Current research projects in the Discipline of Radiation Therapy include:
Translational Radiobiology and Molecular Oncology
The aim of this research strand is to improve patient health, care and health systems, through better stratification of patients and individualised treatment options.
This laboratory-based strand of the research specifically aims to:
- Predict radiotherapy treatment failure, though the identification of non-radiation responsive cells such as stem cells and hypoxic cells. Current research aims to:
- Identify novel biomarkers (associated with biochemical failure after radiation therapy in tissue, blood and urine specimens
- Identify radioresistant tumour “hotspot” within the tumour volume using molecular biological imaging techniques (MRI, PET)
- Develop novel actionable drug target to improve the therapeutic ratio of radiation therapy
Development of a Companion diAgnostic teSt for radiotheraPy prostAte canceR patients (CASPAR)
PI: Laure Marignol
There is an unmet need to develop companion diagnostic tests that can guide patients and their clinicians through the treatment decision process. This project assesses a novel protein for its prognostic and therapeutic potential in high risk radiotherapy prostate cancer patients. The long-term focus of CASPAR is to develop a novel companion diagnostic test and therapeutic combination that can allow personalized prescription of radiotherapy for these patients. This project -is funded by Science Foundation Ireland.
Prognostic Potential of miRNAs in high-risk radiotherapy prostate cancer patients
PI: Laure Marignol
This study aims to identify a miRNA panel that can be detected in diagnostic tissue biopsy specimen from high-risk patients, which will assist the identification of the 30-50% who are at greater risk of biochemical failure following radiotherapy. To enable this discovery process, our lab has developed a radioresistant prostate cancer cell line model (McDermott et al. Scientific Reports 2016 PDF 1MB) Candidate key miRNAs were identified through the comparison of the profiles generated (PDF 595 kB) As part of this project we are constructing a biobank of tissue collected from Irish high-risk prostate cancer radiotherapy patients. Insight gained in this project will influence future direction of prognosis of treatment of RT prostate patients. Long-term, this may reveal potential targets for future targeted-drug development and lead to the development of a novel prognostic clinical test with significant commercial potential. This project was funded by the Irish Cancer Society.
Radiotherapy in Practice
The aim of this strand of research is to improve patient health, care and health systems though the optimisation of current treatment protocols.
1. Treatment Planning
This research strand specifically aims to:
- Improve the delineation of tumour volume and organ at risks using novel molecular imaging modalities
- Reduce radiotherapy normal tissue toxicities by incorporating novel imaging modalities for optimised planning of dose delivery.
1.5T Diffusion-Weighted MR-guided Target Volume Delineation and Treatment Planning for High Risk Prostate Cancer.
This study investigates the ability of 1.5 Tesla Diffusion-Weighted MRI to identify the gross tumour volume (GTV) in radiotherapy for high risk prostate cancer and to dose escalate the GTV through dose painting. It is hypothesised that the use of ADC maps or logistic regression may reduce interobserver variability in target volume delineation. The study will also establish whether a specific treatment technique is optimal for dose escalation to these defined GTV in high-risk prostate radiotherapy. . Insight gained in this project will influence the ability to safely dose escalate and may reduce the number of biochemical failures.
2. Radiation Physics
The focus of this research strand is to:
- Improve image quality to maximise sensitivity and specificity of target delineation
- Incorporate biological and physical parameters of radiotherapy treatment to current algorithm for the improved modelling to treatment outcomes
3. Risk Assessment
This research strand specifically aims to:
· Improve the quality assurance of Radiation Oncology through the development of a platform of incident reporting (ROSEIS project)
· Improve the delivery of radiation therapy though training and the development of safety guidelines.
Development of a common taxonomy and refinement of the Radiation Oncology Safety Education and Information System
PI: Ms Mary Coffey, Ms Anita O’Donovan
This study aims to improve patient safety in radiotherapy by enabling more efficient and effective sharing of information on incidents and near incidents to enable centres to learn from each other and in this way to improve the safe delivery of radiotherapy and to develop a safety culture internationally.
ROSEIS was developed to support ESTRO in its position as a leader in Europe in radiation oncology, by facilitating a reporting and learning system which would enable clinics to meet the legal requirement laid down in Directive 2013/59/EURATOM to report, analyse and learn from incidents and accidents in the medical use of radiation. It can be used as a local system by individual departments but also to enable sharing of information with the wider radiation oncology community.
ROSEIS is managed by the ESTRO Radiation Oncology Safety and Quality Committee (ROSQC) committee who will analyse data and liaise with other national and international systems to consider trends and prepare reports for dissemination.
4. Clinical Evaluation of the Proliferation Saturation Index: A proof of concept study
PI: Sarah Barrett
This study aims to investigate the role of imaging biomarkers as predictors initial response to radiotherapy in Locally-Advanced Non-Small-Cell Lung Cancer.
It has been hypothesised that the proliferation rates of a tumour can be mathematically modelled based on routine clinical images, and from this we can predict tumour response to treatment. This research aims to evaluate this concept in clinical datasets, and will further investigate if this can be linked to patient outcomes.
5. Current Research: Radiomics based assessment for radiation induced normal tissue damage in the head and neck
Researchers: Elizabeth Forde and Laure Marignol
The long-term goal of this research is to better understand how cone beam CT based radiomics may be used to inform clinicians of the need for early plan adaptation in order to lessen damage of normal tissues, improve functional outcomes and decrease adverse events in head and neck radiotherapy.
The central hypothesis is that early changes to the vascular architecture, detected on quantitative image analysis, could act as an imaging biomarker and hold prognostic value for radiation induced normal tissue damage. This information can then be used by clinicians to perform adaptive radiotherapy with a focus on lessening normal tissue damage. This hypothesis was formed, in part, based the literature, which shows that radiomics has a proven predictive value; however to date this has largely been confined to tumour response and not normal tissue damage.
Health Services Research
The aim of this strand of research is to improve patient health, care and health systems though the development a standard of care adapted to sensitive populations.
1. Management of the elderly (radiotherapy) cancer patient
This research strand is an integral part of the Ageing Challenge of Trinity College Dublin. This research specifically aims to:
- Adapt the Geriatric Assessment Tools to the care of the radiotherapy patient
- Improve the knowledge of health care professionals on the elderly patient’s needs
- Evaluate the impact of specific management of the elderly on treatment outcomes and the health care system
Geriatric Assessment in Radiation Oncology
Despite the body of evidence demonstrating the benefits of geriatric assessment, its adoption in oncology has not been widespread. The purpose of this study was to gain consensus on the optimal method of assessing older patients in Oncology. A three phase approach is being used. The first phase consisted of a consensus seeking study (O’Donovan et al, EJC, 2015), employing an expert task force to iteratively develop guidelines on the optimal method of Comprehensive Geriatric Assessment (CGA) in Oncology. These guidelines, were used as the basis for a phase 2 pilot study in clinical practice. Phase 3 is currently underway, and comprises a secondary data analysis of CGA outcomes in Irish cancer patients. Insight gained in this project will influence the provision of oncology services to elderly patients within the Irish healthcare system. This work is extremely timely in Ireland, where there will be a predicted doubling in the proportion of the population over the age of 65.
2. Education and Information
The focus of this research strand is to:
- Develop better means of communication with the Radiation Oncology community (student, patients, staff)
- Increase awareness of Radiation Oncology within the professional and public community.
PI: Agnella Craig
“Health Literacy Levels in Prostate Cancer Patients: Relationship of Health Literacy Level, Understanding of Cancer Information and the Decision Making Process” The purpose of this study is to examine the relationship between health literacy levels, cancer knowledge and decision making in a population of newly diagnosed prostate cancer patients. This study of a prostate cancer population specifically aims to evaluate the impact Health Literacy level has on cancer knowledge and ascertain if prostate cancer patients who are involved in decision-making are knowledgeable about their treatment options. The nixed method approach will provide quantitative data from a large number of participants and the qualitative aspects will offer insights into the decision-making process. The results from this study will help to identify the impact of health literacy level on cancer knowledge and the decision making process. From this, the current approach to patient information may need to be revised to ensure that prostate cancer patients involved in decision making, adequately comprehend cancer information ensuring their treatment decision is truly informed.
3. Barriers to Accessing Radiation Oncology –BARO project
PI: Claire Poole
This project will investigate the barriers to RT utilisation following the ESTRO-HERO project which reported underutilisation of radiation therapy as a treatment modality. Radiotherapy is an essential and cost effective treatment for most cancers which often gets overlooked. Access to Radiation Therapy is sub-optimal with worldwide access reported as being unacceptably low. Some of the gap between actual and optimal use can be addressed by policymakers prioritising funding and resources to the development of RT services however we also need to comprehend and understand other factors/barriers that may also be contributing to suboptimal utilisation of RT in a comprehensive treatment program for cancer. The aim of this project is to investigate the barriers to access from a patient/consumer perspective and ultimately see how these can be addressed.