AECC University College Leads the way in Cancer Care Education…
At AECC University College, it is important to us that we continually review our course content to include teaching of the very latest methods and technology available to health practitioners - our aim is to ensure all our students receive top-class training while studying with us.
We’re keen to equip our Radiography students with the tools and knowledge to ensure they have a rewarding career at the frontline of cancer care, helping patients through the toughest experience of their lives, while having a direct impact on their care and outcome.
In light of the recently commissioned film by Health Education England on Proton Beam Therapy and the significant advances in the treatment of cancer patients, AECC University College's BSc (Hons) Radiotherapy and Oncology Course Lead, Shelley Blane has prepared an insightful blog post on the importance of the pioneering new treatment and the role of the Therapeutic Radiographer…
Protons in Radiotherapy
Radiotherapy utilises high energy radiation to destroy cancer cells. The most common method of treating patients is with external beam radiotherapy using a high energy X-ray. It is an effective treatment for most treatment sites, with approximately 50% of all new cancer patients receiving radiotherapy during the course of their illness. This method of treatment is used in over 40% of patients who are cured of their cancer. It does, however, have limitations, mostly due to how an X-ray beam interacts with the body and can lead to significant doses of radiation being deposited in healthy tissue, which can lead to long term side effects. The consequences of these side effects for certain treatment areas have led to research into alternative techniques.
In recent years there has been a lot of publicity about the use of high energy protons in radiotherapy as an alternative to X-rays. This is not a new idea, it was first suggested in 1946, and the first patient was treated at the Lawrence Berkeley Laboratory in 1958. Although there are centres worldwide, apart from a low energy proton facility at The Clatterbridge Cancer Centre NHS Foundation Trust, there have been no Proton Therapy Centres in the UK. Since 2008 any patients that required this treatment had to be sent abroad at significant cost to the NHS.
In 2013 the government undertook a major review of Radiotherapy services and, consequently, they announced an investment of £250 million into two high energy proton therapy centres. The two centres are located at The Christie NHS Foundation Trust in Manchester and The University College London Hospital (UCLH) NHS Foundation Trust. The Christie NHS Foundation opened their high energy proton department in autumn 2018 and treated their first patient in December 2018. UCLH is due to open in the autumn of 2020. The aim is that by the end of 2021 both departments will each treat up to 750 patients per year and meet the clinical needs of patients in the UK for this type of treatment.
The advantage of proton therapy over X-rays is in how the beam interacts within the body and where it deposits its dose. X-rays are a wave of electromagnetic radiation, when they are absorbed by a patient most of the dose is deposited close to the skins surface and the amount of dose the beam deposits is reduced as the X-ray travels through the patient. The X-ray does not stop after the tumour so the healthy tissue behind the tumour also receives radiation. To minimise the dose to healthy tissue, conventional radiotherapy is usually given using multiple beams from varying angles all focussed on the tumour.
Protons are heavy charged particles, all charged particles have a distinct way of depositing their dose within the patient. They have a finite depth that they can travel within a medium and they deposit the majority of their dose at the end of their path length called a Bragg peak. This means that compared to X-rays there is less dose given to the healthy tissue before the tumour and due to the finite stopping distance of charged particles there is little or no dose deposited in the healthy tissue behind the tumour. This can be a major advantage over X-rays if there are radiosensitive tissues directly behind the tumour.
These advantages mean that, for certain tumour sites, protons will offer reduced side effects for the patient and a possible increase in post treatment quality of life. One treatment site that shows a benefit from the use of proton therapy is paediatric brain tumours. In this case with conventional radiotherapy the dose to the healthy brain can lead to long term side effects, such as learning difficulties and lack of cognitive control. With the use of proton therapy, the dose to the healthy brain tissue can be reduced significantly and reduce these side-effects improving the life of these patients in the future.
Above: The diagram shows the difference in dose delivery within the brain using protons, conventional radiotherapy
The new degree at AECC University College in Radiotherapy and Oncology has been devised to include proton therapy and consider this innovative and pioneering technology within cancer management. It is our belief that educating future Therapeutic Radiographers in this, and other emerging technologies, is vital to their professional development, the advancement of their careers and to the continual research into improving the treatment of cancer in the UK. Due to this we have integrated these principles into all three years of the degree course. We will always endeavour to make sure that our students get the best education on all delivery of radiotherapy and will strive to make sure that our students are at the forefront of new methods of treatment delivery.
For more information the www.nhs.england.uk has further information and an informative video produced in partnership with Health Education England. There is also links to additional information on the clinical use of proton therapy.
To find out more about studying at AECC University College to become a Therapeutic Radiographer, visit: https://www.aecc.ac.uk/undergraduate-courses/bsc-radiography-radiotherapy-and-oncology/
Allen A, Pawlicki T et al (2012). An evidence based review of proton beam therapy: The report of ASTRO’s emerging technology committee. Radiotherapy and Oncology, p8-11.
Bekelman J, Asch D et al (2014). Principles and Reality of Proton Therapy Treatment Allocation. International Journal of Radiation, Oncology, Biology, Physics, p499-508.
Cancer Research UK (2017). Proton beam therapy arriving in the UK: what does this mean for patients? Retrieved from Cancer Research UK: cancerresearchuk.org/2017/07/17/proton-beam-therapy-is-arriving-in-the-uk-what-does-that-mean-for-patients/
Mangan S, Leech M (2019). Proton therapy – the modality of choice for future therapy management of prostate cancer. Technical Innovations and patient Support in Radiation Oncology, p1-13.
Mohan R, Grosshans D (2017). Proton therapy – Present and Future. Advanced Drug Delivery Reviews, p26-44.
NHS England (2020). Proton Beam Therapy. Retrieved from NHS England: https://www.england.nhs.uk/commissioning/spec-services/highly-spec-services/pbt/