Current research projects in the Discipline of Radiation Therapy include:
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.
The focus of this laboratory-based strand is to:
- Predict radiation therapy treatment failure, though the biological characterisation of non-radiation responsive cells
- Develop novel therapeutic strategies to improve the therapeutic ratio of radiation therapy
Creating the next-generation Cancer cell DNA damaging agent
PI: Dr. Laure Marignol [ hyperlinks to https://www.tcd.ie/medicine/radiation-therapy/research/research-projects/MARIGNL]
Our insufficient, biologically challenged or poorly targeted ability to generate fatal DNA damage in cancer cells is recognised as an underlying major limiting factor to therapeutic efficacy of current cancer treatments. While efforts to modify the DNA damage response are yielding encouraging results, few novel anti-cancer DNA damaging agents are emerging. This project aims to create the next generation cancer cell DNA damaging agent.
Tumours have a sex: Impact on disease development and treatment response.
PI: Dr. Laure Marignol [ hyperlinks to https://www.tcd.ie/medicine/radiation-therapy/research/research-projects/MARIGNL]
The issue of sex bias or sex dismorphism in science is rapidly gaining momentum. Sex is a variable that affects several biological functions including both the innate and adaptive immune systems, the mode of stress-induced cell death and pain responses. Sex-specific studies have highlighted that drugs may affect males and females differently. But the impact of sex on the radiation response remains largely unstudied. Our lab investigates the impact of sex as a biological variable in the response to anti-cancer treatment. This work involves the generation of in vitro survival curves using both female and male cancer cell lines, the review of published and recorded clinical data, and a solid evaluation of the potential sex-specific differences in the behaviour of cancer cells.
Past projects may be viewed via Dr. Laure Marignol’s CV profile [ hyperlinks to https://www.tcd.ie/medicine/radiation-therapy/research/research-projects/MARIGNL ]
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.
Magnetic Resonance Imaging (MRI) Radiomics-Towards the personalisation of prostate radiation therapy.
PI Dr. Michelle Leech and Dr. Laure Marignol.
Radiomics is the high throughput of mineable quantitative imaging biomarkers. This project firstly uses phantom analysis to determine the impact of image acquisition parameters on the reproducibility of radiomics features. Pre-processing of images prior to feature extraction include the processes of normalisation, voxel resampling, bin width selection and interpolation algorithm selection. The second part of this project evaluates the impact of these pre-processing parameters on the reproducibility of radiomics features in multiparametric MRI. Finally, radiomics features are evaluated to ascertain their ability to predict clinical features in prostate cancer on mpMRI- namely pimonidazole score, Gleason score, clinical T stage and D’Amico risk stratification.
Radiomics based assessment for radiation induced normal tissue damage in the head and neck
PI: Ms. Elizabeth Forde and Dr. 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.
E-PRO: Empowering European Patients in Radiation Oncology.
PI: Dr. Michelle Leech, Co-Investigator: Ms. Claire Poole, External Collaborators: Dr. Ciska Hoving, Maastricht University, Ms. Antonella Cardone and Mr. Max Schravendeel, European Cancer Patients Coalition, Mr. Will Fox, Trinity Online Services Ltd.
Funding Agency: EIT Health.
E-PRO is a project that provides European citizens with accurate information about radiation therapy to empower those who have cancer to decide if radiation therapy is a treatment option for them. It is delivered as a two week MOOC on the Future Learn platform using easily understood materials such as video and short articles. The MOOC was developed in 2018 and is now being translated into Russian, French and Spanish, together with the development of new modules on shared decision making.
ROSEIS: Radiation Oncology Safety Education Information System
PI: Dr. Anita O’Donovan and Ms. Mary Coffey
This research strand specifically aims to improve the safety and quality of radiation oncology through the development of a platform for incident reporting and provision of training and safety guidelines.
To this end, ROSEIS strives for the development of a common taxonomy and refinement of incident reporting practices across Europe. This study aims to improve patient safety in radiation therapy 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.
It may be accessed here: https://roseis.estro.org
ACROPP: Analysis of Changes in Radiation Oncology Practice during the Covid-19 Pandemic
PI: Dr. Michelle Leech, Co-Investigator: Dr. Aileen Flavin, Cork University Hospital and National Cancer Control Programme.
Funding Agency: Covid-19 Response Funding-Harnessing Trinity’s Collective Expertise for the Greater Good- Dean of Research Fund.
Radiation therapy is a key component of cancer treatment with 50% of all cancer patients requiring radiation therapy at some point in their management. During the Covid-19 pandemic, changes in radiation therapy practice are inevitable due to the immunocompromised status of patients, the potential for patients to be Covid-19 positive as well as the Covid-19 status of specialised radiation therapy professionals involved in the planning and delivery of treatment. The primary aim of this research is to collate the reported changes in practice in participating Irish radiation oncology during the pandemic over the full range of cancer sites and analyse the potential strengths and weaknesses of these changes.
Clinical Evaluation of the Proliferation Saturation Index: A proof of concept study
PI: Ms. Sarah Barrett and Dr. Laure Marignol
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.
Cardiac Exposure in Lung Cancer Radiation Therapy: A Systematic Review of Heart Doses Published During 2013 to 2018
P.I. Ms. Maeve Kearney, Dr. Maeve Keys, Dr Frances Duane
The aim of this study is to present a systematic review of heart doses reported in lung cancer radiotherapy in the modern era. It aims to summarise the cardiac sparing effect of current treatment approaches by describing how cardiac exposure varies according to region irradiated, laterality, treatment modality, planning technique, and the use of respiratory motion management. The findings may serve as a benchmark for research groups designing future epidemiological and clinical studies investigating radiation-related heart disease in lung cancer
Usage rates of single-fraction radiation therapy for the palliation of bony metastases in the Republic of Ireland
PI Ms, Laura Mullaney and Dr. Laure Marignol
A considerable body of evidence from randomised trials supports the use of a single fraction radiation therapy (SFRT) over multiple-fraction courses (MFRT) in the treatment of uncomplicated bone metastases. Consequently, many international practice guidelines have recommended SFRT in this setting. Despite this, international patterns of practice have demonstrated a reluctance to adopt SFRT as standard practice. This study investigates the SFRT usage rates for bony metastases in Ireland and assessed the impact of clinical factors and patient demographics on the selection of SFRT and MFRT in this setting.
Feedback in a Clinical Setting
P.I. Ms. Maeve Kearney, Dr. Michelle Leech, Dr. Siobhan Davis
Clinical practice is an integral component of the education and training of healthcare professionals. Clinical supervision and the provision of feedback is key to enhancing the learning experience of students during clinical practice. An eLearning module was developed to empower healthcare professionals to engage more actively in clinical supervision and the feedback process. The aim of this research is to analyse the effectiveness of this educational intervention by evaluating the attitudes and approach of healthcare professionals to the feedback process before and after completing this eLearning module.
Radiation therapy health services
This research strand specifically aims to improve the knowledge of health care professionals of the older patient’s needs and to evaluate the impact of specific management of the older person on treatment outcomes and the health care system as a whole. It also explores the barriers to radiation therapy utilisation worldwide and advocacy issues for patients accessing treatment.
Geriatric Assessment in Radiation Oncology
PI: Dr. Anita O'Donovan and Dr. Michelle Leech
Despite the body of evidence demonstrating the benefits of Comprehensive Geriatric Assessment (CGA) in older adults, 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 was used in this research and PhD study.
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 CGA in Oncology. These guidelines, were used as the basis for a phase 2 pilot study in radiation oncology. Phase 3 comprised a secondary data analysis of CGA outcomes in Irish patients with cancer from TILDA (The Irish Longitudinal StuDy on Ageing).
Insight gained in this project will influence the provision of oncology services to older patients with cancer within the Irish healthcare system.
Barriers to Accessing Radiation Oncology –BARO project
PI: Ms. 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.
Prostate Cancer Patient Survivorship ASPIRE Post CSCST Fellowship
PI: Dr. Anita O’Donovan and Dr. Pierre Thirion
The proposed ASPIRE Fellowship in Prostate cancer survivorship (ongoing) will comprise the acquisition of subspecialised clinical experience, knowledge and competency in the management of patients with prostate cancer focusing on the detection, evaluation and management of treatment-related sequelae and overall survivorship care. It will also evaluate and address unmet needs, in the specific Irish context and review the impact of existing guidelines on bone-health, including an audit of DEXA scans. A third component is the evaluation and implementation of frailty assessment tools in daily practice for patients aged 70 years and older. The overarching purpose of this programme of research is to provide more evidence-based guidelines for the treatment of older people with cancer.
Funding Agency: HSE https://www.hse.ie/eng/staff/leadership-education-development/met/ed/postcscst/