Section of Academic Radiotherapy and Department of Radiotherapy
Chairman: Professor Alan Horwich
Scientific Overview
Most clinical radiotherapy research is described under the individual Clinical Units in the research themes Radiotherapy and Cancer Therapeutics. The focus of the research programme in the Academic Radiotherapy Unit is on novel techniques of conformal radiotherapy and intensity modulation (jointly with the Joint Department of Physics and supported by a programme grant from Cancer Research UK). The more precise delivery of radiotherapy may lead either to reduction of radiation side effects or dose escalation to increase tumour control. The research programme was reviewed at a site visit during 2003 and scored as 'Forefront', indicating that both previous research and future proposals were regarded as internationally competitive. The department is well equipped to continue research on technical advances in radiotherapy, with installation of a computed tomography (CT) simulator and major expansion of the complement of modern linear accelerators, which include cone-beam CT verification on the treatment couches.
Present laboratory research work is on the biology of normal tissue reactions to radiotherapy. Cancer patients differ widely in their tolerance of radiation therapy in respect of radiation damage to normal tissues, with a small minority of patients suffering a significant degree of damage. The management of these patients is clearly suboptimal and, moreover, it is the risk of treatment complications that limits the dose of radiotherapy for the whole patient group. The aim of the research is to improve our understanding of the molecular mechanisms involved.
Relevance to NHS Research and Development Programme
Technologies to support conformal and intensity modulated radiotherapy are now available for purchase by NHS Trusts. It is important to define the indications and benefits of more sophisticated and resource-intensive techniques, and to help to disseminate methods that bring patient benefit as rapidly as possible.
Highlights of 2006
- Publication of our multi-centre trial of accelerated radiotherapy for bladder cancer (PI Professor A Horwich)
- Completion of accrual (860 patients nationally) to the RT01 Trial of dose-escalated conformal radiotherapy in early prostate cancer(PI Professor DP Dearnaley)
- Final analysis of the RMH Breast Radiotherapy Dosimetry Trial confirms that 3D intensity modulated radiotherapy compared to standard 2D dosimetry significantly reduces the late adverse effects of breast radiotherapy (PI Professor J Yarnold)
- Publication of the long-term effects on normal tissues of hypofractionated breast radiotherapy based on the outcome of the RMH/GOC randomised clinical trial of 1451 patients (PI Professor J Yarnold)
- Evaluation of the Active Breathing Control device with gated radiotherapy for lung cancer has now reached the clinical phase (PI Professor M Brada)
Future Aims
- To implement the CTAAC-funded trial of adjuvant chemotherapy in anaplastic astrocytoma (TATA) (PI M Brada)
- To activate a Phase II trial of nelfinavir (an akt/PI3 kinase inhibitor) with radiotherapy in lung cancer (Collaboration with Gillies McKenna, Oxford)
- To activate the NCRI-funded IMPORT LOW Phase III randomised clinical trial evaluating partial breast radiotherapy in 2000 women with early breast cancer and the IMPORT HIGH trial evaluating intensity modulated breast radiotherapy in 900 women with early breast cancer
- To complete accrual to the NCRN FAST Trial evaluating a 5-fraction schedule of breast radiotherapy in 900 women with early breast cancer
- To complete accrual to the NCRN HOT randomised trial evaluating hyperbaric oxygen in 64 patients with arm lymphoedema following radiotherapy for cancer
- To analyse the results of the CR-UK funded RACE project testing for associations between DNA polymorphisms and the risk of late radiation complications
- To implement a recent CR-UK project grant RACE(S) that tests for associations between the risk of late radiotherapy complications and the in vitro expression profiles of irradiated fibroblasts and lymphocytes, fibroblast senescence and lymphocyte apoptosis in patients with and without late adverse effects of breast radiotherapy
- Completion of the Phase I trial of intensity modulated radiotherapy to pelvic lymph nodes in prostate cancer
- To extend to multi-centre setting the CTAAC-funded dose escalated hypofractionated conformal trial in prostate cancer (CHHIP-PI DP Dearnaley)
- Development of localising seed techniques for conformal boost radiotherapy for bladder cancer
