Radiotherapy has been in use since around the turn of the 20th century, making it a very well-established area of medicine. Nevertheless, like any other form of medicine, nothing has stood still; as well as establishing more kinds of cancer (and other ailments) that radiotherapy can treat, its use has been refined and new technology developed.

Alongside that has emerged a wealth of research that goes on to this day, highlighting where and when the treatment is most effective, as well as highlighting problems such as temporary and lasting side effects.

What all this has achieved is to enable every radiotherapy centre that exists today to offer better treatment and a wider range of options to patients than was ever the case in the past.

Personalisation Research Shows Promise

Among the areas of research in recent years is the use of more personalised medicine. This approach rejects the assumption that there is a standard one-size-fits-all approach to treatment and operates on the theory that each patient has requirements that are best met by tweaking the treatment according to a specific combination of characteristics.

New research on personalised care has produced some interesting conclusions in the area of muscle-invasive bladder cancer, suggesting this may be a more effective approach to delivering radiotherapy to sufferers.

A study by the Institute of Cancer Research in London, co-funded by bodies in Australia and New Zealand and published in the journal European Urology, has indicated that the use of personalised radiotherapy can be particularly effective for patients with this form of cancer.

A particular difference about this approach is that the amount of radiation delivered to any given part of the body will vary in each session, reducing side effects while in no way diminishing the impact the radiation has on the cancer.

Explaining the significance of this approach, Professor Robert Huddart, one of the leaders of the research, said it “has allowed us to deliver effective treatment safely and allowed us to use a high dose which promises to cure more patients, with relatively few long-term side effects”.

He added that further research would find out more about the effectiveness of this approach in treating cancer in comparison with other methods.

How The Research Was Carried Out

The research split 345 bladder cancer patients into three groups, one of which was treated in a standard way, while the other two received adapted treatment plans, with each patient getting a different treatment each time. One of the latter two groups saw patients receiving higher radiation doses in each session.

Group Leader at the Institute for Cancer Research, London Professor Emma Hall, said: “As medical technologies continue to improve, it means that we can investigate delivering more complicated and personalised forms of radiotherapy to treat certain cancers.”

Such treatments may be of benefit to more than just bladder cancer patients, but help sufferers from many other forms of cancer that are treated with radiotherapy, using modified approaches to suit the circumstances of each patient.

Other Personalisation Research

Indeed, investigating ways to develop the use of personalisation across a range of cancer treatments (not just radiotherapy) using the power of new technologies like artificial intelligence (AI) is central to a new project headed up by the Universita Cattolica in Rome.

Known as the Horizon IHI product, the stated aim is that of developing “Thera4Care – Theranostics Ecosystem for Personalised Care,” (theranostics being the name given to the deployment of next-generation personalised therapies).

With funding of €28 million and 29 partners in industry and academia, this may go a long way towards further advancing the personalisation of radiotherapy for cancer treatments.

This does not necessarily mean that if you come to our radiotherapy centre you will be receiving a personalised treatment. Part of the reason for that is that you may have a cancer where there is already a clear treatment path to take that would not be enhanced by attempting to personalise it.

Alternatively, it may be your condition is in an area where there is insufficient research to date to indicate clearly what benefits (if any) would be gained by taking a novel, non-standard approach to treatment. It is by no means certain at this time that all cancer treatment will be personalised in the future, even after much research has been done.

What you can be assured of is that the radiotherapy treatment you will receive will be the best available, based on the latest research and knowledge, in order to obtain the most optimal outcome for somebody in your condition, whether that includes an element of personalisation or not.

Radiotherapy, like other cancer treatments, will continue to change and advance, but we can provide you with the best treatment there is today.

One of the most comforting aspects of entering a radiotherapy centre is that whilst many of the therapies and technologies being used are new, the underlying concept behind the treatment has been established for over a century.

This means that the properties of radiation as a therapeutic treatment are very well-established, anyone who is recommended a course of radiotherapy will be made completely aware of what to expect and treatments are designed to maximise the benefits whilst minimising harm.

The Gamma Knife is one of the greatest examples of this, as its use of stereotactic beams precisely located at specific points means that it can destroy harmful lesions, tumours and growths on the brain without incision and with as little harm to healthy tissue as possible.

Radiotherapy has technically existed since 1896, but the Gamma Knife and the modern era of radiotherapy took over half a century to emerge, and even half a century after that there are still constant evolutions and developments in modern radiotherapy techniques to make it more effective and able to treat even more patients.

Part of the reason it took so long was due to technological evolution; modern radiotherapy is very dependent on computers, which only existed theoretically in the 19th century through concepts such as the Analytical Engine.

By the 1940s and 1950s, when radiotherapy emerged in a more modern, recognisable form, computers existed and were developing at such an exponential rate that they could be used to safely control radiation dosages in a way that was at the time unprecedented.

However, there was not only a technological shift but also a cultural one, one that required people to look at radiation for what it could do for us and not be swayed by overly optimistic views of a radioactive utopia.

The Fall Of Radiomania

The discovery of X-rays by Wilhelm Rontgen, and later the radium experiments by Marie and Pierre Curie meant that the early 20th century was dominated by a belief that radioactivity would be a major positive part of everyone’s lives.

Water dispensers were “infused” with radioactivity based on somewhat dubious claims about the connection between the benefits of health springs and the presence of radioactivity in said wells.

This spread to intentionally radioactive cosmetics, toothpastes, cigarette packaging and revitalising tonics were all advertised using extremely twisted and manipulated evidence.

Radiation was an effective therapy not because it encouraged healing but because it destroyed particularly dangerous cells, masses and growths and ensured that no trace of them was left, which allowed healthy tissue to recover over time.

In the 1910s, there were a lot of products that proudly marketed themselves as containing some form of radioactive substance, although due to the expense of using actual radium at the time, most of these products thankfully contained none.

The Radium Brand Creamery Butter had no radium in it, and whilst the cosmetic brand Tho-Radia did, it would get rid of any radioactive materials by 1937. Other existing products such as spring water or hot spring spas would capitalise by advertising the trace amounts of radium.

However, whilst some products of the radiomania era accidentally made themselves safer by lying about the amount of radium in them, others, unfortunately, highlighted why radiation needs to be used responsibly.

The deaths of Marie Curie and the Radium Girls highlighted that irresponsible use of radiation in research and industrial manufacturing respectively could cause significant harm. The latter, in particular, led to changes in occupational health and safety laws to hold companies responsible.

The final shift and the catalyst that ended the unintentional restrictions of radiomania for good was the case of Eben Byers.

An industrialist and amateur golfer, Mr Byers would suffer a significant injury to his arm in 1927 after falling from his bunk bed on a sleeper train. Whilst his arm recovered, he would have persistent pain for the rest of his life.

A doctor recommended that he try a radium salt solution known as Radithor, and within three years he had taken 1400 doses, giving him a radium intake of around 1000 microcuries (when the base tolerance level is estimated to be 0.1 microcuries).

This caused a lot of major health complications, and he died on 31st March 1932, leading to a fundamental change in medical safety legislation and the perception of radioactivity in the wider world.

When radiation therapy emerged as a treatment for cancer, it was grounded in the practical goal of precisely targeting and eliminating harmful parts of the body. Over time, advancements have refined its precision and effectiveness, offering hope and healing to countless patients.

A referral to a radiotherapy centre for treatment means that a person is going to receive non-intrusive, effective and versatile treatment for a wide variety of conditions.

Brain tumours, as well as certain types of lesions and growths in the brain, are more safely managed using stereotactic radiosurgery than through other treatments, and this being the case highlights the progression in technology and medical understanding when it comes to radiation therapy.

However, radiotherapy was first discovered in the late 19th century, and within a year of this was already being used experimentally to treat various types of conditions.

Once the efficacy of radiotherapy was established, what were the conditions it was first used to treat?

The First Four Treatments

Given the scale and scope of the evolution of radiotherapy over nearly 130 years, it is quite astonishing just how quickly it was being used to treat various medical conditions, and even was used in attempts to treat certain forms of cancer.

A lot of this can be credited to the work of Léopold Freund, a Nobel Prize runner-up, the first person to suggest that X-rays can be used to treat disease, and the first person to successfully treat a patient using radiotherapy, although not the first to actually attempt it.

By the dawn of the 20th century, he was already seen as an expert in the field and had established four classes of medical conditions that even at this early stage could be treated by radiotherapy, as well as a group of conditions where radiation was used more experimentally.

Here are the four conditions, as well as the first-line treatment used today to showcase just how much radiotherapy has evolved over the years

Hypertrichosis

Often confused with hirsutism, hypertrichosis is a rare set of conditions that cause excessive hair growth on a person’s body, typically in places where they would not ordinarily have hair.

Sometimes known as werewolf syndrome, hypertrichosis is typically treated with hormone treatments, avoiding certain hair growth medications such as minoxidil or removing the hair that is already there.

Typically, this takes the form of either laser surgery or electrolysis, but in 1900 Mr Freund suggested that radiation could also remove unwanted body hair.

As people who have undergone long-term radiation therapy or chemotherapy can attest, there is a connection between radiation and a loss of hair, but within 15 years the effects of unnecessary radiation would be a cause of concern in the medical world and other treatments would take its place.

The Necessary Removal Of Hair

Mr Freund separated hypertrichosis from other situations where it could be necessary to remove hair in order to treat the disease.

This could include preparing an area for surgery or removing hairs to avoid infection or irritation, such as ingrown hairs.

These would typically not be managed through radiation but instead some kind of short-term hair removal treatment such as shaving, waxing, removal creams or plucking unwanted hairs out.

Inflammatory Skin Affections

Because the earliest form of radiation therapy involved the use of X-rays, they were most effective at treating conditions close to the skin. As a result of this, skin inflammations were a common way early radiotherapists would determine how effective radiation was as a treatment.

This included conditions such as eczema and acne, both of which are skin conditions that cause what Mr Freund described as “inflammatory affections”, which manifests as redness and irritation in the former, and spots in the latter.

Using radiation therapy is not undertaken for skin inflammations that do not have their origins in skin cancer, with a wide range of alternative options for treatment used in its place, from simple emollients to topical steroids depending on the intensity of the conditions.

Interestingly, phototherapy, a form of radiotherapy where the affected area is put under a lamp that emits ultraviolet radiation, is still an option from specialist dermatologists for some forms of eczema.

Malignant Skin Conditions

One of the first successful uses of radiotherapy was in the treatment of lupus by both Mr Freund and his research partner Eduard Schiff, primarily because it would be easy to determine the difference between the treated and untreated area of a butterfly patch flare-up on the face.

As lupus is a multifaceted condition that has a wide range of symptoms, it is typically treated by either managing the symptoms, such as using hydroxychloroquine, steroid creams or anti-inflammatory medication or through using immunosuppressant medication.

Part of the reason why radiotherapy worked is because of this, but given the nature of lupus as a condition that affects people in waves, radiotherapy was not seen as a front-line solution.

However, epithelioma, or abnormal growths on the skin, are often treated with radiation therapy as a routine procedure.

Better known as basal cell carcinoma, epithelioma is a form of skin cancer that rather unusually does not spread to other areas, meaning that it is seldom a threat to life. 

However, it can also be easily treated with cancer radiotherapy in what is commonly a routine procedure.

Facing a battle against cancer can be one of the most daunting prospects anyone can be confronted with. It is not just the reality of our mortality – since we will all die eventually – but the uncertainty of outcome, both for you and your loved ones.

At the same time, a cancer diagnosis can bring out the fighter in many people. The best attitude anyone can have is not a fatalistic one, but a determination to do what not takes to beat the disease, or at least to extend life as long as possible. This is often the attitude of those who are always determined to make the most out of every single day life brings.

However, there will be inevitable compromises. Radiotherapy centre visits will be regular events and therefore will mean there are many days when you don’t have the freedom to go about your normal business or pursue your preferred activities.

Also, the treatment is likely to bring a range of side effects, which can include symptoms like fatigue, hair loss, nausea, skin changes and – for those whose treatment focuses on the abdomen – stomach trouble, and urinary problems like incontinence. For those with cancers in the pelvic areas, the consequences can include sexual dysfunction and infertility.

This will inevitably mean that while you want to continue life as normally as possible, it will never be exactly normal. Some things will change.

Why Your Diet Must Change

While these are the consequences of treatment, there are also some aspects of your lifestyle you need to alter yourself, including your diet.

This is because the effects of radiotherapy on your body can make you vulnerable to certain problems that can arise when you consume food, either making bad things worse or simply making normal things into a problem. At the same time, however, there are foods that can help you cope better with the treatment and are therefore an ally in your cancer battle.

Firstly, there are the foods you should cut out of your diet. For example, if you like fish you can still enjoy this when it is cooked well, but you must avoid raw fish and shellfish, such as sushi, clams or oysters. Smoked salmon, soft-boiled eggs, soft cheese and cheese made with unpasteurised milk should also be avoided.

The reason is that all these can contain a lot of bacteria. That might normally just mean a small bout of tummy trouble, although you can get worse food poisoning. But when you undergo radiotherapy, your immune system will be weakened and that means any bacteria you ingest could be much more harmful to you.

In the same way, you should avoid other risky food choices such as unpeeled fruit and vegetables, while any impact of radiotherapy on your gut, causing stomach upsets and diarrhoea, will be made worse by spicy food such as curries.

If you have treatment around the chest, throat or mouth, avoid sharp-edged or crunchy food, while acidic fruits like citrus or tomatoes can actually cause burns or cuts. Alcohol does this too, so sadly you should avoid that as well. Avoid Saturated fats too. These are bad for you anyway but are hard to digest, which will make any gastric symptoms worse.

What You Should Eat

However, there are also foods you can and should eat that will do you a lot of good, as these can help you suffer fewer and less unpleasant side effects and recover from the therapy faster and more easily. This means you should be eating lots of nutrient-rich products.

While highly acidic fruits may bring problems, others are very good for you, offering lots of fibre and vitamins. Grains, vegetables and lean meats are also very good in providing healthy proteins.  

Carefully choosing the ingredients in your meals is an important step, but it is not the only issue. It is likely your appetite will be affected by your treatment and this effect may vary, so you should monitor this. But in most cases, your appetite will be reduced, so the wisest approach is to make your meals smaller but more frequent.

By doing this, you generally will not eat less, while avoiding getting bloated by consuming a big meal. At the same time, if your appetite is greatly reduced, the quality of the proteins and nutrition you get will help to compensate for a smaller intake.

Planning For Healthy Eating

To ensure you eat well, you need to plan ahead. That means discussing these matters with your doctor to ensure you are eating all the right things and eliminating others, but it also means making sure you are correctly stocked up with the right kinds of food at home.

Because radiotherapy will compromise your immune system, especially if used alongside chemotherapy, you may find you go out less and therefore eating out is something you may not do. This may not be a bad thing, for if you do eat out you will have to be very careful about what you choose.

What To Drink

Alcohol has already been mentioned here as something to avoid. Among its harmful effects is that it is a diuretic, reducing your water when you need to stay hydrated. It is very important to make sure you drink a lot, not least as this will help flush any toxins out of your body sooner, limiting their effect at a time when your immune system is weaker.

Water is the obvious thing to consume, but there are also lots of other healthy alternatives. Because you need to avoid acidic and sugary foods, you should not consume soft drinks, or cordials with high sugar content.

Taking these steps may mean you forego some of your favourite foods and drinks, but it will be worth it because it will make it easier to cope with radiotherapy, reduce additional problems, lower health risks at a time when you are vulnerable and may also establish some good habits.

The last of these factors may be worth thinking about after successful treatment. It might be tempting to celebrate the ‘all clear’ with a hearty meal and a few glasses of wine, but in the longer run, eating and drinking healthily will help you achieve the long, healthy life your radiotherapy treatment may have done so much to increase your chances of enjoying.