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Radiotherapy Research Sheffield

Radiotherapy Research Sheffield. SWOT Analysis for Weston Park Hospital, Sheffield June 2011. The need for national coordination in radiotherapy research. Radiotherapy research is complex and challenging, both academically and practically The starting point in 2000

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Radiotherapy Research Sheffield

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  1. Radiotherapy Research Sheffield SWOT Analysis for Weston Park Hospital, Sheffield June 2011

  2. The need for national coordination in radiotherapy research Radiotherapy research is complex and challenging, both academically and practically The starting point in 2000 Having been internationally leading for much of 20th century (epitomised by Gray laboratories, Holt Radium Institute in Manchester) Scientific base reduced over 2–3 decades Relatively few clinical academic leaders Overloaded clinicians using outdated equipment with long waiting lists

  3. The NCRI Clinical and Translational Radiotherapy Research Working Group • NCRI identified radiotherapy as area of need 2003 • Gray Institute for Radiation Oncology and Biology in Oxford 2006 • Rapid review 2008: more to be done: 10 point plan • NCRI initiated CTRad Nov 2008, launched July 2009 • CTRad has a14-person Executive Group and 4 workstreams • Workstream 1: Science base • Workstream 2: Phase I / II trials • Workstream 3: Phase III trials • Workstream 4: New technology, physics and QA

  4. The NCRI CTRad approach PARP DNA Pk Angiogenesis EGFR Chk1, chk 2 IMRT IGRT RTQA Protons Advanced radiotherapy New drugs Cancer biology Imaging & biomarkers FDG Hypoxia MRI, MRS DNA, RNA protein DNA repair Microenvironment Check point control Tumour biologies Signalling Improving outcome for Cancer patients Translational research Clinical trials

  5. CTRad Executive Group Chair – Tim Illidge Deputy Chair – Neil Burnet Workstream co-chairs Consumer representatives Ex-officio members NCRI secretariat (1FTE) • Workstream 1 • Science base • Kaye Williams & • Thomas Brunner • 15 members • Preclinical studies • Drug-RT interactions • Biomarkers & imaging • Workstream 2 • Phase I/II trials • Kevin Harrington & Ruth Plummer • 18 members • Phase I/II studies • ECMCs • Biomarkers & imaging • Workstream 3 • Phase III trials and methodology • Chris Nutting & • Cindy Billingham • 17 members • Phase III trials • Trials methodology development • Workstream 4 • New Technology • Physics, QA • John Staffurth &Ranald Mackay • 17 members • New technologies (e.g. proton therapy) • Quality assurance for trials

  6. Rapid review 2008: 10 point planNCRI CTRad launched July 2009

  7. CTRad 10-point plan 2. Steps will be taken to break down barriers to access to funds for physics and radiotherapy support for radiotherapy trials within the NHS, and where necessary to provide additional resources. 9. The national leader and the Working Group will work with NHS service providers to ensure a timely and evidence-based approach to the implementation of new radiotherapy technologies for the benefit of patients.

  8. The quality of RT delivery has a major impact on outcome TROG 02.02 • Large international phase III trial evaluating RT with concurrent cisplatin plus tirapazamine for advanced head and neck cancer • Regardless of randomization arm, poor RT resulted in: • 20% decrement in 2-year OS • 24% decrement in freedom from locoregional failure • Effect of poor RT was highly significant in multivariate analysis Compliant ab initio Made compliant Non-compliant, no major tumour control probability impact Non-compliant, major tumour control probability impact Peters et al. J Clin Oncol 2010;28:2996–3001

  9. A UK survey (2008) of the use of advanced technology in radiotherapy • 50/ 58 centres responded (89% pts) • 46/50 had >1IMRT capable LA • 26/50 had 1 LA capable of IGRT • 32/50 doing forward planned IMRT • 18/50 doing inverse-planned IMRT • 10.7% (consensus 22%) of radical patients had forward-planned IMRT, (breast 18.6% patients) • 2.2% (consensus 32%) of radical patients had inverse-planned IMRT, (prostate (7.5%) and head and • neck cancer (6.7%)) • 9775 of optimal 41421 pts (23%) received radical IMRT rather than conventional RT in 2008 Pts forward planned IMRT Pts inverse-planned IMRT Mayles Clinical Oncology 22 (2010) 636-642

  10. Patient accrual to RT trials • From 2008/09 to 2009/10: • 17% increase in patients entered into RT trials • Doubling in accrual in Northern Ireland 3857

  11. Strengths • ECMC Centre • CCTC • 80 staff (research radiographers, nurses, data managers, admin) • Portfolio of approximately 100 clinical trials • Centre of Active Cancer Research Network • Engaged clinicians – clinical research embedded in radiotherapy department • Experienced research radiographers and physicists • EqualESTRO accredited for IMRT

  12. Weaknesses • Increased pressure of clinical work on linac time with deteriorating situation worsening over last year. • Limited staff numbers - vulnerable to sickness • 2.2 research radiographers • 1 research physicist + 0.4 supporting trial QA. • Radiotherapy research low priority within Sheffield Cancer Research Plan. • No coherent strategy • Focus is preventing breaches

  13. Opportunities • CR-UK status and YCR funding • CLRN Funding • Income to hospital significant because of past record of successful recruitment into clinical trials • Local Cancer Charity • Second centre in UK to implement PDR brachytherapy • Membership of CTRad Workstreams (CR-UK) • Links with University of Sheffield Radiology research – He MRI in lung cancer

  14. Threats / barriers • Radiotherapy research low priority within Sheffield Cancer Research strategy • Major investment in Leeds radiotherapy from NHS and local charities e.g Chair of Clinical Oncology, 2 research linacs, gamma knife, stereotactic radiotherapy • Financial meltdown of NHS with result in huge service pressures and similar pressures on Universities • Inability to recruit clinical staff • Lack of radiotherapy physics research in UK • Local focus on Research Units and Academic Health Service Centre – now failed • Retirement of Senior Academics (threat or opportunity)

  15. CR-UK status √ Collaboration with neighbouring Research Active centres e.g Leeds. More drug-radiation studies as part of ECMC program. Develop stereotactic radiotherapy. Appoint research active Radiographer at Supt level to work within department to initiate research and develop links with SHU. Use current academic clinical oncologist funding to support research time of selected consultants. Support them with research physicist time. Double recruitment into NIHR trials. Vision for the centre – the next 5 years

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