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Improving radiotherapy treatment for patients with pancreatic cancer

Lay study title: Developing a strategy to help reduce the amount of intra-abdominal motion in patients who are having radiotherapy to their upper abdomen. 

Institution: The Christie, Manchester

About the study: The Christie NHS Trust radiotherapy department is home to two recent radiotherapy developments; the proton beam treatment (PBT) centre, one of only two in the NHS, and the MR Linear accelerator (MRL), again one of only two currently operational within the NHS. Being a cancer centre possessing both modalities puts the Christie in a unique position within the UK.

In principle PBT and the MRL possess distinct advantages over conventional radiotherapy for abdominal tumours. The advantage of using MRL is that we can visualise soft tissue structures more clearly which helps us identify the tumour and organs at risk more accurately.  This means that we may be able to boost the radiation dose to the tumour whilst sparing the sensitive organs at risk around it.

However, motion is a major technical issue in both of these novel technologies. Strategies such as - breath hold, gating, tumour tracking and rescanning have been reported. Abdominal compression has also been investigated.  In this funded study, we will run a prospective clinical trial which will evaluate two potential techniques for managing breathing motion: abdominal compression and guided breath holds. We will assess the advantages and disadvantages of each technique, and potentially incorporate one or both into the clinical service at the Christie.

Abdominal compression is a relatively simple technique to implement and has been demonstrated to reduce respiratory motion in a number of previous studies using cone beam CT which we use regularly on conventional radiotherapy linear accelerators.

Breath hold techniques have also been successfully used in radiotherapy of several tumour sites. The main advantages of breath hold are that it is less intrusive for the patient than a physical device, and that there is effectively no respiratory motion during the beam on period, allowing a reduction in treatment planning margins, as long as the breath hold is reproducible. Reproducibility is a particular concern given the long treatment times on the MR linac, and it will be important to quantify in this study.

Type of opportunity: Focus group event

When will this opportunity be recruiting/taking place?: 6-8 pm on the 12th or 13th August 2019 at the proton beam unit at the Christie (reasonable out of pocket expenses from the local Manchester area can be reimbursed.) 

What will participants be asked to do?: To help the team understand whether patients would be willing to be included in the study with its design at present, there will be an explaination of how the study will be carried out that will include showing the group what the compression belt looks like and how it is intended to be used. There will then be a general discussion/focus group.

Who can take part?: Anyone with experience of pancreatic cancer, either as a patient or family member/carer.

Who is conducting the research?: The research is being conducted by Dr Ganesh Radhakrisna, Dr B Rowlands, Mr J Rodgers, Mrs L McDaid and Dr C Eccles from the Christie in Manchester. 

Who has reviewed the study?: The study is being sponsored by The Christie, and has been submitted to NHS ethics.

How will the study benefit people affected by pancreatic cancer?: By reducing intra-abdominal motion for patients undergoing radiotherapy treatment for their pancreatic cancer, it will allow clinicians to target the radiotherapy more effectively and efficiently, it will also allow them to reduce the radiation dose to nearby organs at risk.  This all means that we should be able to treat pancreatic cancer more effectively using radiotherapy.

How will feedback of the results of the study and impact of involvement be passed on to members and the charity?: It is intended that this study will be published and presented at formal events and the impact made will be fed back via the RIN newsletter. 

What steps will be taken to ensure that information about participants is stored and used in compliance with the provisions outlined in the Data Protection Act 1998?:  All data acquired will be used in compliance with GDPR and The Christie NHS Foundation Trust Policy.  Images will be stored on the Trust PACS system within the patient record.  Paper records will be stored in a site file in accordance with Good Clinical Practice guidelines.

What next/who to contact: Please contact Lisa McDaid or John Rodgers with any expressions of interest.