Intensity modulated radiotherapy for treatment of specific cancers
Scoping Workshop: 8 November 2007 
 
The Mouth Cancer Foundation has been invited to comment on the draft remit and draft scope for this proposed appraisal whose objective would be to appraise the clinical and cost effectiveness of Intensity Modulated Radiotherapy for the treatment of specific cancers. The modulation of the radiation beam in IMRT allows precise delivery to cancerous tissue while sparing surrounding normal tissue from exposure. It is therefore suitable for the delivery of radiation to locations where diseased tissue is located close to vital structures (like saliva glands). The Hi-ART system is used to deliver one form of IMRT called helical tomotherapy. Helical tomotherapy combines a helical computed tomography (CT) scanner for online imaging with a linear accelerator that delivers intensity modulated radiotherapy (IMRT). There is one Hi-Art System (delivering helical tomotherapy) in use in the UK at present. Currently there are no helical tomotherapy systems available in the NHS. The availability of other IMRT systems is not known.

We will be commenting on the need for use of IMRT for Head & Neck cancer patients.
 
The scoping workshop for this proposed appraisal will take place on 8 November 2007 at the NICE office in Central Manchester. Refreshments will be available from 1:30pm; the meeting will start promptly at 2:00pm and is expected to last for approximately two and a half hours. The aim of the workshop is to:

• Ensure that the scope and remit have been appropriately defined;
  
• Discuss the main issues raised by consultees and commentators in their written comments on the draft remit and draft scope;
  
• Ensure that relevant issues are highlighted to the Assessment Group, who will be carrying out a systematic review for the proposed appraisal, should it proceed.

The Mouth Cancer Foundation has been invited to send a maximum of two people to attend a ‘scoping workshop’, to further explore the remit and scope for this proposed appraisal.

• I would be glad to hear from members about their thoughts about how they thought they might/have benefitted from IMRT.
  
• I also need a patient volunteer with experience of the treatment to accompany me to the workshop to give the patients' viewpoint. Travel expenses will be paid.

Please post your comments here. If you would like to accompany me to Manchester for the workshop, please let me know using the personal message facilty of this message board. Thanks.

Best wishes

Dr Vinod K Joshi
Founder and Chief Executive
Mouth Cancer Foundation

Sounds like a good development to me.

Saving saliva glands will help with long term quality of life, removing the cause of many eating and dental care problems.

Restricting the area hit by R/T will reduce the discomfort caused during treatment, ulcers, mucus, etc.

Apart from cost, is there any downside?

No downside, but it takes longer to plan (programme the computer) the treatment. So if we don't have enough oncoradiologists, the rest might have to wait longer!

Robert is on the PARSPORT trial which involves IMRT. Details of the trial are on the Cancer Research UK website.

Link: PARSPORT trial

quote:

This trial is comparing a new method of radiotherapy treatment with the standard radiotherapy treatment for head and neck cancers. It will look at the outcome and side effects of each treatment.

The new method is called Intensity Modulated Radiotherapy, or IMRT for short. IMRT alters the radiotherapy dose depending on the thickness of the body tissue. So the same dose is given across the treatment area. It also allows the radiotherapy beams to be shaped more accurately. It is directed at the cancer, while avoiding the surrounding normal tissue. So, the patient may have fewer side effects. But there is a small risk that this shaped radiotherapy will miss some of the cancer and so may not work so well.

Recruitment
Starts 01/06/2003
Ends 31/12/2007

Trial design
This trial is recruiting 100 patients. There are 2 treatment groups. It is a randomised trial. This means that the people taking part will be put into the groups by a computer.

• Group 1 will have standard radiotherapy treatment.
• Group 2 will have IMRT.

Location of trials:

• Cambridge
• Ipswich
• London
• Manchester
• Sheffield
• Stoke-on-Trent
• Sutton

Click for more info

Just reading the discusion really interesting. I think that I was treated using a Varian IMRT.
I wonder if that why I can eat most foods without to much problems, the dryness in my mouth seems to get better as time goes on.

Tony

so now i read why i had to wait so long to get my treatment started. IMRT. my taste is slowly returning. only thing is that like grape juice which i love does not tast exactly the same... much sweeter and a little different.... still remember that not too long after my treatment ended i couldn't even eat a hot dog because they were too spicey. never knew hot dogs had any spice in them. however, now i can eat spicey foods once again..... just had THAI basil beef over the weekend.... my last radiation treatment was 24 september 2007.

i have to eat slow and sip water as i eat to avoid plugging up my throat..... course i used to have a problem anyway in getting stuff stuck in my throat for the last 15 years or longer....

my mouth is not excessively dry now...... mainly gets dry at night when i sleep with my mouth open, snoring my head off i am sure.....

Dear Dr.Joshi,

I've read about brachytherapy. I understand that this treatment targets the cancer cells only using the radioactive seeds which would be planted into the tumour itself. Sounds really good.

If it is as good as claimed, why is brachyterapy not administered as often as the standard rt or the IMRT? Is it really effective?

Sharifah
http://hiduplama.blogspot.com

"Life is too short, but intend to grow old gracefully"

My father was told they have not found it effective for this type of cancer yet.....not sure if that was just a line or not but I guess it easier to plant the seeds in some tumors than it is in others...

quote:

Originally posted by Dr Vinod K Joshi:
Intensity modulated radiotherapy for treatment of specific cancers
There is one Hi-Art System (delivering helical tomotherapy) in use in the UK at present. Currently there are no helical tomotherapy systems available in the NHS. The availability of other IMRT systems is not known.


Best wishes

Dr Vinod K Joshi
Founder and Chief Executive
Mouth Cancer Foundation

Hi Vinod

I am slightly confused by this post. It sort of implies there is only one machine in the whole of the UK which can deliver IMRT and yet my understanding is that Bart's has 3 machines all delivering IMRT treatment and have been operational for at least the last 12 months and was told I was one of over 75 H&N patients to receive IMRT over that period.

Surely one of these statements must be wrong or is me getting the wrong enr of the stick again?