Hypofractionated Radiotherapy: A Method to Reduce Carbon Emissions and Improve Patient Quality of Life?
Written by Dr Katie Lowles, Communications Officer at the MCRC
Leading Environmental Change in Radiotherapy
Rob Chuter, The Christie’s Principal Clinical Scientist and Environmental Sustainability Lead in Radiotherapy (RT), has been environmentally minded since he was a child. A keen birdwatcher and David Attenborough fan since the age of 8, Rob carried his eco-conscious values into adulthood, making practical changes including adopting a vegetarian diet and choosing trains over flights. After exhausting the changes he could make in his personal life, Rob wanted to make a difference in his professional life too.
Climate change is absolutely happening in front of our eyes, and we can’t ignore that.
Dr Rob Chuter
Principal Clinical Scientist and Environmental Sustainability Lead in Radiotherapy, The Christie
Measuring the Carbon Cost of Radiotherapy
In 2021, Rob secured a grant from the North West Greener NHS Innovation Fund to estimate the carbon footprint of the RT pathway – from diagnosis to follow-up. This study assessed the carbon emissions from patient travel, imaging, consultations, PPE and treatment on the linear accelerator (used for external beam radiation therapy). The findings were striking: patient travel alone accounted for approximately 70% of the total carbon footprint of the RT pathway.
Hypofractionated Radiotherapy: A Greener Solution
The solution to reducing the carbon footprint of RT seemed clear: reduce patient travel by delivering higher doses of RT per session over fewer sessions and in a shorter time frame – a method known as hypofractionated radiotherapy.
For prostate RT for example, whereas standard RT delivers around 3.0 Gy per session, with 20 sessions over 4 weeks, hypofractionated RT delivers around 7.25 Gy per session, with 5 sessions over just 2 weeks.
Crucially, fewer RT sessions or increased dosage must not compromise patient outcomes or safety. Fortunately, several high-quality trials have shown that hypofractionated RT is as safe and effective as standard RT for prostate and breast cancers.
These tumour types are the ideal candidates for hypofractionated RT as:
- They represent a high proportion of patients treated at The Christie, meaning hypofractionated RT could enable more patients to be treated in the same timeframe.
- Both prostate and breast cancer have a low α/β ratio, indicating sensitivity to larger doses and a greater capacity for repair between fractions.
The use of hypofractionated RT for other cancer sites is being explored and refined.
Quantifying the Impact of Switching to Hypofractionated Radiotherapy
To assess the benefits of hypofractionated RT, Rob secured NIHR funding for a multi-centre study involving The Christie and Worcester Oncology Centre. The research will examine the environmental impact of transitioning to hypofractionated RT.
The study will assess environmental impact by measuring and comparing resource consumption, energy use and patient travel for cancer patients with standard versus hypofractionated treatment schedules.
The project also aims to expand the boundaries of what is commonly carbon footprinted, incorporating elements such as patient immobilisation, treatment planning and data storage – areas often overlooked in carbon assessments.
Rob’s earlier work – identifying travel as the main driver of emissions in the RT pathway – has thus sparked an evidence-led approach to making cancer treatment more sustainable.
Improving Patient Experience
In addition to its sustainability benefits, hypofractionated RT can also enhance patient quality of life by reducing hospital visits, travel time, and daily disruption.
As part of the study, patients will be asked to complete questionnaires on travel burden, treatment experience, and quality of life, helping the team determine the impact of hypofractionated RT from the patient’s perspective.
Extending Climate Awareness Beyond the Clinic
Rob has also turned his focus to large-scale oncology conferences, estimating the carbon footprint of the European Society for RT and Oncology (ESTRO) conference. Using Climatiq, a carbon footprint calculation engine, Rob’s team evaluated the carbon footprint of the venue, travel and accommodation. As with the RT pathway, travel was the greatest contributor to carbon emissions, accounting for 95% of total emissions.
It was also found that switching air travel to train for those in Europe could reduce conference emissions by over 17%. Another carbon-sparing method is the use of multiple hubs hosting small conferences simultaneously to cut travel-related emissions.
Proactive Climate Action in the Workplace
The work Rob does to promote environmental sustainability is done as part of the Institute of Physics and Engineering in Medicine (IPEM) Environmental Sustainability Group, which he founded in 2020.
In collaboration with The Royal College of Radiologists and The Society of Radiographers under the Radiotherapy Board a collaborative initiative was launched.
The group’s aims include developing a framework to help departments reduce their carbon footprint through specific actions and provide an awards system to reward centres for their efforts. Read more about this here.
If you're looking to improve sustainability in your workplace, my advice is to join or create a group. Collaborating with others allows you to share ideas, build momentum, and make real progress. Doing it alone can feel isolating.
Dr Rob Chuter
Principal Clinical Scientist and Environmental Sustainability Lead in Radiotherapy, The Christie
This project is funded by the National Institute for Health and Care Research (NIHR) under its NIHR Health Services and Delivery Research (HSDR) programme (Grant Reference Number NIHR155944). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.
