Our SABR UK clinical director of stereotactic radiotherapy, Dr James Good, shares his insights into SABR
These are unprecedented times in healthcare. The rapid global spread of a virus that affects both older people and younger people, poorly people and well people, will continue to have a profound impact on our economy and the way care is delivered for the foreseeable future. In the UK our National Health Service does a phenomenal job of caring for the nation – but as an oncologist, one of my chief questions is: what about those affected by cancer?
The press is full of articles indicating that front-line staff and resources will have to be redeployed to address the COVID-19 epidemic. What impact will this have on the provision of chemotherapy and radiotherapy? How will the oncology workforce, and therefore treatment pathways, be affected if schools don’t re-open next term? As operating theatres are re-purposed to become intensive care units, what impact will any resulting delays have on cancer survival rates?
I have taken heart from many things over the last couple of weeks: patients and relatives participating bravely in the difficult decisions we now face; hospitals rapidly pivoting to an entirely new way of doing things, and keeping their staff informed along the way; and oncologists looking for new and flexible solutions to keep cancer patients well for as long as possible. And the glimmer of good news here is that radiotherapy has a key role to play.
It often takes a long time to change practice. This is partly because we seek to prove benefit via complex, expensive and necessary clinical trials — but institutional inertia plays a role too. So it has been particularly heartening to find that radiotherapy specialists have been willing to come together (often on WhatsApp and other platforms) to rapidly establish a consensus on how to keep things afloat. A unifying theme in these conversations has been the concept of hypofractionation – which means treating cancer using shorter treatment schedules. This keeps the patient out of the clinic as much as possible, reducing the risk of infection for them, as well as minimising the burden on radiotherapy departments running on a skeleton staff.
Stereotactic ablative radiotherapy (SABR, also known as SBRT) is one such approach to hypofractionated radiotherapy. SABR harnesses the advanced technology in modern radiotherapy machines to focus the cancer-killing power of radiation with enormous precision, maximising the chance of tumour control whilst minimising the likelihood of side effects. It can be used to treat primary cancers of the prostate, lung, liver, and pancreas; secondary tumours anywhere in the body, including the brain, spine and liver; and for certain forms of breast cancer and rectal cancer. Treatment is delivered over three to five sessions, with no need for an anaesthetic or overnight stay. SABR can also be used to stabilise patients with up to five secondary tumours, in situations where it is risky or logistically impossible to continue chemotherapy.
We can expect NHS radiotherapy departments to be using these shorter treatment schedule in the near future.
GenesisCare is the leading independent provider of SABR. Rapid access to high quality treatment is available across our network, delivered by skilled staff and underpinned by a robust process of peer review and clinical governance. Our MRIdian MR-guided SABR service is treating prostate cancer, pancreatic cancer and a variety of secondary tumours. And we’re working with our academic partners at the University of Oxford to bring this to NHS patients as soon as possible.
Find our more on SABR here.