Research Interest

Radiotherapy

Considerable technological advances over the past decade have improved the ability to sculpt dose distributions to the prostate target and improve treatment accuracy. Several phase III randomised control trials (RCTs) have demonstrated the benefit of dose escalation. The largest of these was the MRC RT01 Trial and high dose conformal radiotherapy has become the standard of care in the UK using conventional 2Gy daily fractions to a total dose of 74Gy.  

In parallel there has been much interest in the fraction sensitivity of prostate cancer which is usually expressed using the alpha-beta formalism. The alpha-beta ratio for most cancers is believed to be about 10Gy, but for prostate cancer values as low as 1.5Gy have been suggested which is lower than that reported for the late reactions of most normal tissues including rectum of about 3Gy.

These findings have potentially important therapeutic implications. Hypofractionated radiotherapy using a smaller number of larger treatments would be beneficial delivering a higher equivalent biological dose to tumour whilst maintaining a similar or lower incidence of late normal tissue reactions. In addition, there would be important gains in resource utilisation and patient convenience with shorter treatment duration. The maintenance of a low level of treatment related side effects is of paramount importance as these are increased with dose escalation.