RTAG is comprised of people and organisations who are aligned in their desire to raise the profile of radiation therapy and ensure it is adequately funded by government.
The Group provides highly informed advice to government and to the general public about radiation therapy and associated health policy issues.
RTAG's initial focus is on highlighting the radiation therapy ‘gap’ that is clearly evident in regional and rural Australia. RTAG also offers advice and information on a range of relevant issues to the sector and how it affects cancer patients and communities.
Who we are
RTAG is an alliance of cancer patient advocates, health care providers, medical technology vendors and oncology professionals. The following organisations support our activities:
Radiation therapy and the many different specialised treatments it involves is not always simple to understand. Below are some short informative descriptions of different types of radiation therapy and what is involved from a technical standpoint.
Radiation Therapy (also called radiotherapy) involves delivery of focussed high energy radiation from X-rays, gamma rays, protons, neutrons or other sources in the treatment of cancer. Radiation therapy typically damages cancer cells by destroying tumor DNA either directly or by releasing charged particles or free radicals within the cells. Cancerous cells are more susceptible to radiation than healthy, non-cancerous cells. Radiation therapy is a safe, effective and cost effective treatment for many types of cancer.
Radiation therapy can be either delivered from outside the body when it is called external beam radiotherapy (teletherapy), or it can be delivered from within or close to the body when it is called brachytherapy. Other forms of radiation involve injecting or ingesting radioactive agents that preferentially go to the site of the tumour to deliver radiation (such as I-131 for thyroid cancer).
External Beam Radiation Therapy (EBRT)
External beam radiation therapy is the delivery of tightly targeted radiation beams from outside the body. A course of treatment can be a single dose or involve several daily treatments (fractions) over a few days to a few weeks. The radiation oncology team operate the radiation machine (usually a linear accelerator) which generates and delivers the radiation beams. It usually delivers X-rays (also called photons) but can also use electrons or other less common particles such as protons. The different particles have different properties which can be useful for the treatment of different cancers. The experience for the patient is similar to having an X-ray or a CT scan; they do not feel or see anything during treatment.
When radiation therapy is delivered to a patient, it is difficult to treat the tumour without also irradiating some of the normal cells surrounding it. The dose received by the normal tissue depends on its proximity to the tumour and the radiation technique utilized. The dose to normal tissue contributes to toxicity/side effects from the treatment. The use of newer treatment techniques and technology has significantly improved the ability to deliver dose to the tumour whilst minimising dose to the adjacent normal tissues. This means that accurate treatment to higher doses can be delivered to the target with a decrease in treatment related toxicity and side effects.
Conventional Radiation Therapy
Conventional radiation therapy is an EBRT treatment technique. It is a non-invasive method of treating a tumour. The radiation beams are shaped as they come out of the linear accelerator and/or before they reach the patient to make sure that they are carefully directed at the cancer. The shapes are generated specifically for each patient from their treatment planning; with the shaping achieved through the use of multi-leaf collimation.
Intensity Modulated Radiation Therapy (IMRT)
IMRT is a special form of radiation therapy involving the delivery of hundreds of small radiation beams with different intensities (modulation), entering the body from a number of different angles to generate a highly conformal treatment plan. IMRT can allow for higher doses to be delivered to the target with a steep dose gradient (high dose rapidly dropping off) to minimise the dose to surrounding healthy tissue.
Image-Guided Radiation Therapy (IGRT)
IGRT involves repeated imaging of the tumour prior to and during treatment. It is used in nearly all IMRT treatments to ensure accuracy to the millimetre. IGRT allows the treatment team to see small changes in tumour or organ shape, size and position, enabling the treatment team to make necessary adjustments to radiation delivery during or between daily treatments. Visualising the target and surrounding tissue can allow clinicians to reduce the volume of tissue irradiated, decreasing the tumor margin and sparing the surrounding normal healthy tissue. Ultrasound, planar imaging (kilovoltage or megavoltage) and Cone Beam CT (CBCT) can be utilized for the delivery of IGRT techniques.
Stereotactic Radiosurgery (SRS)
Stereotactic radiosurgery (SRS) is a technique that delivers high doses per fraction of radiation to small, well defined targets. SRS is most commonly used for tumors in the brain or central nervous system (CNS). With SRS, clinicians can focus the radiation dose to the outline of the tumor or multiple tumours and minimize dose to the surrounding healthy tissue. SRS treatments use specific immobilization and sophisticated imaging to deliver a concentrated dose of radiation in a single or multiple treatment sessions.
Stereotactic Body Radiation Therapy (SBRT)
Stereotactic Body Radiation Therapy (SBRT) or Stereotactic Ablative Radiotherapy (SABR) is emerging as a non-invasive treatment option for treating cancers in the lung, head and neck, prostate, liver and other disease sites outside the CNS. The objective of SBRT/SABR is to escalate the dose to the target lesion to increase local control while limiting dose to nearby critical structures and normal tissue. Precise immobilisation of the patient and image guidance techniques are critical to the safe delivery of this technique, although small movements that may affect the delivery of the treatment, such as breathing, are taken into account. These treatments are typically delivered in 5 or fewer treatments. SBRT may also be used for tumours in the brain or spinal cord, similar to SRS but generally with lower doses per fraction.
Not currently available in Australia (or New Zealand) particle therapy is an advanced form of radiation therapy that can be advantageous in specific cases of treating cancer. The most common form is called proton therapy. Individuals who are most likely to benefit from proton therapy include those who have tumours that are near vital organs (such as base of skull tumours adjacent to the brainstem and nerves responsible for vision) and young patients where long term effects of treatment can potentially be minimised (such as hormonal imbalances, intellectual development delay and secondary cancers).
Protons are heavy charged particles and have a unique way of depositing their energy. Rather than causing damage through their whole path, they deposit most of their energy at a distinct depth before stopping completely. This effect is referred to as the Bragg Peak and allows the largest dose to be delivered in the tumour. Modern proton machines have intensity modulation technology which utilise pencil beam scanning, allowing the radiation oncologist to prescribe treatment which 'paints' dose across the tumour volume, whilst sparing healthy tissues and organs.
Access to proton therapy is limited and strict criteria have been established to determine cases appropriate for Federal Government support via the Medical Treatment Overseas Program. As part of this application, the patient's treating team will be asked to provide supporting documentation and evidence of benefit compared to conventional (photon) radiation therapy that is specific for the individual case.
Worldwide, proton therapy today represents less than 1 percent of radiotherapy treatments in the jurisdictions where the technology is available. Based on the experience of large academic centres and the supporting clinical literature, at least 20 percent of cancer patients presenting relevant symptoms would benefit from proton therapy.
Because at present there are no local proton therapy facilities used for either research and treatment, this is an area of radiation therapy that RTAG is keen to highlight and promote. Australians requiring proton treatments are currently sent to distant locations (eg the United States) at considerable expense to Australian governments. With rates of Australian cancer incidence anticipated to grow by 2 percent annually, and the clinically appropriate demand for proton therapy to increase proportionally, we believe it is timely that Australia formulate its own Proton Therapy strategy.
Brachytherapy involves radiation delivered from a tiny source implanted directly into or next to the tumour. These sources produce gamma-rays, which have the same effect on cancer cells as X-rays. This treatment reduces damage to surrounding healthy tissue, thereby limiting side effects. Brachytherapy has been proven to be a successful treatment for cancers of the prostate, cervix, endometrium, breast, skin, bronchus, esophagus, and head and neck, as well as soft tissue sarcomas and several other types of cancer.
There are two main types of brachytherapy: low dose rate (LDR) and high dose rate (HDR).
Low Dose Rate (LDR) involves the placement of small radioactive seeds placed in the organ of interest that release small amounts of radiation over a period of a few weeks to a few months, the seeds stay in place but cease to be radioactive after a known amount of time. The most commonly used LDR treatment site is the prostate.
High Dose Rate (HDR) uses a more intense but short-lived dose from a radioactive source contained within an afterloader device. The afterloader delivers the source for a pre-determined period of time via catheters, needles, or other appliances placed in the tumor site. Per treatment, HDR is much shorter procedure than LDR but it can require multiple treatments (usually 1-3). HDR brachytherapy is most commonly used for gynaecological, prostate and breast treatments, and is often given in conjunction with EBRT.
Image guided Brachytherapy is a newer technique which utilizes the advances in imaging in conjunction with delivering these treatments.
For detailed stories that explain the patient experience of radiation therapy and to see where treatment centres around Australia are located – excellent information can be found at: www.targetingcancer.com.au
Some important facts about radiation therapy...
This year we know there will be over 130,000 new diagnosis of cancer in Australia.
People are living longer and cancer rates are increasing.
40% of cancer cures involve radiation therapy.
Currently only 9 cents in every cancer dollar is spent on radiation therapy.
It is an underutilised form of cancer treatment.
1 in 2 cancer patients should receive radiation therapy but only 1 in 3 do so.
Three quarters of people with bone cancer have pain relief via radiation therapy.
Significant regional population centres such as NSW South Coast, Gladstone, Sunraysia, Shepparton, Mt Gambier and Broken Hill do not have radiation therapy services. A number of regional areas are also underserviced by the capacity of existing treatment centres.
Indigenous cancer patients in Queensland are 9% less likely to receive radiation therapy.
The role of radiation therapy in palliative care and pain relief for cancer patients is crucial.