Dr Tom Roques, Consultant Clinical Oncologist, Norwich UK and Vice President, Clinical Oncology, Royal College of Radiologists
In the UK, radiotherapy is provided by clinical oncologists who are also trained in systemic anti-cancer treatments. There are 60 radiotherapy centres in the National Health Service as well as a small number of private centres. Radiotherapy for benign disease is not commonly in use, partly because it is not commissioned (funded) in many parts of the country but also because there is a significant UK clinical oncology workforce shortage, so doctors are often too busy treating cancer to be able to focus on benign disease.
In 2015, the Royal College of Radiologists (RCR – the professional body supporting clinical oncologists) published a very thorough review of benign radiotherapy techniques. The pandemic has delayed the second edition but an updated set of recommendations have now been released. The updated document reflects any changes in evidence and is considerably shorter, with the intention of covering only those indications where radiotherapy is used in multiple UK hospitals. There are sections covering musculoskeletal, skin, head and neck and brain/eye indications as well as total lymphatic irradiation. There is a clear set of summary recommendations at the start of the document.
UK doctors who do treat benign disease with radiotherapy should find it a helpful summary but I also hope it will encourage each radiotherapy centre to consider which benign diseases they could treat and to stimulate discussions with local commissioners and partner centres to ensure patients have access to effective radiotherapy for non-malignant conditions across the country.
The guidance will be reviewed in 2027 but the RCR is increasingly keen to publish short documents that really support clinical practice and reduce unnecessary variation rather than long textbook-like guidance. It may be more appropriate to combine efforts with international teams to write subsequent versions rather than to publish our own. It is encouraging to see new high-quality evidence supporting radiation for benign disease being published, and to see precision radiotherapy techniques like stereotactic ablative radiotherapy showing promise for new benign conditions. These developments, and the RCR recommendations, will hopefully enable more UK patients to benefit from radiotherapy for non-malignant diseases.