Research into radiotherapy is looking into how to make treatment more accurate, and whether combining radiotherapy with other treatments is effective.
Why we need research
Radiotherapy is a common treatment for many types of cancer. Researchers and doctors have worked to refine radiotherapy treatments. This gives the best chance of curing the cancer while reducing side effects.
Research is continuing to try to improve radiotherapy treatments and reduce side effects.
Many clinical trials are comparing different ways of giving treatments or trying out new ways of giving radiotherapy.
Trials and research have 4 phases. Visit our clinical trials database if you are interested in taking part in a clinical trial. Print out the trial that interests you and take it to your own specialist. Your doctor will refer you to the research team if the trial is suitable for you.
The video below tells you more about clinical trials.
Cancer research trials involve patients in medical research. They help us to understand cancer stages, cancer symptoms and develop drugs and treatments that will eventually enable us to cure cancer. We work with volunteers fighting cancer to test new therapy and make that breakthrough.
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:
- intensity modulated radiotherapy (IMRT)
- image guided radiotherapy (IGRT)
- volumetric modulated arc radiotherapy (VMAT)
- stereotactic body ablative radiotherapy (SABR)
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.
Combining external and internal radiotherapy
Some trials are looking at combining external beam radiotherapy with internal radiotherapy (high dose rate brachytherapy).
A trial combining external and internal radiotherapy for prostate cancer was completed. The study aimed to see whether using internal radiotherapy or external radiotherapy as a treatment booster gave patients a better quality of life during and after treatment.
The trial found no difference between the two techniques. Patients from both groups had similar side effects and quality of life.
Different ways of giving radiotherapy
Researchers are looking at different ways of giving standard external beam radiotherapy. These include hyperfractionated radiotherapy, hypofractionated radiotherapy and giving lower or higher radiotherapy doses.
Hyperfractionated means giving more than one treatment of radiotherapy per day. Continuous Hyperfractionated Accelerated Radiotherapy (CHART) gives treatment 3 times a day for 12 days. This includes over the weekend. The whole dose of radiation is about the same as you would have for your cancer with standard radiotherapy.
Researchers are looking into hyperfractionated radiotherapy for non small cell lung cancer. They are waiting for results to see if a higher dose can be given per treatment.
CHART without treatments at the weekends is called CHARTWEL. You have treatment 3 times a day but not on the weekend.
Hypofractionated radiotherapy is another area of research. Clinical trials are looking into giving larger doses of radiation per treatment. They also want to reduce the number of treatments. 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.
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.
They are also 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.
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)
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. This is 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.
Some studies are trying to find out whether biological therapies can help radiotherapy to work better for other types of cancer.
Radiolabelled monoclonal antibodies
A lot of research is looking into using monoclonal antibodies (MABs) to treat cancer. MABs are proteins that are made in the laboratory. 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.
Zevalin is a monoclonal antibody attached to a molecule of radioactive yttrium (pronounced it-ree-um) also known as Y-90. Zevalin is now licensed in the UK to treat follicular B cell lymphoma. 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.
Radiotherapy or hormone therapy
A 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 cancer that has spread to the bone
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.
Researchers 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.
Another trial looked at whether a second course of external beam radiotherapy could help reduce pain caused by cancer that had spread to the bone. Researchers 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.
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.
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 wanted to find out if specific tests and treatments helped these bowel problems and improved patient's 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.
Another 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.
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 trial has looked at a cream for skin reactions caused by radiotherapy to the breast. The trial team found that a steroid cream called mometasone furoate helped to reduce skin reactions to the breast and chest wall, and improved quality of life, compared to a non steroid cream.