Practice-changing radiation therapy trials for the treatment of cancer: where are we 150 years after the birth of Marie Curie?

• Published in: British journal of cancer 2018-08, Vol.119 (4), p.389-407
• Main Authors: Thompson, Mareike K., Poortmans, Philip, Chalmers, Anthony J., Faivre-Finn, Corinne, Hall, Emma, Huddart, Robert A., Lievens, Yolande, Sebag-Montefiore, David, Coles, Charlotte E.
• Format: Article
• Language: English
• Subjects: 692/4028/67/1059/485; 692/4028/67/1347; 692/4028/67/1612; 692/4028/67/589/466; Biomedical and Life Sciences; Biomedicine; Birth; Breast Neoplasms - radiotherapy; Cancer Research; Cancer therapies; Clinical trials; Clinical Trials as Topic; Curie, Marie (1867-1934); Drug Resistance; Epidemiology; Europe; Female; Gastrointestinal Neoplasms - radiotherapy; Health Services Accessibility - organization & administration; Humans; Intestine; Linear accelerators; Lung Neoplasms - radiotherapy; Lungs; Male; Medical research; Molecular Medicine; Neoplasms - radiotherapy; NMR; Nuclear energy; Nuclear magnetic resonance; Oncology; Practice Guidelines as Topic; Quality assurance; Radiation; Radiation therapy; Review; Review Article; Side effects; Urologic Neoplasms - radiotherapy
• ISSN: 0007-0920; 1532-1827; 1532-1827
• DOI: 10.1038/s41416-018-0201-z

As we mark 150 years since the birth of Marie Curie, we reflect on the global advances made in radiation oncology and the current status of radiation therapy (RT) research. Large-scale international RT clinical trials have been fundamental in driving evidence-based change and have served to improve cancer management and to reduce side effects. Radiation therapy trials have also improved practice by increasing quality assurance and consistency in treatment protocols across multiple centres. This review summarises some of the key RT practice-changing clinical trials over the last two decades, in four common cancer sites for which RT is a crucial component of curative treatment: breast, lung, urological and lower gastro-intestinal cancer. We highlight the global inequality in access to RT, and the work of international organisations, such as the International Atomic Energy Agency (IAEA), the European SocieTy for Radiotherapy and Oncology (ESTRO), and the United Kingdom National Cancer Research Institute Clinical and Translational Radiotherapy Research Working Group (CTRad), that aim to improve access to RT and facilitate radiation research. We discuss some emerging RT technologies including proton beam therapy and magnetic resonance linear accelerators and predict likely future directions in clinical RT research.