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Home » Oncology » How risk-adapted radiotherapy is revolutionising breast cancer care

Dr Imogen Locke

Consultant Clinical Oncologist at The Royal Marsden NHS Foundation Trust

Pictured above: Sophie Alexander, senior radiographer (right) with Katherine Neale, radiographer, positioning a patient for radiotherapy.

Personalised treatment for breast cancer has made therapies more targeted and patients’ lives easier. The next big breakthroughs could be here before long, says one cancer specialist.

“This is an exciting time to be working in the field of breast cancer,” says Dr Imogen Locke, Consultant Clinical Oncologist at The Royal Marsden NHS Foundation Trust. Ground-breaking innovations are personalising cancer treatment and improving patients’ quality of life.

“Historically in breast cancer radiotherapy, for example, all breast cancer patients would undergo broadly similar radiotherapy treatments, whether their prognosis was good or poor. However, advances in genomic medicine have helped oncologists unlock their understanding of breast cancer biology so that treatment can now be ‘risk-adapted’ to each individual, so that patients aren’t under or over treated.”

Better treatments delivered in more sophisticated ways

“Risk-adapted radiotherapy recognises that breast cancer is not one disease, but a whole spectrum of diseases with different prognoses,” says Dr Locke. “By looking at the molecular subtype of a person’s cancer, as well as the stage of their cancer, we can assess each patient’s risk of recurrence following surgery — very low, low, intermediate or high — and therefore which radiotherapy strategy will be best for them.”

I expect that in the future we’ll be able to offer those patients who need it even more effective radiotherapy in even fewer treatments.

This means that some women with low-grade breast cancers may not need to have radiotherapy, which can cause side-effects such as tiredness or sore skin, at all. Or that low-risk patients, who do need treatment, may be better suited to partial radiotherapy, which pinpoints the area of their breast most at risk of recurrence.

“We can also deliver radiotherapy in increasingly sophisticated ways,” says Dr Locke. “Techniques such as intensity-modulated radiotherapy can target a tumour more precisely without compromising healthy tissue.”

There have also been important surgical breakthroughs. For instance, when patients have their tumour removed, titanium clips are placed at the time of surgery to mark the tumour bed and improve radiotherapy accuracy.

Reducing the risk of cardiac complications

New techniques are also helping radiotherapy patients reduce the risk of cardiac complications because the heart — which sits immediately behind the left breast — may be clipped with beams of radiation during treatment.

“Modern radiotherapy techniques now make this risk very small,” explains Dr Locke. “One big recent advance is a technique called ‘voluntary breath-hold’, where patients take a really big breath in to make their heart move backwards, down and away from their breast.” This simple strategy is effective at lowering instances of radiation-induced heart disease.

Dr Locke emphasises that all these changes are evidence-based and introduced after robust randomised trials. “We’re on the cusp of further improving treatments and patient experience. For instance, hypofractionation delivers higher doses of radiotherapy in far fewer treatments,” she says. “This makes a huge difference to patients’ lives. I expect that in the future we’ll be able to offer those patients who need it even more effective radiotherapy in even fewer treatments.”

The Royal Marsden Private Care is due to expand its presence in London, with a diagnostic and treatment facility opening, on Cavendish Square, in autumn 2020 between Oxford Street and Harley Street. The new outpatients centre will offer patients fast and direct access to world-leading experts, in an easily accessible and reassuring environment.

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