An exciting £720,000 pioneering clinical trial to improve the treatment and survival rates of patients with head and neck cancer will soon be underway in Wales. This work has been jointly funded by charitable funds from Cancer Research Wales and the Velindre Moondance Programme.
Using the very latest technological advances, the trial – which takes award-winning research into a clinical setting and is scheduled to begin later this year – will combine modern radiotherapy with advanced medical imaging, known as PET, to pinpoint the exact site of live tumours and therefore enabling radiotherapy treatment to be targeted more effectively.
Although head and neck tumours can be treated successfully with conventional chemo-radiotherapy; the complex anatomy of the head and neck make large tumours difficult to define and accurately target with radiotherapy, and cancers in this area can recur.
Standard radiotherapy treatment for head and neck cancers can also leave lasting long-term side effects, including a dry mouth, difficulty in swallowing, loss of taste and alterations to the voice.
Now, Welsh patients taking part in the trial at Velindre Cancer Centre and Singleton Hospital Radiotherapy Centre in Swansea, will be treated with an innovative medical imaging technique that has the potential to greatly improve the accuracy and targeting of radiotherapy.
A PET scan works by exploiting the tendency of cancer cells to take up high amounts of sugars in the body, which cancer cells require for rapid growth. Patients are given short-lived radioactive sugars which then distribute within the body, accumulating in areas with cancer cells and regions of the tumour with high metabolic activity. These areas are then picked up on a specialised PET scanner that captures serial digital slices to generate a detailed 3D colour image of the body – much like a heat map – allowing doctors to target fine tumour margins and areas of increased disease activity with high levels of accuracy.
Although PET technology has been around for some time – certain barriers such as operator variability has limited the use of PET for standard radiotherapy planning, However, award-winning research previously funded by Cancer Research Wales, has enabled scientists at Velindre Cancer Centre to develop an automated computer aided programme called ATLAAS which circumvents these issues to create reproducible PET-based treatment plans with great precision.
Once patients on the trial have received initial radiotherapy to eradicate the bulk of the cancer, they will then undergo additional highly specialised PET scans at the state-of-art PETIC facility at Cardiff University, which will be combined with the conventional CT scans to produce a detailed PET/CT scan that contains both structural and functional information.
Those patients found to have remaining high levels of disease activity, as evidenced by increased glucose uptake, will receive further doses of PET-guided radiotherapy to those areas in the head and neck. This technique, known, as ‘dose painting’ will improve the targeting of radiotherapy to live tumours, while sparing normal tissues or cancer already destroyed by the initial bursts of radiation. This will potentially result in better control of the disease, lower rates of relapse, reduce side effects and ultimately improve patient survival and quality of life.
Professor John Moore, President of Cancer Research Wales says, “As a charity we have a rich history of funding radiotherapy research in Wales, particularly at Velindre Cancer Centre, and this exciting new project is a culmination of our investment, over many years, that has enabled local scientists and clinicians to realise their full potential. We are very pleased to partner with Velindre Cancer Centre, as it will allow patients in Wales to benefit first from this ground-breaking technology, which if successful, can be transferred to other cancer centres across the UK, and used to treat other tumour types”.
Dr Tom Crosby, Clinical Consultant at Velindre Cancer Centre and Clinical Lead for the Moondance Programme said: This exciting programme builds on previous work done by this cutting edge research group in Velindre Cancer Centre. It is using state of the art computational science to adapt radiotherapy treatments to precisely target patient’s cancers based on their initial response to treatment. This personalized approach offers the possibility of achieving the holy grail of precision oncology, hitting the tumours harder with higher doses of radiation, improving the chance of disease control and possibly cure, whilst sparing normal tissues which when damaged can lead to disabling long terms side effects. This supports the ambition of Velindre Cancer Centre to be a centre of excellence for radiotherapy, comparable with the best centres in the world.
Dr John Staffurth, co-Chief Investigator and Chair of Velindre’s Radiotherapy Research Group says, “I am very excited to be leading the PET-based Adaptive Radiotherapy Clinical Trial (PEARL) with Dr Mererid Evans. This study will offer the highest quality, innovative radiotherapy to patients with advanced head and cancer to patients across South Wales. There is a long-history of leading national radiotherapy trials from Velindre and this study will both continue this and give us closer links with our colleagues in the South West Wales Cancer Centre and the excellent scientists within Cardiff University”.