The targeted radiation beam helps cancer patients swallow

A new technique can help patients undergoing radiotherapy for throat cancer retain the ability to swallow normally — a development that could benefit around 12,000 people in the UK who are diagnosed with head and neck cancers each year.

Treatment usually involves surgery, chemotherapy and radiotherapy and can be successful, with up to 90 per cent of patients surviving for five years. 

But radiotherapy can damage the tissue and muscles around the tumour because the treatment is unable to target the cancer precisely.

Often the muscles that control swallowing are affected, so eating and drinking can become difficult. Around 75 per cent of people who are cured of this type of cancer are left with lifelong swallowing issues due to treatment. In around 40 per cent of cases, these problems are moderate to severe.

Now, a more accurate radiotherapy treatment, designed to reduce the dose of damaging radiation received by these muscles, has been trialled by the Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, both in London. Following a successful study, the treatment should be rolled out across NHS centres next year.

Professor Chris Nutting, an oncologist at the Royal Marsden Hospital, says: ‘Most patients with head and neck cancers have intensity-modulated radiation therapy (IMRT), which is a computer-controlled way to deliver radiation. This has been the gold standard treatment since 2011.

‘The radiation needs to pass through skin and other tissue to reach the tumour and, as a result, it causes collateral damage around the treatment site, to important structures in the throat area.’

With the new treatment, called optimised IMRT, each radiotherapy course is designed for the patient like a bespoke suit, says Professor Nutting.

‘A CT scan is used to design the treatment based on the size and position of the tumour — this process is complex and takes around two weeks, involving doctors and medical physicists,’ he adds.

‘The dose and route is programmed by a computer system which divides the radiation into lots of smaller beams that can be better targeted and then turned off, so they don’t transmit through organs and muscles.

‘This bespoke treatment is then delivered every day for six weeks, the same regularity as standard radiotherapy.

‘We check that the ‘suit’ still fits perfectly by taking scans on the radiotherapy machine every few days.

‘This is a game-changer. In our clinical study of 112 patients from 23 UK cancer centres, 25 per cent fewer patients suffered with swallowing issues when they got the optimised radiotherapy, compared with those who received it via the standard technique. It means many patients will be able to return to eating normally again after treatment.’

During the trial, half the patients were given standard IMRT, while the other half received optimised IMRT. The same strength of radiotherapy was used in both groups.

All the patients underwent treatment every week day for six weeks. They were closely monitored afterwards and swallowing ability was assessed 12 months after completing treatment.

The results, presented at the American Society of Clinical Oncology virtual conference in May, found that 40 per cent of those who had the optimised IMRT reported significant improvements in swallowing one year after treatment, compared with only 15 per cent of those who had the standard treatment.

‘If the swallowing muscles get damaged and never recover, this has a huge impact on someone’s life,’ says Professor Nutting. ‘Those with swallowing issues can eat only softer foods — or have their food liquidised.

‘A small number of people end up having to use swallowing tubes.’

Retired healthcare manager Martin Murphy was part of the trial, after being diagnosed with cancer of his right tonsil in July 2017.

He had a sore throat and pain in his ear for a few months, but his GP found nothing sinister. For peace of mind Martin saw a private consultant who examined his throat and found his right tonsil was enlarged.

After a biopsy confirmed the presence of cancerous cells, the tonsil was removed in October 2017 and Martin needed radiotherapy. ‘I’d been told about the trial by my consultant and jumped at the chance to take part,’ says Martin, 71, from Fakenham in Norfolk.

In November 2017, he had his first 12-hour session of chemotherapy and then began six weeks of treatment with the optimised radiotherapy.

At the end of this, he had a second 12-hour chemotherapy session, which has been found to improve the cure rate.

‘Gradually, after radiotherapy, my throat started feeling sore, a bit like when you have a throat infection and it’s a bit raw,’ says Martin. ‘I took paracetamol and used a spray to numb it. At first I ate soft foods but even drinking water was difficult.’

Under the guidance of speech and language therapists, Martin practised daily exercises such as gently flexing his neck muscles.

‘It would have been awful if it had remained like that, so I was determined to get back to normal,’ says Martin.

‘Due to the specialists and my persistence, thankfully now I am back to eating as before, with no lasting swallowing problems.’

As well as improving the quality of life for the patient, the technology could mean a reduced cost to the NHS, as patients will not need ongoing care, suggests Professor Nutting.

Dr David Thomson, a consultant clinical oncologist at The Christie in Manchester, believes the study’s findings will change how patients are treated in future.

‘Radiotherapy is used to treat head and neck cancers which usually respond well and there is a good chance of cure,’ says Dr Thomson.

‘This practice-changing trial should result in the rapid adoption of this technique throughout the UK, and an international standard of care for this cancer treatment.’