The Royal Marsden

Leading edge

The Royal Marsden is pioneering the latest radiotherapy treatments, with state-of-the-art machines such as CyberKnife and the MR Linac delivering significant improvements
The MR Linac is a key part of The Royal Marsden's array of advanced radiotherapy equipment

The MR Linac is a key part of The Royal Marsden's array of advanced radiotherapy equipment

Home to one of the largest radiotherapy departments in the UK, The Royal Marsden delivers more than 70,000 treatments a year, of which around 10,000 are for Private Care patients.

Rated ‘outstanding’ by the Care Quality Commission, the radiotherapy service works in close partnership with The Royal Marsden’s academic and research partners to design, deliver and assess the latest techniques in order to remain at the forefront of international radiotherapy delivery. The techniques developed at The Royal Marsden have been rolled out across the country, and new treatment methods have been shared with more than half of the UK’s radiotherapy departments.

Dr Susan Lalondrelle, Consultant Clinical Oncologist and Lead for Clinical Oncology, says: “At The Royal Marsden, we thrive on change and embrace it. We like to try new ways of doing things for the benefit of our patients. Our radiotherapy studies have changed the way cancer patients are treated, not only here but also across the country.”

With the arrival of a new CyberKnife machine at our Sutton hospital later this year, the Trust will have more capacity and scope to deliver advanced stereotactic body radiotherapy (SBRT). Using a robotic arm to support a linear accelerator (linac) head with an advanced multi-leaf collimated system, the CyberKnife can deliver larger doses of precisely targeted SBRT to moving tumours and very small brain  tumours. The non-invasive treatment minimises damage to healthy tissue and is delivered with such accuracy that fewer treatment sessions are required, offering improved quality of life for all patients.

This is the second CyberKnife to be funded by supporters of The Royal Marsden Cancer Charity, after the first was installed in Chelsea in 2011. The Royal Marsden was one of the first NHS hospitals to install the CyberKnife, which has since treated nearly 3,000 patients and been the focus of international research.

Study success

Recent results from the PACE-B trial suggest that this advanced radiotherapy technology could safely deliver curative treatment for some prostate cancer patients over a shorter period. Led by Dr Nicholas van As, Medical Director and Consultant Clinical Oncologist at The Royal Marsden, and Reader at The Institute of Cancer Research, London, researchers used the CyberKnife to deliver five higher doses of radiation to patients over one to two weeks. They found that, in the three months after treatment, the side effects were no worse than those in patients who had the conventional therapy of lower doses over a longer period.

Dr van As says: “We are focused on developing smarter, better and kinder treatments for patients across the UK and internationally. Developments in radiotherapy such as SBRT mean we can target tumours much more effectively. Using SBRT to deliver this treatment would mean that patients could
be spared numerous visits to hospital, allowing them to get back to their lives sooner.”

In September, The Royal Marsden reached the milestone of treating patients with the MR Linac for one year. This pioneering type of radiotherapy combines two technologies – an MR scanner and a linac – to precisely locate tumours, tailor the shape of X-ray beams in real time, and accurately deliver doses of radiation to moving tumours.

We became the first centre in the UK – and only the third in the world – to use the revolutionary machine in September 2018, treating prostate cancer patient Barry Dolling as part of the PRISM trial. Our multidisciplinary team of clinical oncologists, physicists and therapeutic radiographers have since delivered 600 treatments to almost 50 patients with prostate, rectal, bladder, cervical and ovarian cancers, and recently treated a head and neck tumour for the first time.

The MR Linac allows us to see the anatomy in greater detail at the time of treatment and so adapt the radiotherapy plan accordingly each day, explains Dr Lalondrelle: “The progress we have made in the past year has been exceptional. We are working towards using the imaging quality and real-time image acquisition to improve the pinpoint accuracy of treatment in fewer sessions and with less toxicity. For some tumour sites, the MR Linac has enormous potential to transform the way we treat cancers and significantly improve patient outcomes.”

Well equipped

In addition to the CyberKnife and MR Linac, a total of 14 linacs across Chelsea and Sutton enable The Royal Marsden to deliver all forms of advanced external-beam radiotherapy. Sutton has three of the newest Elekta Versa HD machines, while in Chelsea, there are three of the latest models of the Varian TrueBeam, costing about £2.3 million each.

The TrueBeams can treat up to 40 patients with breast, lung, head and neck, prostate, gastrointestinal or gynaecological cancers every day. They also feature an advanced flattening filter-free delivery system, which means the treatment dose can be delivered more quickly.

Also, the high dose rate (HDR) brachytherapy suite at Chelsea provides the latest MR-guided adaptive treatments for gynaecological cancers using an internal radiation technique to escalate dose, which is proven to improve cancer control. Sarah Helyer, Radiotherapy Services Manager, says: “Developments in imaging allow us to target tumours with sub-millimetre precision. Greater accuracy means fewer healthy cells are damaged, which, in turn, means higher doses can be given. This makes treatment more effective and reduces side effects.

“Our unit aims to continue to improve radiotherapy treatment and be at the forefront of radiotherapy delivery in the UK and internationally for the coming decades, offering new techniques to patients and training the next generation of radiographers and researchers who will shape the future of cancer treatment.”