Alan Horwich - Overview
Management studies in Clinical Oncology
The programme is centred on development of improved radiotherapy techniques
and involves the Institute of Cancer Research Sections of Radiotherapy
and of Physics. Physics teams address new techniques such as intensity
modulation and stereotactic delivery systems, as well as biological modeling
of tissue tolerance with respect to radiation dose and volume. Dose distribution
studies have identified the particular benefits of intensity modulation
for a range of sites including prostate cancer and cancers of the parotid
gland, maxillary sinus and thyroid. An IMRT technique has been developed
for the treatment of breast cancer and will be combined with fixation
and breathing manoeuvres to reduce cardiac dose. Real time verification
is being developed based on electronic portal imagine.
New robotic IMRT techniques are being investigated.
Physics research has undergone clinical trials of conformal radiotherapy
in prostate and breast cancers as well as CNS tumours. Having demonstrated
reduced toxicity associated with conformal radiotherapy for the prostate,
a multicentre radiation dose escalation trial has been launched through
the MRC. A phase I trial of IMRT to prostate and pelvic nodes is being
undertaken. A trial of IMRT in breast cancer has completed accrual to
determine the benefits of the improved isodose distribution.
For CNS tumours, the technique of multiple non coplanar fixed field stereotactic
conformal radiotherapy has been implemented and allows hypothalamic sparing
to reduce the long term toxicity of treatment of paediatric brain tumours.
In breast cancer, trials we have inititated include the ABC trial investigating
alternative approaches to adjuvant therapy and the START trial of radiotherapy
fractionation. A phase II randomised trial of hyperbaric oxygen to treat
patients with radiation-induced arm lymphoedema has been completed and
further studies on treatment of radiation toxicity continue. Management
of trials in urological cancers include analysis of systemic isotope therapy
in prostate cancer based on rhenium-186 supported by peripheral blood
stem cell transplant. We have also been involved in studies of matrix
metalloproteinase inhibitor and taxane-based chemotherapy and have initiated
a trial of the growth factor inhibitor Atrasantin. We are leading a national
study assessing positron emission tomography in testicular cancers and
chemoradiation in bladder cancer.
