The Royal Marsden Radiotherapy

Advanced technology, precision treatment

The Royal Marsden has one of the UK’s largest radiotherapy departments, treating up to 5,000 patients a year using a range of techniques

Dr Imogen Locke, Lead for Clinical Oncology

High-tech equipment

The Trust’s Radiotherapy Department is one of the largest in the UK, treating up to 5,000 patients and delivering more than 75,000 treatments each year. The multidisciplinary team includes therapy radiographers, radiotherapy aides, medical physicists, engineers and clinical oncologists. 

Now, a new linear accelerator has been installed at The Royal Marsden in Chelsea, offering patients the most up-to-date radiotherapy techniques. The £2.3-million Varian TrueBeam machine, known as the Brunel, treats up to 40 patients a day across a variety of tumour types, including breast, lung, head and neck, prostate, gastrointestinal and gynaecological cancers. 

The TrueBeam can deliver all forms of advanced external-beam radiation, including image-guided radiotherapy (IGRT), intensity-modulated radiotherapy (IMRT), stereotactic body radiotherapy (SBRT) and volumetric modulated arc therapy (VMAT). This unit also has the flattening filter free (FFF) delivery system, which means the dose can be delivered more quickly. 

“Developments in radiotherapy imaging allow us to target tumours with sub-millimetre precision,” says Sarah Helyer, Radiotherapy Services Manager. “Greater accuracy means that fewer healthy cells are damaged, which, in turn, means higher doses can be given, making treatment more effective and reducing side effects.” 

In total, the Trust operates 11 linear accelerators across the department. Additionally, the CyberKnife machine in Chelsea is used specifically for stereotactic treatments. The Sutton department has a Gulmay superficial radiotherapy machine for the treatment of skin cancers.

This year, the Trust is replacing the oldest machine at the Sutton site with an Elekta Versa HD linear accelerator. This will be known as the Hawthorn Unit and can deliver the full range of advanced techniques, including the FFF delivery system.

Greater accuracy means that fewer healthy cells are damaged

SARAH HELYER RADIOTHERAPY SERVICES MANAGER

Clinical trials

Patients at The Royal Marsden have access to clinical trials for new radiotherapy treatments, with many national trials being instigated here. 

Our trials are evaluating methods such as IMRT and IGRT in order to deliver higher doses to the tumour while reducing the risk of long-term side effects. Such trials include IMPORT HIGH, for patients with breast cancer, or the HYBRID and RAIDER trials, which use IGRT and adaptive radiotherapy in patients with bladder cancer. 

Other trials are looking at reducing the numbers of treatments that patients receive. The Prostate Advances in Comparative Evidence (PACE) study is a randomised clinical trial that compares stereotactic radiotherapy treatment to the current standard treatments of surgery and conventional radiotherapy.

Sharing pioneering techniques

The Royal Marsden’s new radiotherapy techniques are often rolled out across the country, thanks to its commitment to training and education. New treatment methods have been shared with more than half of the UK’s radiotherapy departments. 

“At The Royal Marsden, we thrive on change and embrace it well,” says Dr Helen McNair, Lead Research Radiographer. “We like to try new ways of doing things for the benefit of our patients. Radiotherapy studies at The Royal Marsden have changed the way cancer patients are treated, not only here but across the country.”

Training future generations

The Royal Marsden’s Radiotherapy Department prides itself on offering the best training for the next generation of radiographers. We support about 70 students over their three-and-four-year courses, as well as radiographers who are undertaking a Masters.

“Although we support students on the conventional full-time three-year BSc course, we also train staff who are recruited for admin and clerical work in radiotherapy while they undertake a part-time degree programme,” says Sarah Armstrong, Professional Development Lead. 

“The in-service programme allows people who would like to train to be a radiographer to work full-time and receive a salary while they undertake the part-time four-year BSc.” 

Tailored treatment: our range of radiotherapy techniques

Image-guided radiotherapy (IGRT) 

Uses a variety of imaging techniques, such as X-rays or CT scans, alongside radiotherapy. Imaging confirms the position of the patient and the tumour so that the radiotherapy beam is targeted more precisely.

Intensity-modulated radiotherapy (IMRT) 

Multiple beams of radiation of varying intensity are used to shape the radiotherapy more precisely. 

Volumetric modulated arc therapy (VMAT)

This is an advanced method of radiotherapy first performed in the UK at The Royal Marsden. During VMAT, the linear accelerator delivers radiotherapy in one or more continuous arcs to conform the treatment to the exact size and shape of the tumour.

Stereotactic radiotherapy

The use of multiple small beams to deliver a high dose in just a few treatments. It is delivered using an IGRT technique on a linear accelerator or CyberKnife. 

CyberKnife 

Delivers stereotactic radiotherapy, using a moving couch and a small linear accelerator on a robotic arm to deliver multiple  beams of radiation from different angles. 

Brachytherapy 

Radioactive sources are placed inside the patient’s body.

Adaptive radiotherapy

These treatments are chosen on the day. The patient is imaged and the treatment plan designed to ‘fit’ the volume to be treated. For example, in bladder cancer, we will select the plan that fits the size of the bladder that day.

The evolution of radiotherapy is based on shaping the beam of radiation

DR IMOGEN LOCKE LEAD FOR CLINICAL ONCOLOGY

Q&A radiotherapy

In the past 10 years, research into radiotherapy techniques has transformed the way we treat patients. Dr Imogen Locke, Lead for Clinical Oncology at The Royal Marsden, explains

What is radiotherapy?

Radiotherapy uses high-energy X-ray radiation produced by linear accelerators to shrink tumours and kill cancer cells. Radiation is delivered by a machine outside the body (external-beam radiation therapy), or from radioactive material placed in the body close to the cancer cells (internal radiation therapy, also called brachytherapy). Systemic radiation therapy uses radioactive substances such as radioactive iodine that travel in the blood to kill the cancer cells.

What factors decide the type of radiation you use?

The radiation therapy prescribed depends on many factors, including the type of cancer, its location, how close it is to normal tissue that is sensitive to radiation, and how far into the body the radiation needs to travel. The type of therapy will also take into consideration the patient’s general health and medical history, location of the cancer, and whether the patient will be receiving other types of cancer treatment. Radiotherapy cures approximately 40 per cent of cancers, and half of all cancer patients should receive radiotherapy at some point during their treatment pathway.

How does radiation therapy kill cancer cells?

Radiation therapy damages the DNA of cancer cells beyond repair, so they stop dividing or die. When the damaged cells die, they’re broken down and eliminated by the body’s natural processes.

How has radiotherapy technology developed?

The way we treat patients is more sophisticated now. The evolution of radiotherapy is based on shaping the beam of radiation so that it minimises the damage to healthy tissue and organs.

Has the way we treat patients changed over the past few years?

We’ve seen advances with research into radiotherapy techniques. The PACE trial, for example, is exploring the benefit of reducing radiotherapy sessions from 39 standard treatments to five delivered with stereotactic radiotherapy. This would be less time-consuming for the patient. The START trial proved it was as effective to give three weeks of radiotherapy as it was for five weeks in breast cancer cases. The next phase is looking at reducing this further, with bigger doses for shorter periods. The FAST trial has completed recruitment and compared three weeks with just one week. The results will be published in the next couple of years.