One dose therapy for some breast cancer patients
25th July 2014 – A new one-shot radiotherapy treatment for breast cancer patients has been provisionally recommended for use by the NHS in England.
Intraoperative radiotherapy (IORT) using the Intrabeam Radiotherapy System, is administered from inside the patient once a tumour has been removed in surgery, destroying the remaining cancer cells and the need for later hospital visits.
Regular radiotherapy, or external beam radiotherapy, typically requires numerous doses over a 3 week period – although some people may receive it for longer - and is performed weeks or months after surgery or chemotherapy.
Questions over effectiveness
However, the National Institute for Health and Care Excellence (NICE) says some doubts remain about the effectiveness of intraoperative radiotherapy compared with conventional radiotherapy and patients should be made aware in advance of the pros and cons of both treatments.
Professor Carole Longson, director of health technology evaluation at NICE, says in a statement: "The Appraisal Committee concluded that whilst current evidence was not extensive, this type of radiotherapy was more convenient for patients and can improve a person’s quality of life."
The new treatment is only suitable for patients who have been diagnosed when their cancer is at an early stage.
Just over 41,500 women and 300 men in England are diagnosed with breast cancer every year, and figures suggest that about 86% of them – 35,970 people each year – will potentially have early breast cancer.
The Appraisal Committee says there is insufficient evidence to conclusively say that intraoperative radiotherapy is as effective as conventional radiotherapy at preventing breast cancer returning, and is planning a clinical audit of the results.
So far limited tests have suggested that recurrence rates with the new treatment are not out of line with those using conventional radiotherapy.
The Committee also acknowledges that for some people, the benefits of avoiding the need for post-surgical radiotherapy will outweigh the consideration that much less is known about the long-term outcomes of intraoperative radiotherapy treatment compared with conventional radiotherapy.
"It’s still a new treatment," says Professor Longson. "So far, only 6 centres in the UK have used the Intrabeam Radiotherapy System to treat early breast cancer.
"Because it is still relatively new it is only right to recommend its use in a carefully controlled way. This will ensure patients are fully aware of the risks and benefits before choosing which treatment to have and allow doctors to gather more information about the treatment."
'Great news': Cancer charity
Commenting on the draft guidance in a statement, Sally Greenbrook, senior policy officer at Breakthrough Breast Cancer, says: "This is great news for early breast cancer patients due for breast conserving operations. Intrabeam is unique in that it is given during surgery, avoiding the need for weeks of follow-up appointments and, for many women, this is all the treatment they need.
"As this is a new technology, patients will need to be made aware of the pros and cons before going ahead. However, this technique can greatly reduce the disruption, stress and inconvenience of what for some people can be over 15 additional trips to and from hospital, as well as saving the NHS money and time.
"Whilst this is just an initial decision from NICE, which we will be responding to, we look forward to their final decision which we very much hope will remain positive."
NICE is expected to publish final guidance in November 2014. Until then, local NHS bodies are expected to make their own funding decisions for new treatments.