New scanning machine ready only attacks tumour

Hi, what is the machine? I ask because scanning machines don't treat or attack tumours, they just show where they are, and they don't have any side effects.

Sometimes money doesn't help to speed things up. If treatments are being thoroughly tested for potential harmful side-effects one of the things they have to do is observe the effects over time. Sadly more money doesn't make this any quicker.

Hi I've no idea what the machine is I heard about it on a TV programme, aparantly it's in America 

The problem  I had with the radio therapy what they had to remove my back teeth, the new machine you don't have to. 

OK so we're talking a new machine that administers radiotherapy then rather than a scanner, though certainly the machines they used on me (and I'm guessing most if not all are the same) incorporate scanning tech because they use them periodically to see what's happening; hence the odd RT session being longer than normal.

I think new generations and upgrades of these machines are being brought in all the time; certainly where I am the Royal Devon and Exeter hospital have just spent a long time building an extension to the oncology dept to put in a new machine. I chatted to the "senior head and neck therapeutic radiographer" who I bumped into by chance at the hospital recently and she said it would treat patients more accurately and involve fewer sessions. This was apparently due to "go live" this month so good news for us yokels down in Devon; they have/had three separate "zappers" (depending on whether anyone's found out how to plug the new one in yet) and they're decommissioning the oldest one.

Point is just that technology moves on all the time; that's why so many of us on here are still alive when maybe 10/20 years ago we wouldn't have been. The loss of a few back teeth is a small price to pay for that in my view.

Sounds interesting 

I have seen details of a combined PET/CT/MRI but then that is just a scanner. It’s very complicated technology to prevent the huge magnetic fields interfering with CT. 

Like  MikeO  says new machines are coming on line all the time. But everything comes at a cost. Radiotherapy is severely underfunded in the UK and yesterday being World Cancer Day Radiotherapy for Life had an event in the House of Commons yesterday to raise awareness of the issue. 

I’m not a radiologist or an oncologist but I can understand that the treatment field has to be somewhat wider than the tumour to take care of microscopic spread. 

I don’t know about this tooth issue. The concern is that irradiated jaw bone heals badly and if you are firing these X-rays at something in the mouth from outside it jawbone can’t be avoided. There is a protocol to evaluate teeth that may be problematic after RT so they can be dealt with but on the other hand there have been surveys showing jaw necrosis just happens in some people whenever their teeth come out. 
It’s a minefield for even an informed team and patient. 
I had a wisdom tooth out today. I’ve lost a lot of bone round it and it was beginning to loosen so it came out easily. 
I know I would rather have had this tooth out before RT but there you are. 

There’s just so much stuff out there

Swallows have reported a talk on this on their Twitter feed

Mapping tumours with virtual reality

https://www.cancerresearchuk.org/funding-for-researchers/how-we-deliver-research/grand-challenge-award/funded-teams-hannon

https://www.cruk.cam.ac.uk/research-groups/imaxt-laboratory

I think this is Proton Beam therapy. A new form of radiotherapy which uses proton beams rather than xrays. Less damage to adjacent structures. Used for brain & head & neck cancers mostly. It’s the future I believe, 1st 2 machines in UK are in Christie & UCL and only started about 12 months ago.

Apparently it is more precise at targeting the cancer. Side effects will be similar but hopefully less severe. Will be interesting as patients who have had it come onto this site.....

Hilary

Hi Hilary

Its available privately in Wales and elsewhere. I think they are using it for prostate cancer too.  
I think The Rutherford offers it at all its clinics. 
I seem to remember being offered it.... or maybe I got that wrong. 
Set up time is longer but I would have jumped at the chance. 
With you, I’m looking forward to some reports here in the Community

I think this is Proton Beam Therapy (PBT). It has been available in the USA for just over a decade, and in the UK for a couple of years - at Christies in Manchester (NHS), UCLH London (NHS), and Rutherford in Newport. There is another Rutherford about to open in Reading.

PBT delivers the same dose as IMRT but is able to concentrate it slightly more. This is useful for tumours in sensitive areas such as close to the brain, and in young people where there may be lower long term morbidity. However, generally the evidence to date does not suggest greater cure rates, hence the NHS commissioning policy does not routinely promote PBT....

https://www.england.nhs.uk/commissioning/spec-services/highly-spec-services/pbt/

PBT is much more expensive, mainly because it requires a different piece of (costly) equipment, and much more detailed treatment planning and daily set up. A typical PBT treatment takes 45 minutes as opposed to 10 minutes for IMRT. As a result a 6 week course of PBT costs c£40-50,000 - three times the cost of IMRT.

As it delivers the same dose the overall morbidity isn't really any different. There is an emerging view that PBT MAY be a potential treatment option in the case of local recurrence after IMRT (which cannot generally be repeated).

For what it's worth I considered PBT having spoken with an acquaintance who travelled to the USA for it several years ago at his own cost. I went to Rutherford for a long consultation, but in the end could not really see any benefit in my case (adjuvant RT for tonsil and neck L5 post surgeries) even though my private healthcare plan would have covered it. Indeed if I had progressed at Rutherford they may have recommended IMRT anyway.

So I'd rest assured that if PBT is right for you and is essential to maximise cure the NHS will provide it.

In terms of side effects I'd have to say it's all personal. Please don't take this the wrong way, and my heart aches for friends on this forum that are having real troubles, but I didn't really find the 30 sessions of IMRT too difficult. I cycled 50k to each session, went to work each day after treatment, and was able to eat normally (albeit with some softer foods at times), 3 square meals a day throughout. I think it helped that I'm physically fit and otherwise in good health, but I think it's important to be positive and recognise that it can be easier for some people.

Hope this helps. I have learnt a lot and happy to share.

The NHS commissioning body needs a kick up the proverbial. I would much rather be told X treatment is the best but the NHS can’t afford it than to be told that despite much to the contrary there is no evidence that it is better. 
Pembrolizumab  in the treatment of advanced or recurrent OPSCC being a case in point. 

I'm not sure that's fair.

Government is responsible for overall NHS budget which I think many would say is inadequate - for that blame the elected representatives.

In terms of commissioning, whilst resources are constrained, they generally don't hold back treatment that is proven to increase cure rates. 

There is no evidence that PBT outcomes are superior to those achieved with IMRT. However PBT is more appropriate for a small number of cancers cases where precision and/or dose concentration is critical.

From what I have seen I don't think PBT is 'better' for the vast majority of H+N cancer cases.