To tackle the significant challenges facing radiotherapy we are part of a multidisciplinary research group combining expertise in Engineering, Chemistry, Physics, Medicine, Informatics and Computing. Our research is looking at ways to adapt or improve radiotherapy at time-of-treatment, also know known as adaptive radiotherapy (ART), to account for changes in both tumour and normal tissues. In addition, with the recent advances in medical imaging there is the potential to identify imaging biomarkers, using image analysis, which are indicative of underlying biological processes and could be used for ART.
Figure: Adaptive radiotherapy workflow and ongoing research.
Typically, radiotherapy follows a sequential pathway in which a patient is imaged using computerised tomography (CT) and a bespoke radiotherapy treatment plan is next produced (Figure 1). Whilst other forms of imaging (e.g. MR and PET) and clinically relevant information (e.g. patient case history) are consideredn, they are NOT used routinely by the current treatment planning algorithms. Furthermore, ART still remains a massively challenging problem. The focus of our multidisciplinary research is to address these challenges and thereby change practice.
Current Research Projects
The IMAGE-INE Project: IMAGE-INE: Analysing IMAGE guIdance scaNs to prEdict late toxicity after radiotherapy in head and neck cancer patients
Funder: Chief Scientist Office (CSO), Scotland
Collaborating Institutions: University of Edinburgh (Lead), University of Cambridge (Partner), University of Glasgow(Partner), NHS Lothian (Partner)
Cancers of the head and neck are increasing in incidence. Advanced radiotherapy techniques cure most patients, but permanent side effects are common and can be severe. Use of adaptive (changing) radiotherapy plans (ART), in which the dose or target treated is altered during the 6-week course of therapy, could reduce side effects while maintaining excellent cure rates. However, it is not yet known how, or when, to select patients for ART. Recent research using sophisticated image analysis techniques shows that features in pre-treatment CT scans can partly predict late toxicity. Modern radiotherapy machines can take image guidance (IG) CT scans immediately before each daily treatment. Because they are taken daily during a course of therapy, these on-treatment images will give more predictive information about individual responses. The aim of this project is to look for features that predict toxicity, to identify patients in whom ART may improve quality of life. This will also validate the efficacy of the image analysis techniques developed in this project, and previously published studies, for ART in head and neck cancer patients. This project is in partnership with the University of Cambridge and the University of Glasgow.
The IMPACT Project: IMPACT: Implantable Microsystems for Personalized Anti-Cancer Treatment
Funder: Engineering and Physical Sciences Research Council (EPSRC)
Institution: University of Edinburgh
Well-oxygenated human tumours are 2-3 times more likely to positively respond to radiotherapy than hypoxic tumours. However, no existing technique can identify the fluctuations in hypoxia at the time of radiation delivery, which may change during a single fraction of radiotherapy. Advanced radiotherapy techniques can deliver radiation with sub-mm accuracy to a hypoxic region and therefore higher radiation doses could be used in hypoxic regions to overcome radio-resistance. The aim of the IMPACT project is to develop a wireless implantable biosensor that will detect changes in tumour hypoxia, pH and other key biomarkers and to adapt radiotherapy to target these areas. https://www.impact.eng.ed.ac.uk
IMPACT is a 5-year, £5.2M research project, funded by an EPSRC Programme Grant, to develop new approaches to cancer treatment, using implanted, smart sensors on silicon, fabricated in the University of Edinburgh’s Scottish Microelectronics Centre.
IMPACT will use miniaturised, wireless sensor chips the size of a grass seed to monitor the minute-to-minute status of an individual tumour. This will allow RT to be targeted in space and time to damage cancer cells as much as possible. The team consists of engineers, physicists, chemists, veterinary clinicians, social scientists and human cancer specialists, led by Prof Alan Murray from the University’s School of Engineering.
Prof Alan Murray, Professor Anthony Walton, Dr. Stewart Smith, Dr. Brian Flynn, Dr. Martin Reekie, Prof Steve McLaughlin, Prof Mark Bradley, Prof Andy Mount, Prof David Argyle, Prof Joyce Tait, Dr. Gill Haddow Prof Ian Kunkler, Prof Edwin Van Beek, Dr. William H Nailon, Dr. Duncan McLaren
The inspiration for this work came from seminal advances in the field from devices such as the Radiosonde, which was developed in 1957 to take pH-readings in the gut.
Figure: Radiosonde to be swallowed to transmit pH-readings during its passage through the gastro-intestinal tract. The battery drives the unit continuously for fourteen days. [B. Jacobson and R.S. MacKay. Lancet, 1957; 1(1224)]