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Why we need research

Radiotherapy is a common treatment for many types of cancer. Researchers and doctors have worked to refine radiotherapy treatments to give the best chance of curing the cancer while giving the lowest chance of causing side effects. Research is continuing to try to improve radiotherapy treatments and reduce side effects. There are many clinical trials comparing different ways of giving current radiotherapy treatments or trying out new ways of giving radiotherapy. 

The trials and research section has information about what trials are, including information about the 4 phases of clinical trials. If you are interested in taking part in a clinical trial, visit our searchable database of clinical trials. If there is a trial that interests you, print it off and take it to your own specialist. If the trial is suitable for you, your doctor will need to refer you to the research team.

The video below tells you more about clinical trials:

 

Making radiotherapy more accurate

In recent years doctors and researchers have developed new ways of targeting external radiotherapy more accurately. The new techniques give a higher dose of radiation to the tumour and there is less damage to surrounding tissue. The newer techniques include

You can read about these treatments on our page about external radiotherapy.

Doctors are carrying out many trials to find the best way of using these newer types of radiotherapy and sometimes combining them with other treatments. Some trials are looking at whether giving fewer doses of IMRT works as well as a longer course of standard radiotherapy.

Trials are also looking at a short course of IMRT for prostate cancer and increased dose IMRT for head and neck cancer. These trials have closed and we are waiting for the results. 

You can search for IMRT trials on our clinical trials database.

 

Combining external and internal radiotherapy

Some trials are looking at combining external beam radiotherapy with internal radiotherapy (high dose rate brachytherapy). For example, there is a trial combining external and internal radiotherapy for prostate cancer. The study aims to see whether using internal radiotherapy instead of a booster dose of external radiotherapy can give patients a better quality of life during and after treatment. The trial has closed and we are waiting for the results.

 

Different ways of giving radiotherapy

Researchers are looking at different ways of giving standard external beam radiotherapy. These different ways include hyperfractionated radiotherapy, hypofractionated radiotherapy and giving lower or higher radiotherapy doses.

Hyperfractionated radiotherapy

Hyperfractionated means giving more than one treatment (fraction) of radiotherapy per day. One type of hyperfractionated radiotherapy is called CHART. It stands for Continuous Hyperfractionated Accelerated Radiotherapy. The whole dose of radiation is about the same as you would have for your cancer with standard radiotherapy. The difference is that you have treatment every day over 12 days instead of over several weeks. You have to stay in hospital because you have as many as 3 treatments every day. Researchers are looking into hyperfractionated radiotherapy for non small cell lung cancer. This trial has now closed and we are waiting for the results. 

CHART without treatments at the weekends is called CHARTWEL. This stands for weekend less CHART. With this type of treatment you have more than one treatment a day, between Monday and Friday. The CH03 trial is using CHARTWEL for head and neck cancers. It is comparing radiotherapy once a day with radiotherapy 3 times a day to see which is better at stopping the cancer from coming back. This trial is closed and we are waiting for the results. 

The CONVERT trial is looking at whether it is best to have radiotherapy once or twice a day, when you are also having cisplatin and etoposide chemotherapy for small cell lung cancer. The trial has closed and we are waiting for the results.

You can find details of these trials on CancerHelp UK's clinical trials database. Type 'hyperfractionated' into the search box and tick the box for closed trials.

Hypofractionated radiotherapy

Hypofractionated radiotherapy is another area of research. Clinical trials are looking into giving larger doses of radiotherapy per fraction, but giving fewer fractions. Although the dose of each individual fraction is higher, the total dose of radiotherapy you get is lower. Researchers want to find out if this way of giving radiotherapy helps to reduce the risk of the cancer coming back. They also want to know what the side effects are compared to standard radiotherapy. 

The CHHIP trial is testing hypofractionated radiotherapy for prostate cancer. It has found that giving a higher dose of radiotherapy per session (fraction), but fewer fractions, is as safe as standard radiotherapy and does not cause more side effects. The next phase of this trial aims to find out whether the higher doses in fewer fractions is better at curing the cancer than the standard treatment.

Giving lower or higher radiotherapy doses

Doctors want to find out if changing the dose of radiotherapy after surgery for early breast cancer can make the treatment work better and reduce side effects. The IMPORT LOW trial is for women who have a low risk of the cancer coming back. It is testing 3 different ways of giving radiotherapy to the area where the cancer was and the surrounding breast tissue. The trial has closed and we are now waiting for the results. The IMPORT HIGH trial is for women who have a higher risk of the cancer coming back and is also testing 3 different ways of giving breast radiotherapy.

The FORT trial is comparing low dose radiotherapy with standard radiotherapy for people with follicular lymphoma or marginal zone lymphoma. It has closed and we are waiting for the results. 

The ART DECO trial is supported by Cancer Research UK. It is comparing standard and higher doses of intensity modulated radiotherapy for advanced cancers of the voice box (cancer of the larynx) or hypopharynx. The hypopharynx is the part of the food pipe (oesophagus) that surrounds the larynx.

You can find details of these trials on our clinical trials database.

 

Internal radiotherapy during or after surgery

Having standard external beam radiotherapy and going to the hospital every day during the week can be very tiring, especially if you live a long way away. Doctors are looking at simpler, quicker ways of giving radiotherapy to women with early stage breast cancer. These are ways of giving radiation inside the breast tissue, instead of aiming it onto the breast from a machine outside the body. The big advantage is that treatment takes much less time than the usual 6 weeks. 

If they are successful, these methods could mean speedier treatment for many women with breast cancer and less pressure on radiotherapy equipment and staff. Doctors hope that the treatment may give a better appearance of the breast tissue too. But we need more research before we will know the true benefit. The treatments include

  • TARGIT (TARGeted Intraoperative radioTherapy)
  • ELIOT (electron intraoperative radiotherapy)
  • Brachytherapy using a new device called MammoSite RTS – used in the FORUM trial
  • Electronic brachytherapy (eBx)

You can find detailed information about these treatments on the breast cancer research page.

 

Combining chemotherapy and radiotherapy

In some types of cancer chemotherapy can make the cancer cells more sensitive to radiotherapy and make the treatment work better. So doctors are looking at combining chemotherapy and radiotherapy. For example, there is a trial looking at giving temozolomide chemotherapy during or after radiotherapy to see if it is better than radiotherapy alone for people with a type of brain tumour called anaplastic glioma.

 

Radiotherapy and biological therapies

Biological therapies are drugs developed from natural body substances or chemicals that change the way particular body processes work. Recent research has found that the biological therapy cetuximab (Erbitux) can be used for quickly growing head and neck cancers alongside radiotherapy instead of chemotherapy. The DeESCALATE study is looking at using cetuximab in place of cisplatin chemotherapy in combination with IMRT for cancer of the throat.

Some studies are trying to find out whether biological therapies can help radiotherapy to work better for other types of cancer. The TACTIC trial is looking at a biological therapy called Tarceva (erlotinib) combined with radiotherapy as a treatment for non small cell lung cancer (NSCLC) that has spread to the brain. The trial has closed and we are waiting for the results. 

 

Radiolabelled monoclonal antibodies

A lot of research is looking into using monoclonal antibodies (MABs) to treat cancer. MABs are proteins, made in the laboratory from a single copy of a human antibody. They are designed to recognise abnormal proteins on the outside of cancer cells and stick to them so that cells from the immune system can find and kill them. Scientists are tying to make monoclonal antibodies better at killing cancer cells by attaching radioactive molecules. The MAB then carries radiation directly to the cell. These treatments are called radiolabelled antibodies or radioimmunotherapies. They are being used and tested in people who have lymphoma and myeloma.

Zevalin is a monoclonal antibody attached to a molecule of radioactive yttrium (pronounced it-ree-um). You may see yttrium written as Y-90. Zevalin is now licensed in the UK to treat follicular B cell lymphoma, where it has come back after, or not responded to, rituximab. But the SMC (Scottish Medicines Consortium) has decided not to approve this treatment on the NHS in Scotland. The FIZZ trial recently found that Zevalin works well as a first treatment for follicular lymphoma. The SCHRIFT trial is looking at Zevalin with chemotherapy for follicular lymphoma that has come back. The trial has now closed and we are waiting for the results.

Researchers are also looking at using a radio labelled monoclonal antibody called BW 250/183 for people with myeloma before they have high dose melphalan chemotherapy and a stem cell transplant. The trial has closed and we are waiting for the results.

To find monoclonal antibody trials look at our clinical trials database and type 'antibody' into the search box. Tick the box for closed trials and results.

 

Radiotherapy or hormone therapy

The RADICALS trial is looking at radiotherapy and hormone therapy after surgery for early prostate cancer. One of the aims of the trial is to find out whether men need radiotherapy after they have had surgery to remove the prostate gland. It is also looking at whether hormone therapy is as good at preventing the cancer from coming back.

 

Radiotherapy for bone secondaries

Doctors are trying to find better treatments for cancers that have spread to the bone. Radiotherapy liquids given as a drink or injection find their way into the bloodstream and can target the cancer cells in the bone. Early results from the ALSYMPCA trial were released. The trial found that the radioactive injection radium 223 (called Xofigo or Alpharadin) can help some men with advanced prostate cancer to live a few months longer than current internal radiotherapy treatments. It also seemed to cause very few side effects. The trial looked at this treatment for men with prostate cancer that had spread to the bone and where hormone therapy is no longer working.

The TRAPEZE trial is comparing different combinations of treatments for prostate cancer that has spread to the bones. The treatments include docetaxel chemotherapy, the bisphosphonate zoledronic acid (Zometa) and the radioactive liquid strontium 89. The trial has now closed and we are waiting for the results.

The SC20 trial looked at whether a second course of external beam radiotherapy could help reduce pain caused by cancer that had spread to the bone. The trial team found that the bone pain responded in around half the people who were treated and followed up. They also found that a lower dose of radiotherapy in a single session was as good as a higher dose in 5 sessions. 

There is more information about these trials on our clinical trials database.

 

Giving radiotherapy with oxygen

Doctors have known for over 50 years that getting oxygen into cells can help radiotherapy work better. Oxygen makes cells 2 to 3 times more sensitive to radiotherapy. But cancer cells often have low levels of oxygen. The BCON trial reported in 2011. It tried 2 different ways of boosting oxygen levels in the cancer cells before radiotherapy for people with bladder cancer. The researchers found that boosting oxygen levels by taking nicotinamide tablets and wearing a breathing mask for a few minutes before and during each radiotherapy treatment helped people to live longer.

 

Proton and ion beam radiation treatment

Proton and ion beam radiotherapy are more complex types of radiotherapy treatment. You may also hear the treatment being called conformal proton beam radiotherapy, intensity modulated proton beam radiotherapy or spot scanned proton therapy.

Proton beam therapy is currently only available in the UK to treat cancer of the eye. Other countries in Europe, Japan and the USA are using or testing proton beam radiation for other types of cancers. These include spinal cord tumours, sarcomas near the spine or brain, prostate cancer, lung cancer, liver cancer and some children’s cancers. We have more information about proton beam therapy for chordoma, a type of spinal cord tumour.

People who have melanoma of the eye can have proton therapy at the Clatterbridge Centre for Oncology. Currently the NHS pays for people (mostly children) to go abroad if they need proton treatment for cancers in other parts of the body. NHS England provides information about the funding process for proton beam therapy.

In December 2011 the UK Department of Health confirmed that proton therapy will be made available for patients in the UK. There will be 2 treatment centres, in London and Manchester. Patients will be able to have treatment there from 2018.

Instead of using X-rays, proton beam therapy aims proton beams at the cancer. Protons are part of the centre of the atom, the atomic nucleus and carry a positive electrical charge. They release energy as they travel and slow down. They then cause a peak of energy at their target point – the cancer. Scientists call this point the Bragg peak. Basically the protons release their energy when they stop rather than when they are travelling through tissue. So most of the radiation goes directly to the cancer, reducing damage to the surrounding normal tissue. Ion beam therapy has the same principle but uses carbon ions rather than protons. Carbon ions peak more sharply than protons.

Like conformal radiotherapy, proton beam radiotherapy increases the chance of killing cancer cells by giving a higher dose of radiation straight to the tumour. At the same time, the treatment spares healthy tissue, particularly tissues and organs behind the tumour. Because less healthy tissue is included in the radiotherapy field, there could be fewer long term side effects. 

Early results from trials using proton beam radiotherapy are promising. Some reports show the treatment works well, with fewer side effects than standard radiotherapy. But there is no evidence that people going abroad for this treatment do any better than those having conventional radiotherapy in the UK.

There is more information about proton beam therapy on the Cancer Research UK blog.

 

Reducing bowel problems after radiotherapy

After radiotherapy to the pelvic area, some people have long term side effects including frequent bowel movements, diarrhoea, pain, and bleeding from the bowel. Researchers for the ORBIT study wanted to find out if specific tests and treatments helped these bowel problems and improved quality of life. They found that following set steps (an algorithm) did help people who had side effects from radiotherapy to the pelvic area. People who had the most improvement had seen a specialist doctor (gastroenterologist) or specialist nurse, rather than use a self help booklet. You can read the results for the ORBIT study on our clinical trials database.

The HOT 2 trial recently reported that using a high pressure oxygen treatment called hyberbaric oxygen (HBO) therapy helped to relieve the long term side effects of radiotherapy to the pelvic area. This trial was for people who had treatment for bladder, bowel, cervical, ovarian, prostate, testicular and womb cancers.

There is detailed information about these trials on our clinical trials database.

 

Helping with skin side effects

Radiotherapy can make the skin go dry, red, itchy and sore in the treatment area. Doctors are looking for ways to lessen this effect but are not sure what is best. A small research study has shown that using a steroid cream may help to decrease radiotherapy skin reactions. So now there is a larger trial testing steroid cream for skin reactions caused by radiotherapy to the breast. The trial is comparing a steroid cream and a non steroid cream. The trial has closed and we are waiting for the results.

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Updated: 1 September 2014