Royal Surrey NHS Foundation Trust, Guildford, UK: Focusing on Patients Who Will Benefit Most | Varian

Royal Surrey NHS Foundation Trust, Guildford, UK: Focusing on Patients Who Will Benefit Most

Royal Surrey NHS Foundation Trust, Guildford, UK: Focusing on Patients Who Will Benefit Most

The Royal Surrey County Hospital comprises two sites about 20 miles apart in the county of Surrey, UK. Across the two sites, radiotherapy clinicians treat about 3,500 patients a year, typically with IMRT or RapidArc® radiotherapy, including stereotactic ablative radiotherapy.

In 2018, the radiotherapy team at Royal Surrey, led by Marianne Dabbs, associate director of oncology and Liz Adams, head of radiotherapy physics, started planning a machine replacement, and chose an Ethos™ therapy system.

“We had originally intended to purchase a Halcyon system due to the additional patient treatment benefits, such as the enclosed gantry and streamlined workflow,” Mrs. Dabbs explained. “When Ethos launched, we saw that it additionally offered a great opportunity to implement daily adaptation, which is a treatment we wanted to be able to offer our patients.”

The Royal Surrey team started with conventional IGRT treatments on their new Ethos system when it was installed in summer 2020, with the first adaptive therapy patient treated for bladder cancer in January 2021.

“We very much want to focus the adaptive treatments on patient groups who we consider will benefit clinically, and so we're starting with the pelvic region where anatomy can vary on a daily basis,” Adams said. “So far, in every case we’ve selected the adapted plan rather than the original. Some days, the difference between the two is small, but on other days we see significant anatomical variations. Treating adaptively is really helping us reduce dose to healthy organs at risk.” 
Patient feedback has been extremely positive too.  Helen Burland, professional head of radiotherapy, said that: “Patients are reporting that their treatments are quieter and smoother, which is supportive of the environment we want to provide to our patients.”

As the clinic moves away from the restraints of the COVID pandemic to roll out more training, the team is looking at increasing the number of sites it can treat adaptively, focusing in particular on large pelvic cases involving lymph nodes, such as gynecological cancers. The clinic’s first cervical cancer patient was treated using Ethos adaptive in June 2021.

“Although it’s early days, the results look promising and our long-term goal is to reduce margins and potentially increase dose, while lowering side effects,” Adams said. “At the moment we're using our standard margins and markers, but because of the high-quality images and ability to see the delivered dose on a daily basis, we are hoping to improve the entire patient experience.”  

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