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Introduction
8
Inside News
toxicity, days spent away from work),
the community (e.g. keeping a trained
teacher with head and neck cancer at
work, because they have had larynx
preservation and kept their saliva) and
to the nation (an overall reduction in
treatment costs).
Technology is iterative, morphing (for
example) from static IMRT to rotational
or volume modulated arc therapy
(VMAT) type of IMRT, and helical
IMRT. These are all variations on the
same theme, using slightly different
technologies to perform the same
technique, with subtle differences.
To formally evaluate each version of
the technology which can be used
to deliver IMRT, would not be effort
well spent. The rigid format currently
used by governments to evaluate new
techniques for reimbursement can fail to
take this into account.
Some new techniques may not require
formal comparison with conventional
radiation therapy. SABR for medically
inoperable lung cancer can achieve
local control rates of greater than 95
per cent at three years, with three-year
survival rates of 47 per cent compared
with retrospective five-year survival rates
of 13–39 per cent using external beam
radiation therapy. This is a development
in the management of medically
inoperable lung cancer analogous to
parachutes or penicillin, and randomised
trials in this setting can be considered
redundant and unnecessary.
Exciting new technologies and
techniques are seductive, but it is
important that they are properly
evaluated. New is not always better.
A recently published randomised
controlled study investigating
robotic prostatectomy versus radical
prostatectomy reported similar
functional outcomes at a 12-week follow-
up and equality with respect to margin
positivity could not be demonstrated.
We must not be tempted by what we
can do, but do as we should, based on
what is best for the patient given all the
available information.
As a profession, radiation oncologists
need to ensure they record outcomes of
new treatments—not only to be aware
of what the outcomes are, but so we
can inform our patients. Despite being a
relatively small profession, we can make
a significant impact by contributing
to national or international registries
and becoming involved in data mining
projects.
We also need to embrace all the tools
available to identify the tumour. In the
past we used computed tomography
(CT) scans and where we could, or
thought it relevant, we fused other
available imaging. These days, in many
sites it is imperative that we use CT,
magnetic resonance imaging (MRI) and
nuclear medicine scans to delineate
the tumour. We use the anatomical
information, and importantly also the
functional information. There is no
doubt that MRI is going to become
an increasingly important component
of radiation therapy. The functional
information about tumours provided by
MRI is an area of much interest, there
is now an MRI linear accelerator (linac)
being marketed. In Australia there
is a large MRI-linac research group,
and we are seeing studies using only
MRI planning. We should expect that
adaptive radiation therapy will become
the standard of care—truly personalised
treatment based on both anatomical
and functional imaging performed
during treatment.
Radiation oncology in Australia and New
Zealand can be proud of its research
output. The Trans Tasman Radiation
Oncology Group (TROG) has been very
well served by our Fellows and as an
organisation has served us proud. We
should use our research experience and
skills to support our colleagues in other
areas such as interventional radiology.
There is an exciting coming together of
radiologists and radiation oncologists
in the area of interventional oncology,
where we expect to see ongoing
development of ablative local therapies.
Funding for research in radiation therapy
can be difficult to source, as we lack the
generous industry support enjoyed by
our medical oncology colleagues. We
need equipment vendors to support
not only the development of their
equipment, but also the research to
demonstrate its clinical value.
We have also seen some impressive
advances in drug therapies in recent
years, no more so than in the area of
melanoma, where previously drugs with
no more than 10 per cent response rates
were being recommended. Exciting
new immunotherapy therapies provide
us with an opportunity, as we know the
abscopal effect exists and radiation
therapy combined with these modern
drugs is showing interesting results. Yet
this is a time of change and there is still
much to learn.
New developments have to be
considered in the context of the
economic and political environments.
While we have good evidence that
about one in two people who have
cancer would benefit from access to
radiation therapy at some stage in their
illness, in Australia and New Zealand we
“Exciting new
technologies and
techniques are
seductive, but it
is important that
they are properly
evaluated. New is
not always better.”