My name is Stacey Conway and I am the Lead Clinical Research Radiographer (CCR) within the Northern Ireland Cancer Trials Network. As part of my role, I manage a team of six CRRs to deliver a portfolio of local and national radiotherapy (RT) clinical trials. A key element of our role is to translate complex RT trials from paper into clinical practice.
An integral part of the CRR role is to streamline the introduction of new trials into the RT department- ensuring that all relevant processes are in place to deliver the trial safely. RT trials enable our patients to have access to the most innovative and cutting edge treatments for cancer and therefore improving patient outcomes.
As a Clinical Research Radiographer team we provide a vital role from a patient’s diagnosis to follow up. We act as a patient advocate acting as a point of contact at all times, arranging timely follow up and co-ordinating their RT treatment. Patients find this extra level of support very beneficial which undoubtedly further enhances the quality of care they receive. In this way RT clinical trial patients benefit immediately from having the support from the CRR team not just when the trial results are published.
There have been many developments within the RT department as a result of trials. For example, The FAST FORWARD breast trial recently changed national practice by concluding that 1 week, 5-fraction schedule of curative RT was at least as effective and safe as the current 15-fraction regimen after primary surgery for early breast cancer (Brunt et al 2020). This new 5 fraction regime was brought into practice early at the start of the COVID 19 pandemic nationally to free up slot availability on the Linear accelerators. This has been hugely advantageous as more patients can be treated with less frequent exposure without compromising their safety.
The CHHIP trial is another successful example, which led to a national change in RT delivery for low/intermediate prostate cancer patients (Dearnaley et al 2015). This trial randomised more than 3,200 patients between 74 Gray in 37 fractions (control arm), 60 Gray in 20 fractions and 57 Gray in 19 fractions in combination with hormone therapy. The trial concluded that 60 Gray in 20 fractions was effective in terms of progression free survival and acute or late urinary/ bowel toxicities and could therefore be recommended as the new RT standard of care in the UK. Similarly to the above, the CHHIP trial reduced the number of prostate RT fractions/ outpatient visits required and simultaneously increased the RT machine availability for other patients to be treated.
RT clinical trials continually progress and improve standard of care for our patients. There are many examples of other trials that have changed RT practice. For example, the SPORT trial led locally by Professor Suneil Jain enabled high risk prostate patients to have access to SABR (Stereotactic ablative body RT) where RT was delivered at a higher dose over 5 fractions, so that patients could have their full RT course over five days (Houlihan, O.A. et al. 2023). In addition, prior to RT treatments, patients had a SPACEOAR system inserted between their prostate and bowel. The SPACEOAR system was found to reduce unwanted radiation dose to the bowel by up to 70%. This enabled Consultant Oncologists to treat the prostate tumour with a higher dose of RT without increasing the risk of potential side effects. This study has gained tremendous momentum and is now being rolled out as part of a larger national UK study known as PACE NODES. Both Professor Suneil Jain (QUB) and Dr Conor McGarry (QUB) have been instrumental leaders in the PACE NODES trial demonstrating how local Belfast RT trials can lead to large scale (>500 patients) studies with ongoing leadership from Northern Ireland.
More recently, a national head and neck study (DARS trial) led locally by Dr Keith Rooney concluded that dysphagia-optimised RT in oropharyngeal/hypopharyngeal cancer significantly improved a patient’s quality of life post head and neck RT (Nutting, C. et al. 2023). We were top recruiters to this trial in Belfast and key to the success of the trial both in the development and recruitment phases. This trial was truly a team effort with involvement of speech and language, physics, treatment planning, research radiographer and nursing teams with the backing of Northern Ireland Cancer Trials Network and Friends of the Cancer Centre locally.
RT trials are constantly evolving in many different disease sites to include translational research samples. As Lead CRR, I am very proud to be part of a team that strives to secure better outcomes for cancer patients through the introduction of new and innovative RT clinical trials.
Brunt AM, Haviland JS, et al. Hypofractionated breast radiotherapy for 1 week versus 3 weeks (FAST-Forward): 5-year efficacy and late normal tissue effects results from a multicentre, non-inferiority, randomised, phase 3 trial. Lancet 2020 395: 1613-1626
Dearnaley, D, Syndikus, I, Mossop, H et al. 8LBA 5 year outcomes of a phase III randomised trial of conventional or hypofractionated high dose intensity modulated radiotherapy for prostate cancer (CRUK/06/016): report from the CHHiP trial investigators group. Eur J Cancer 2015; 51 (3): S712
Houlihan, O.A. et al. (2023) ‘A randomized feasibility trial of stereotactic prostate radiation therapy with or without elective nodal irradiation in high-risk localized prostate cancer (sport trial)’, International Journal of Radiation Oncology*Biology*Physics [Preprint]. doi:10.1016/j.ijrobp.2023.02.054.
PACE NODES 2023-PACE - The Institute of Cancer Research, London (icr.ac.uk)
Nutting, C. et al. (2023) ‘Dysphagia-optimised intensity-modulated radiotherapy versus
standard intensity-modulated radiotherapy in patients with head and neck cancer (Dars): A phase 3, multicentre, randomised, controlled trial’, The Lancet Oncology [Preprint]. doi: 10.1016/s1470-2045(23)00265-6.
Editor: Cristina Branco
Author: Stacey Conway