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NICE appeal panel rules on use of Intrabeam therapy for breast cancer

31 January, 2018

The National Institute of Clinical Excellence (NICE) has rejected a joint appeal by the Royal College of Radiologists, Independent Cancer Patients’ Voices and the Royal College of Physicians to reconsider its guidance around the use of Intrabeam radiotherapy for treating breast cancer patients.

The ruling effectively enables the use of the treatment in the NHS only on machines which are already installed, for defined categories of patients and subject to the recommendations listed below.  It will therefore not be part of routine commissioning.

The appeal was brought due to the absence of five-year follow up data – the nationally accepted gold standard for NHS commissioning – for this technique.

In response, Dr Jeanette Dickson, Vice President, Clinical Oncology at The Royal College of Radiologists (RCR), commented: “The RCR is disappointed that in the face of expert concerns, NICE has approved the, albeit limited, use of Intrabeam for b​reast cancer patients.

“The College fully agrees that patient choice is paramount, but that choice should be an informed one, based on the best evidence we have.

“However, as we and others in the oncology community have repeatedly warned, there is still not best evidence available on Intrabeam and its potential to cause future harm.”

The NICE recommendations for using Intrabeam radiotherapy are as follows:

1.   The Intrabeam radiotherapy system is not recommended for routine commissioning for adjuvant treatment of early invasive breast cancer during breast-conserving surgical removal of the tumour.

2.   Use of the Intrabeam radiotherapy system is recommended only using machines that are already available and in conjunction with NHS England specified clinical governance, data collection and submission arrangements.

3.   The procedure should only be carried out by clinicians with specific training in the use of the Intrabeam radiotherapy system.

4.   Information to support patient decision making and the choice of Intrabeam radiotherapy should be undertaken by a multidisciplinary team experienced in the management of early breast cancer, which includes both breast surgeons and clinical oncologists.

5.   Clinicians wishing to undertake Intrabeam radiotherapy should take the following actions:

·      Inform the clinical governance leads in their NHS trusts.

·      Ensure that patients understand the uncertainties about the procedure and inform them about alternative treatment options.

·      Provide patients with NICE's written information on the evidence of the risks and benefits of the range of treatment options available as an aid to shared decision making.

Charlotte Beardmore, Director of Professional Policy at the Society commented: “The SCoR have contributed to the technological appraisal process which commenced with the first meeting held in June 2014.

“Throughout this process we have emphasised the need for greater clarity with respect to the data set and we have highlighted the need to place patient information at the centre of the decision making process.

“It is clear from this review that centres implementing the guidance should have adequate support in place to allow patients being considered for Intrabeam therapy to jointly consult with both their surgeon and clinical oncologist to obtain an accurate and balanced overview of this treatment technology.

“The SCoR will work with national stakeholders to promote a joint approach to providing clear information to support patients in making this decision.”

You can read the ruling and the NICE appraisal here.

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