Cancer is a one of the most complex diseases. Today our growing understanding of the biology of cancer is pushing the boundaries of how we detect, prevent, diagnose and treat the disease. These advances mean that a person diagnosed with cancer in today has a better chance of surviving than ever before, with half of people diagnosed surviving for ten years or more.
What once seemed impossible in cancer treatment and care is now a reality thanks to a huge number of technologies and innovations like, artificial intelligence, magnetic resonance imaging (MRI) and robotic surgery. These technologies are at the forefront of enhancing patients’ experiences and treatment outcomes, from detection to diagnosis.
The field of radiation therapy in particular is an exciting treatment area that has witnessed remarkable progress in recent years. This progress can be attributed to technological leaps, from state-of-the-art imaging modalities, immensely powerful computing capabilities, and novel delivery systems like advanced linear accelerators. These advancements enable healthcare professionals to more effectively target cancerous cells, minimising damage to healthy tissue and enhancing overall treatment outcomes.
Today radiation therapy continues to play an important role in cancer treatment with approximately 50 per cent of all cancer patients receiving radiation therapy as part of their treatment regime. The primary objective of radiotherapy is to administer the highest possible dose to the tumour while sparing healthy surrounding tissues.
Advances in cancer diagnosis and treatment
Thanks to its focus on research, the Department of Radiotherapy at The Royal Marsden NHS Foundation Trust is at the forefront of advancing radiotherapy techniques to improve cancer outcomes. The department treats approximately 5,000 patients per year, offering access to state-of-the-art radiotherapy machines and clinical trials for new treatments.
Based in London, The Royal Marsden was the first hospital in the world dedicated to the study and treatment of cancer. Today it’s renowned as a world-leading innovation centre – one of the largest in Europe, treating more than 60,000 patients every year.
From clinical trials that assess the safety and effectiveness of novel treatments, to its unique partnership with The Institute of Cancer Research, London, which allows for ‘bench-to-bedside’ research, the hospital’s commitment to research and collaboration contributes significantly to advancements in cancer diagnosis and treatment.
Groundbreaking treatments
With innovation at its core, The Royal Marsden is pioneering the way many cancer types are treated, using the latest state-of-the-art equipment for radiotherapy. The Royal Marsden’s radiotherapy department covers all main tumour sites and has specialised services for sarcomas and paediatrics. For example, the hospital offers some patients stereotactic ablative body radiotherapy (SABR), a highly targeted type of radiotherapy, as an alternative to conventional radiotherapy.
The pioneering approach can, for example, target metastatic cancers with an intense and targeted dose of radiotherapy, and offers the potential to shift the treatment paradigm for some patients with advanced diseases. It can open up new possibilities for those previously facing a palliative outlook, offering a potentially curative approach.
The Royal Marsden is also at the forefront of groundbreaking research in heart-sparing radiotherapy for breast cancer patients. – Previously centres used expensive machines to help patients with the disease hold their breaths during radiotherapy to minimise radiation damage to the heart. However, the HeartSpare study, which was led by researchers from The Royal Marsden and The Institute of Cancer Research (ICR), led to a simple solution which replaced the need for costly equipment. The study found a a surgical pen and a light field can be used to accurately monitor a patient’s breath hold, replacing the need for expensive machines. This intervention halves the dose of radiation to the heart associated with breast treatment.
Dr. Alison Ranger, Consultant Clinical Oncologist at The Royal Marsden NHS Foundation Trust, is dedicated to advancing complex radiotherapy techniques. She is interested in optimising the delivery of radiation to the breast and lymph nodes for high-risk breast cancer patients, while minimising exposure to the heart and lungs. She says:
“I built on research from the HeartSpare study, which focused on early-stage breast cancer patients, to ensure patients with locally advanced disease could also benefit from our innovative and easily accessible new approach, which can reduce serious long-term side effects from radiotherapy to the heart.
Research is a huge undertaking which takes a lot of time and effort. Fortunately, The Royal Marsden is partnered with The Institute of Cancer Research, who together, using a ‘bench-to-bedside’ approach, work closely to launch and run trials. They also provide invaluable statistical support, so the quality of the data produced by our research is world-class.”
Other innovations at The Royal Marsden
Another innovation in radiotherapy that has been pioneered at The Royal Marsden, in partnership with the ICR, is the MR Linac. Five years ago, the hospital became the first in the UK to treat a patient using this machine, which delivers radiotherapy with the guidance of an MRI scanner. This allows clinicians, radiographers and physicists to work together to tailor the treatment precisely to patients in real time, with detailed imagery.
After an initial trial for prostate cancer patients, many other tumour types – including gynaecological and head and neck cancers – have since been treated on the MR Linac. Studies investigating variations in treatment delivery – such as changes to dose, margins and frequency – are also ongoing at The Royal Marsden, with the aim of improving patient outcomes and reducing time spent in hospital. This technology may one day become a useful tool to treat patients with breast cancer using radiotherapy.
The hospital, building on laboratory research at the ICR, is also at the forefront of groundbreaking clinical trials aimed at harnessing liquid biopsies – which identify fragments of circulating tumour DNA (ctDNA) in the blood – to predict the recurrence of cancer. One notable example is the TRAK-ER trial – which is funded by Pfizer, Invitae and The Royal Marsden Cancer Charity – aims to detect the signs of relapse earlier in oestrogen receptor-positive (ER+) breast cancer patients by looking for ctDNA in the bloodstream. What sets this trial apart as a potential game-changer for patients is that, rather than relying on invasive biopsies, the centre is using a simple blood test that can identify very low levels of ctDNA in the blood, potentially diagnosing recurrence at the very earliest stage. This technology can be combined with novel ablative therapies such as SBRT which is able to significantly improve patient outcomes.
Streamlining the patient journey
Another crucial area of innovation at The Royal Marsden revolves around the patient journey. For example, the hospital offers a streamlined experience through a one-stop diagnostic clinic for breast cancer patients, where tests are completed on the same day, and patients receive results very quickly. This approach seamlessly integrates with various departments, including imaging, surgery, radiotherapy, and chemotherapy. The objective is to create an environment where patients feel well supported and can smoothly navigate their path from diagnosis to treatment as quickly as possible.
“Multidisciplinary team working is absolutely essential in cancer care,” Alison adds. “There are so many different faculties involved in one patient’s treatment, and having a team of experts who you can rely on to give an absolute top-notch opinion is so important. Teams at The Royal Marsden work very closely together from the beginning of the patient pathway to make each step of treatment and care is planned out as much as possible.”