapy poses too great a risk. It is estimated that approximately half of patients with cancer could benefit from radiotherapeutic management. This article synthesises the basics of how radiotherapy works, recent developments in the field and considers how this treatment modality may be adapted in an older patient population or may evolve in the future. Technological advances of relevance include Intensity Modulated Radiotherapy (IMRT), Volumetric Modulated Arc therapy (VMAT), Stereotactic Ablative Body Radiotherapy (SABR), proton therapy, MR guided radiotherapy, as well as better image guidance during irradiation in order to improve precision and accuracy. New approaches for better integration of geriatric medicine principles into the oncologic assessment and workup will also be considered, in order to provide more age attuned care. For more informed decision making, a baseline assessment of older radiotherapy patients should encompass some form of Comprehensive Geriatric Assessment. This can facilitate the optimal radiotherapy regime to be selected, to avoid overly toxic regimes in patients with frailty. The review discusses how these new initiatives and technologies have potential for effective oncologic management and can help to reduce the toxicity of treatment for older adults. It concludes by highlighting the need for more evidence in this patient population including better patient selection and support for treatment to enhance person-centred care.

A Nationwide Survey of UK Oncologists’ Views on the Choice of Radiotherapy Regime for the Reconstructed Chest Wall in Breast Cancer Patients

Aims. This paper describes a UK survey of the choice of radiotherapy regime for the reconstructed chest wall in breast cancer patients. Questions focused on which fractionation regime consultants choose, their reasons for this, whether the type of reconstruction influences their choice, and whether bolus is used in patients who have undergone immediate reconstructive surgery. Materials and Methods. Between July 2014 and July 2015 a survey was sent by email to UK consultant radiation oncologists treating breast cancer. Results. The response rate was 73%. 67% of respondents use 40 Gray (Gy) in 15 fractions, with 22% using 50 Gy in 25 fractions and 7% using other regimes. For 90% of consultants the type of reconstruction did not influence their decision regarding choice of fractionation. 83% of respondents do not usually use a bolus for chest wall radiotherapy in patients who have had immediate reconstructive surgery. Conclusions. This survey illustrates there is variation in practice in the management of patients with breast cancer who have undergone immediate reconstructive surgery in the UK. There is a need for further research to determine which fractionation regime is optimal, whether the type of surgery is relevant, and whether bolus should be added.

The introduction of lung stereotactic body radiotherapy in the UK… it’s now a reality!

Lung stereotactic body radiotherapy (SBRT) is a novel and effective technique for the treatment of early stage non small cell lung cancer which is rapidly becoming the radiotherapy regime of choice for those patients unable or unwilling to undergo surgical resection.Although introduced almost 20 years ago, it was not until the wider establishment of image guided radiotherapy (IGRT) techniques that many UK departments first considered and then succeeded in implementing lung SBRT. Many have been assisted in this through membership of the national UK SBRT consortium which aims to facilitate local introduction and to provide guidelines and practical support for the wider radiotherapy community.This article will seek to place the introduction of SBRT within a broad historical context, outline basic principles for safe and effective practice and describe how such principles are currently being pursued in an era of IGRT. Additionally, the role of the UK SBRT consortium in implementation will be reported alongside the results of its first national survey on the subject.