Balancing the benefits and risks of radiotherapy for the treatment of breast cancer and lymphoma
Kate Vallis, Oxford Institute for Radiation Oncology (OIRO), Vanessa Ferreira, Oxford Centre for Clinical Magnetic Resonance Research (OCMR)
Breast cancer and Hodgkin lymphoma are both highly curable malignancies with approximately 80% of individuals surviving 10 years or more from diagnosis. However it is well recognised that both chemotherapy and radiotherapy increase cardiac morbidity and mortality in survivors as well as causing other important late effects such as second cancers.. Radiotherapy for early breast cancer is proven in meta-analyses to reduce relapse rates and increase overall survival. Additionally, recently reported trials of internal mammary chain (IMC) radiotherapy for breast cancer have demonstrated benefits, but with an increased incidental radiation dose to the heart. Radiotherapy is an important modality in the treatment of Hodgkin lymphoma, reducing relapse rates even in favourable prognostic groups, but treatment of the mediastinum when involved necessarily results in cardiac exposure. There is therefore substantial interest quantifying radiation-induced cardiac toxicity and in the development of radiotherapy techniques which could minimise this. As cardiac toxicity following radiotherapy does not typically become clinically manifest for several years after treatment there is a need to develop early surrogate biomarkers of cardiac toxicity.
RESEARCH EXPERIENCE, RESEARCH METHODS AND TRAINING
1) Recruitment of a clinical cohort of patients, to be treated with IMC radiotherapy for breast cancer or mediastinal radiotherapy for lymphoma. In collaboration with the OCMR, novel cardiovascular magnetic resonance (CMR) biomarkers and advanced myocardial tissue characterisation will be used to allow deep phenotyping of radiation-induced cardiac toxicity. Novel blood biomarkers of cardiac toxicity will also be studied.
2) The pre-clinical assessment of novel radiotherapy techniques to be used in planned studies of proton beam therapy (PBT) for breast cancer and lymphoma, including the development of methods to predict the health and economic benefits that may be derived from cardiac-sparing radiotherapy techniques.
3) The development of risk prediction tools and an associated decision aid to help individualise the use of radiotherapy in the treatment of Hodgkin lymphoma within the context of a forthcoming randomised clinical trial.
field work, secondments, industry placements and training
An honorary NHS contract to allow the recruitment of patients into the clinical components of the study. This would include appropriate clinical training and involvement in the treatment of patients under the direct supervision of the Clinical Supervisors.
Training in radiotherapy treatment planning using proton beam therapy would be provided via the OIRO.
There would be opportunity for formal training in Epidemiology and Statistics.
The ideal candidate would be a Clinical or Radiation Oncologist with experience in or an interest in developing knowledge of Clinical Trials and Epidemiology.