December 21, 2012

experts comment on the Neon Roberts radiotherapy court case

A high court judge ruled that seven-year old Neon Roberts, suffering from a cancerous brain tumour, should have radiotherapy against the wishes of his mother.

Professor Andrew Peet, NIHR Professor and Honorary Consultant in Paediatric Oncology, Birmingham Children’s Hospital, said:

“Medulloblastomas are the most common malignant brain tumours in children. Doctors who treat these children across the world have come together over the past 30 years to work out the best way to treat them through a series of clinical trials each testing out new treatments and making sure they are better than the old ones. Through this work, we now have an excellent understanding of the best way to treat these tumours with what we have currently available. Children who have a tumour which has not spread to other regions of the brain or spine at diagnosis have around an 80% chance of long term survival with surgery, radiotherapy and chemotherapy and it has been well demonstrated that relatively low doses of radiotherapy to the brain and spine are effective. Whilst the treatment does have some unwanted effects, children can survive their tumour and have happy and productive lives. Some go on to higher education, have successful careers and have families of their own. Radiotherapy is a key component of the treatment and there is no robust evidence that medulloblastoma can be cured without it except for children with very specific subtypes which usually occur in very young children. One of the things that we have established is that the time from surgery to radiotherapy should be short and if it is too long then the chances of survival are reduced. This is a quickly growing tumour and treatment must be delivered in a timely fashion to be effective.”

Dr Jane Barrett, President of the Royal College of Radiologists, said:

“The treatment of cancers in children is a highly complex and emotive issue and each case must be treated individually. The decision as to which treatment pathway will be of most benefit to the patient should be made by the multidisciplinary team, which includes clinical oncologists who deliver the treatment, and the family by assessing the risks and benefits. The Children’s Cancer and Leukaemia Group (CCLG) has devised a series of clear protocols to support this process and whilst radiotherapy is an effective treatment for both children and adults, these decisions are always carefully considered and balanced.

“Over the past 20 years there have been major advances in the use of radiotherapy with the advent of more accurate treatment beams and by reducing the amount of radiation to which children are exposed. Parents of a child with a brain tumour can be reassured that their treatment programme is based on carefully conducted clinical trials and that if radiotherapy is recommended it is because the benefits outweigh the side effects.”

Martin Ledwick, Head Information Nurse at Cancer Research UK, said:

“Survival rates have more than doubled for childhood cancers over the last 30 years and this has been thanks to better treatments such as surgery, chemotherapy and radiotherapy. But there’s more work that needs to be done. Cancer Research UK is funding research and trials into new treatments to save more children from cancer and reduce the side-effects that can come from treatments, helping children live full lives unaffected by their cancer.”

Professor Katherine Vallis, MRC-CR-UK Gray Institute for Radiation Oncology and Biology, Oxford University, said:

“About half of all cancer patients receive radiotherapy during their illness, and it forms part of the treatment of just under half of all the patients who are destined to be cured of the disease. It is true that all medical interventions, including radiotherapy, may cause some unwanted side effects but it is also true that with modern radiotherapy, these can be minimised and, in some cases, eliminated. The use of highly precise, advanced radiotherapy techniques means that the cancer tissue can be exposed to the radiotherapy beam while surrounding healthy tissue is avoided. 

“More often than not these days, radiotherapy is used in combination with surgery and chemotherapy, with each type of treatment contributing to the efficacy of the overall treatment programme. Clinical trials that test new radiotherapy techniques and combination treatments lead to evidence-based improvements in practise.”

Professor Tim Maughan, Professor of Clinical Oncology, MRC-CR-UK Gray Institute for Radiation Oncology and Biology, Oxford University, said:

“All treatments for cancer carry the hope of benefit but the risk of short or long term side effects. This is especially the case when considering the case of a child with a brain tumour and the risk of brain damage from treatment.

“The treatments that are used in standard practice (that is surgery radiotherapy and chemotherapy) have all been under long term assessment and there is clear evidence that the benefits of these treatments outweigh the side effects. For that reason they are used as the standard of care across the developed world.

“In the case of radiotherapy, recent improvements in the precision with which the treatment is delivered due to IMRT (intensity modulated radiotherapy), IGRT (image guided radiotherapy) and proton beam therapy have all reduced the doses of radiation given to critical normal tissues near the cancer and this reduces side effects further. All of these treatments are available through the NHS either in UK hospitals or through the national proton beam therapy service which funds suitable patients to receive proton beam therapy at designated overseas centres. Radiotherapy for childhood brain tumours has a clear cut benefit in terms of improving survival.

“In contrast, new treatments have not been shown to be effective in the curative treatment of brain tumours.

“Delay in starting radiotherapy treatment can have adverse effects. In the UK over the last year radiotherapy waiting times have been dealt with so that now over 94% of patients start radiotherapy within the national target of 31 working days. It has been estimated that this removal in the delay to start radiotherapy treatment saves 2500 lives of cancer patients each year. More details about this and all aspects of radiotherapy in the UK are available in the recent DH publication: radiotherapy services in England 2012.

“Research in radiotherapy has received much attention and improved funding in the last decade in the UK. In 2005 the MRC and Cancer Research-UK collaborated to fund the Gray Institute for Radiation Oncology and Biology in Oxford which is a world leader in the research in the underlying scientific mechanisms of the effects of radiotherapy.  Since 2009 a national radiotherapy research working group (the NCRI CTRad) has brought together all radiotherapy related research across the UK resulting in more radiotherapy clinical trials and more patients being treated in research studies. The NIHR funds a national radiotherapy quality assurance programme which ensures that all radiotherapy in these clinical trials is of the highest precision and accuracy. This in turn is increasing the precision and accuracy of radiotherapy used in routine clinical practice.”

Professor Edzard Ernst, Emeritus Professor of Complementary Medicine, University of Exeter, said:

“None of the alternative treatments considered by Sally Roberts are supported by good evidence. In fact, the notion of alternative cancer “cures” is a fallacy: it suggests that conventional oncology ignores promising leads simply because they originate from alternative practitioners; this is silly, insulting and untrue. Alternative cancer “cures” are a contradiction in terms.”