London doctors have rolled out a “game-changing” precision radiotherapy technique that can eliminate debilitating swallowing problems for head and neck cancer patients.
Dysphagia is a common side effect of radiotherapy for head and neck cancer that can, in some cases, leave patients needing a permanent feeding tube.
Head and neck cancer is the 8th most common cancer in the UK, accounting for 3 per cent of all new cancer cases, according to Cancer Research UK. Around 70 per cent of people who are cured of this type of cancer are left with lifelong swallowing issues.
Normal radiation therapy, called IMRT, causes swallowing issues as radiation needs to pass through skin and other tissue to reach the tumour. This causes collateral damage around the throat.
But clinicians at the Royal Marsden have developed a new technique, named dysphagia-optimised intensity modulated radiotherapy (DO-IMRT), that uses a computer programme to divide the radiation into lots of smaller beams that can be better targeted and then turned off. This means they do not pass through organ tissue and damage it in the process.
Patients have hailed the treatment as life-changing, while NHS officials hope it will also create savings as patients will not have to be treated for swallowing issues for the rest of their lives.
A Phase III study found that 62 per cent of patients treated with DO-IMRT reported a normal diet after a year of treatment - meaning they were still able to eat at least some foods that require chewing. Over eight in ten (85 per cent) said they felt comfortable eating in public, compared with just under 45 per cent and 75 per cent of those treated with standard IMRT respectively.
The study included 112 newly diagnosed patients with oropharyngeal and hypopharyngeal cancers, both tumours of the throat, from centres across the UK and Ireland.
Study lead Professor Chris Nutting, a consultant clinical oncologist at the Royal Marsden NHS Foundation Trust, said: “The final results from this study support a new gold standard for treating head and neck cancer patients with radiotherapy. We have demonstrated that this targeted form of radiotherapy can spare the swallowing muscles of patients without impacting the success of their treatment.
“This approach involves oncologists and physicists spending some additional time designing the treatment based on the size and position of the tumour. A computer will then plan the dose and route which turns the radiation into lots of smaller, more precise beams that help to protect the throat where possible.
“As these tweaks to the treatment can significantly improve quality of life, we hope more centres will implement this practice.”
Ian McAllister, 73 from Wandsworth, was diagnosed with oropharyngeal cancer last January. He was treated at The Royal Marsden with DO-IMRT, which has helped him avoid needing a feeding tube. His most recent scan results also showed no evidence of cancer.
He told the Standard: “During the first couple of weeks of radiotherapy, I thought the treatment was a breeze, but the side effects built up. By week four, I had lost my sense of taste and my saliva glands had stopped working, so eating was a real struggle.
“However, thanks to this optimised radiotherapy and The Royal Marsden’s dieticians and speech and language therapists who supported me with diet plans, mouth exercises and buckets of encouragement, I achieved my goal of playing golf three weeks after finishing treatment. I now no longer have trouble swallowing and although my taste and saliva glands have not as yet returned, I am confident my rehab will enable me to achieve that goal.”
Martin Ledwick, Cancer Research UK’s head nurse, said: “It’s difficult for many of us to imagine not being able to swallow properly, but this can be the reality for head and neck cancer patients post-treatment.
“These promising results could make life after treatment brighter for head and neck cancer patients, and we look forward to seeing this kinder form of radiotherapy make its way to the clinic.”
The study was carried out with the help of the Institute of Cancer Research.