Guest post: ‘A Cyberknife in every radiotherapy centre would be madness right now’

In response to recent media stories, Richard Evans, chief executive of the Society and College of Radiographers – one of our partners in the National Radiotherapy Awareness Initiative – asks whether calls for more ‘Cyberknife’ radiotherapy are justified.

Richard Evans is the CEO of the Society and College of Radiographers

Not so long ago, people were predicting that radiotherapy as a cancer treatment was finished. Yesterday’s technology. Drug treatments were going to take over and radiotherapy would be obsolete.

But those of us in the field have seen astonishing developments in radiotherapy delivery systems, and unprecedented accuracy in treating and curing cancer while minimising damage to healthy tissues.

Far from obsolete, cancer treatments with radiation are essential in up to half of all cancer cases. Cure rates and cost-effectiveness are far higher than is achievable with chemotherapy on its own.

But we have been unable to achieve the recognition that radiotherapy deserves. Politicians, the media and the public at large remain wary.

The result is frustration. Frustration as (for example) millions of pounds are set aside for a “Cancer Drugs Fund” which remains under-spent while radiotherapy services struggle to replace outdated kit and implement the most appropriate techniques.

Frustration that pharmaceutical companies are so effective in publicising and marketing cancer drugs, even those with marginal benefit.

What radiotherapy needs is a product to grab the imagination and put our speciality back on the map. Something that could be marketed as effectively as those chemotherapy agents and a company with the nerve to do it.

And, hey presto, that’s just what we’ve got… and we don’t like it much.

Suddenly it is all about Cyberknife. Arguably the sexiest piece of radiation equipment this side of the Large Hadron Collider, and with a name to match. It’s the name on every politician’s lips; it is there in newspaper columns, blogs and web petitions and it is surging into the public consciousness. “We need Cyberknife and we need it now.”

The irritation of the radiotherapy community is to do with the fact that Cyberknife is just one of a number of methods to deliver a technique called Stereotactic Ablative Body Radiotherapy (SABR – as if one sexy name were not enough!). It doesn’t seem fair that one machine should grab all of the limelight, especially when it’s simply not the best technique to treat the vast majority of people who need radiotherapy. A Cyberknife in every radiotherapy centre would be madness right now.

And, of course, it is madness we are afraid of. Will anyone be mad enough to miss the point about radiotherapy and believe that there is only one technique that matters; or that one machine delivering that one technique is some sort of panacea?

It certainly would be madness, with many radiotherapy machines reaching the end of their useful lives, to believe that replacement should be with anything other than the best equipment to treat the largest numbers of people.

Madness to interfere with the best treatment techniques for the most common types of cancer.

Madness to take our eyes off the very pressing concerns over building and sustaining the radiotherapy workforce.

Insanity to slow the expansion in treatment capacity in the UK, where it has been estimated that up to two people in every six who need radiotherapy still do not receive it.

However, wringing our hands over the effective marketing campaign that we have longed for in radiotherapy could risk missing the great opportunities that it provides. Expending energy worrying over whether politicians will get the point is less productive than efforts to make sure they do.

I suspect that worrying about the media is pointless under any circumstances, but let’s try to have something more imaginative to say about our wonderful, life-saving speciality. At the moment we are in danger of appearing to complain that the manufacturers of Cyberknife should have called it something more boring.

Finally, I should like to imagine that all of us – clinicians, patients, policy makers, carers, equipment manufacturers, pressure groups, charities and councillors – are on the same side. Can’t we find a way to agree what is best practice, separate from commercial interest?

Surely we want to see people with cancer receive the best possible care. This means ensuring wide access to radiotherapy for all those who are missing out, and SABR for those who would benefit.

It does not mean SABR in every radiotherapy department.

Richard

• Richard Evans is CEO of the Society and College of Radiographers
• Richard has also written an article about radiotherapy for the BBC Scrubbing Up series