Alan Rodger

Routine follow up of breast cancer in primary care.

Editor—The question of whether and then how to follow up patients after the diagnosis of breast cancer and who should do it remains vexingly unanswered by the inadequacies of retrospective reviews and short term small prospective studies. Most studies concentrate on the efficiency or otherwise of various forms of routine follow up to detect local or distant recurrence. …

Fears over radiotherapy fractionation regimens in breast cancer: Proposed UK trial needs to define techniques as well as numbers of treatments

In the early 1920s Regaud discovered the benefits of radiation treatment fractionation—that is, splitting the dose into several treatments over several days—when he was trying to sterilise the testes of rams with radiation without necrosing the scrotal skin.1 During the 1930s radiotherapy changed from a dangerous mystery that put patients and staff at risk2 to a therapeutic modality with a scientific basis. This was an era when radiotherapy fractionation and treatment guidelines were empirically developed from clinical observation tempered by pragmatic issues such as machine availability. Since then the science of radiotherapy has advanced considerably, but suspicions that pragmatic considerations still weigh too heavily are surrounding a proposed British trial of radiotherapy fractionation in breast cancer.nnEarly randomised clinical trials in cancer—and, therefore, in radiotherapy—reflected the management arguments of the time and addressed questions about what patients to treat with which modality. Trials of radiotherapy process—techniques, fractionation, overall treatment time—had to wait until the 1970s, when radiobiology was suggesting that these factors were crucial. In 1978xa0Withers showed for pig skin that acute radiotherapy reactions were worse after large numbers of small dose fractions than after a few high dose fractions, while the late reactions were worse after the latter.3 Therefore, side effects depended on total dose and fraction size. Other evidence suggested that tumour cells could repopulate a tumour rapidly during radiotherapy. Hence, prolonging treatment could be …

Modern radiotherapy for modern surgeons: An update on radiation oncology

Changes in the practice of radiation oncology have been significant over the last decade and continue to develop at an exciting rate. These advances range from our understanding of the increasingly important role of radiotherapy in the adjuvant and definitive settings to huge technological progress in the areas of tumour delineation, treatment planning, delivery and verification. In many cases, benefits have resulted from the ability of modern radiotherapy to deliver high doses with great accuracy and increasing safety in a highly individualized manner. This has impacted favourably on the management of all major malignancies as discussed in this paper. A good understanding of what can be achieved with modern radiotherapy has never been more important in ensuring an effective multidisciplinary approach to cancer management.

Critical issue is rapidity of review of new drugs.

Baroness Finlay and Lord Crisp support copayments with four essential criteria.1 The fourth criterion will fail as the denominator is described as a small group in the scale of the NHS’s customer base. There is also the assurance that this is “mostly” for drugs yet to be reviewed by the National Institute for Health and Clinical Excellence (NICE).nnThat is not the experience revealed by recent high profile cases in the …