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

– 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– Overloaded clinicians using outdated equipment with long waiting lists

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

The NCRI CTRad approach

Advanced radiotherapy

IMRTIGRTRTQA

Protons

Cancer biology

DNA repairMicroenvironmentCheck point controlTumour biologiesSignalling

New drugs

PARP DNA PkAngiogenesisEGFRChk1, chk 2

Imaging & biomarkers

FDGHypoxiaMRI, MRSDNA, RNAprotein

Translational research

Clinical trials

Improving outcome forCancer patients

CTRad Executive Group

Chair – Tim IllidgeDeputy Chair – Neil Burnet

Workstream co-chairsConsumer representatives

Ex-officio membersNCRI secretariat (1FTE)

Workstream 1Science base

Kaye Williams &Thomas Brunner

15 members

•Preclinical studies•Drug-RT interactions•Biomarkers & imaging

Workstream 2Phase I/II trials

Kevin Harrington & Ruth Plummer

18 members

•Phase I/II studies•ECMCs•Biomarkers & imaging

Workstream 3Phase III trials and

methodology

Chris Nutting &Cindy Billingham

17 members

•Phase III trials•Trials methodology development

Workstream 4New Technology

Physics, QA

John Staffurth &Ranald Mackay

17 members

•New technologies (e.g. proton therapy)•Quality assurance for trials

Rapid review 2008: 10 point plan

NCRI CTRad launched July 2009

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.

The quality of RT delivery has a major impact on outcome

Peters et al. J Clin Oncol 2010;28:2996–3001

• 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

TROG 02.02

Compliant ab initioMade compliantNon-compliant, no major tumour control probability impactNon-compliant, major tumour control probability impact

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 andneck 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

Patient accrual to RT trials

3857

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

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

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

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

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)

Vision for the centre – the next 5 years

• 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.