Conformal radiotherapy at the Royal Marsden Hospital (UK)

Conformal radiotherapy seeks to allow increased intensity of radiation by reducing the volume of normal tissues within the treatment volume. Techniques have developed secondary to improvements in three-dimensional imaging and accessible treatment technology is based on computer-controlled multileaf collimators to create an irregular radiation beam shape. Preliminary clinical work in the Royal Marsden Hospital seeks to quantify the toxicity reduction achievable by conformal techniques in the context of a prospective randomized pelvic radiotherapy trial which has now recruited 240 patients. The data accumulated during this trial will allow comparison of conformal and conventional radiotherapy and also analysis of the impact of dose and volume of a particular organ on both acute and late toxicity. Assessments have revealed that conformal techniques reduced significantly the treatment volume of normal tissues, e.g. by a mean of 54% for rectum and 42% for bladder. However, a relationship between volume and acute toxicity has not been established. Late toxicity is currently being analysed. Dose escalation trials in thoracic and in pelvic tumours are planned.