Presentation on theme: "Radiotherapy Research Sheffield SWOT Analysis for Weston Park Hospital, Sheffield June 2011."— Presentation transcript:
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 20 th 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Scientific base reduced over 2–3 decades –Relatively few clinical academic leaders –Overloaded clinicians using outdated equipment with long waiting lists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 IMRT IGRT RTQA Protons Cancer biology DNA repair Microenvironment Check point control Tumour biologies Signalling New drugs PARP DNA Pk Angiogenesis EGFR Chk1, chk 2 Imaging & biomarkers FDG Hypoxia MRI, MRS DNA, RNA protein Translational research Clinical trials Improving outcome for Cancer patients
CTRad Executive Group Chair – Tim Illidge Deputy Chair – Neil Burnet Workstream co-chairs Consumer representatives Ex-officio members NCRI secretariat (1FTE) 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 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 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 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 Workstream 4 New 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 National leadership Physics & RT support for trials Trial methodology Data on patterns of RT practice Academic career development Training & resources for radiographers Industry engagement for RT-drug trials NHS clinical oncologist engagement in research Timely NHS implementation of RT advances Building on MRC and CR-UK investment
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 Compliant ab initio Made compliant Non-compliant, no major tumour control probability impact Non-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 and neck cancer (6.7%)) 9775 of optimal pts (23%) received radical IMRT rather than conventional RT in 2008 Pts forward planned IMRT Pts inverse-planned IMRT Mayles Clinical Oncology 22 (2010)
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 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.