EFFICACY OF RADIOTHERAPY

There has never been a properly run randomised trial that showed that radiotherapy saved any lives or even produced a significant increase in survival for any type of cancer. Radiotherapy can reduce the rate of recurrence, but has never been found to increase overall survival. In rare cases radiotherapy can extend life for a while by shrinking a tumour that is threatening a vital organ.

In contrast to this there is quite a lot of good evidence suggesting that it does more harm than good.

1. For example a 1993 US study of the deaths of 470,000 cancer patients found that about 27% of those who didn’t die from their cancer had died from their conventional cancer treatment that had mainly damaged the heart and respiratory system (mainly radiotherapy and chemotherapy)1.  The authors of this study attributed the deaths to treatment because most of the extra deaths occurred in the year just after diagnosis.

2. A review of randomised trials of radiotherapy for breast cancer showed that it increased mortality, mainly from damage to the heart and respiratory system2,3.

3. A review of randomised trials of radiotherapy following surgery for early breast cancer showed that overall survival was not affected, with the reduction in deaths from breast cancer being accompanied by an equal increase in death from other causes due to the radiotherapy4.

4. A review of data on 2,128 patients from nine randomised trials of post-operative radiotherapy (PORT) for non-small cell lung cancer comparing post-operative radiotherapy plus surgery with surgery alone showed that after a median follow-up of 3.9 years there was a significant adverse effect of postoperative radiotherapy on survival (hazard ratio 1.21). This 21% relative increase in the risk of death is equivalent to an absolute detriment of 7% at 2 years, reducing overall survival from 55% to 48%5.

5. A review of randomised trials evaluating the effect of mammograms showed that although overall survival was not affected by treatment, the treatment had resulted in women who would have died of breast cancer instead dying of other causes, mainly ischemic heart damage and respiratory failure, probably due to the post-operative radiotherapy6.

6.   An analysis was carried out over a 20-year period of the mortality of 960 Swedish operable breast cancer patients randomised to preoperative radiation therapy, postoperative radiotherapy or surgery alone between 1971 and 1976.  The study analysed the number of myocardial infarctions (heart attacks), deaths from cardiovascular disease and ischaemic heart disease and correlated these factors against dosage of radiotherapy received by the heart.

Compared to the surgery only group the number of myocardial infarctions in the group receiving high dose radiotherapy was 30% higher, the number of cardiovascular disease deaths was 100% higher and the number of ischaemic heart disease deaths was 150% higher7.

Because the higher radiation dose caused increased cardiovascular and ischaemic heart disease deaths but not increased heart attacks overall, the authors concluded that the mechanism of damage was radiation-induced microvascular damage to the heart.

7.   An analysis of trials comparing survival after adjuvant radiotherapy plus surgery with surgery alone for colorectal cancer showed that there was no significant overall improvement of survival from radiotherapy compared with surgery alone.  As with the breast cancer case in item 3 above, the reduction in deaths from colorectal cancer was accompanied by a comparable increase in deaths from other causes8,9.

It is therefore a gross misuse of public funds to channel scarce health monies into equipment that has not been shown to be effective and has been shown to be harmful.

It is important that the principles of evidence-based medicine be applied to all such claims for funds.  The Inquiry you refer to should start off with an investigation of why 35% of cancer patients are being given radiotherapy with no proven survival benefits rather than fewer than 5% who are likely to have their life extended temporarily by shrinking a tumour that is threatening a vital organ such as the bowel or brain.

1. Brown, Barry W et al., Non-cancer deaths in White Adult Cancer Patients. JNCI 1993; 85 (12): 979-987.
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2. Stjernswärd, J. Decreased survival in early operable breast cancer. Lancet 1974; ii: 1285-1286.
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3. Early Breast Cancer Trialists’ Collaborative Group. Favourable and unfavourable effects on long-term survival of radiotherapy for early breast cancer: an overview of the randomised trials. Lancet 2000, p1757–1770
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4. Early Breast Cancer Trialists’ Collaborative Group.  Effects of Radiotherapy and Surgery in Early Breast Cancer – An Overview of the Randomised Trials. NEJM 1995; 333 (22): 1444-1455.
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5. PORT Meta-analysis Trialists Group. Post-operative radiotherapy in non-small-cell lung cancer:  systematic review and meta-analysis of individual patient data from nine randomised controlled trials. Lancet 1998; 352: 257-263
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6. Benjamin, DJ. The efficacy of surgical treatment of breast cancer. Medical Hypotheses 1996; 47 (5): 389-97.
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7. Gyenes G, Rutqvist LE, Liedberg A, Fornander T. Long-term cardiac morbidity and mortality in a randomized trial of pre- and postoperative radiation therapy versus surgery alone in primary breast cancer. Radiother Oncol 1998 (Aug); 48(2): 185-190.
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8. Colorectal Cancer Collaborative Group. Adjuvant radiotherapy for rectal cancer: a systematic overview of 8507 patients from 22 randomised trials.  Lancet  2001; 358: 1291-304.
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9. Moss, RW. Preoperative and postoperative radiotherapy and survival in colorectal cancer. Lancet (March  23) 2002; 359: 1068-69.
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