Radiation Oncology

Radiation Therapy

The Undergraduate course that trains Radiation Therapists. Please follow this link.

Radiation Oncology

Second, third, fourth and fifth year medical students are attached to the department of Medicine in St. James’s Hospital, Tallaght University Hospital and affiliated hospitals. In addition to formal lectures in Radiation Oncology that are delivered in fifth year , students are encouraged to join the visiting Radiation Oncologists (in St James Hospital and Tallaght University Hospital) seeing ward referrals and out-patients. Furthermore students are always very welcome to attend St Luke’s Hospital, which at present (2009) is the country’s largest public radiotherapy facility.  Such attachments include clerkships where the medical student joins a radiation oncology team, seeing patients in the out-patients department or on the wards, observing patients receiving radiotherapy and joining the team in assessing patients on-treatment.

It is anticipated that the completion of the Radiotherapy Facility on the grounds of St James Hospital late 2010/early 2011 will help further enhance the exposure of undergraduates to this important cancer treatment modality.

Key areas of postgraduate education provided by AUCMO staff include programmes within the;

• M.Sc. in Molecular Medicine
• Higher Diploma in Oncology Nursing
• Advanced European postgraduate courses including the European Society for Therapeutic Radiation and Oncology (ESTRO) programmes in Radiotherapy Treatment planning
• ROSIS Course Working towards safer Healthcare Delivery endorsed by ESTRO
• Prostate contouring course
• M.Sc in Advanced Radiotherapy Practice
• Postgraduate diploma in Advanced Radiotherapy Practice

Active research interests within AUCMO include the following areas of translational, clinical and health services investigation:

Translational Research

• Molecular and genetic analyses of prostate, breast, oesophageal and lung cancers
• Pre-clinical study of new cancer therapies including gene targeting and gene therapy
• Development of novel molecular screening approaches for specific cancers
• Study of familial cancer syndromes and high risk families

Clinical

• Development of bio-mathematical modelling tools for radiation oncology treatment
• Development of quality assurance systems for oncology practice
• Development of institutional, national and international phase III cancer clinical trials

Health Services

• Analysis of quality of life indices within oncology clinical practice
• Cost benefit and cost utility analyses of existing and new treatments
• Development of new risk management strategies and protocols for cancer care (ROSIS)
• Analysis of tele-medicine and tele-oncology programmes including Telesynergy ® 

Further details of research
Translational Research
Background

A number of radiation therapy (RT) strategies, including 3-D conformal external beam radiotherapy (EBRT), brachytherapy and intensity-modulated-radiation- therapy (IMRT)  are now accepted as a curative treatment approaches for localized prostate cancer, with equivalent survival outcomes for low, medium and high risk patients when compared to surgical management. Long-term results are however dependent on tumour stage and treatment failure remains a reality for a significant number of patients particularly those with adverse clinical and pathological risk criteria. In addition, controversy exists as to the true value of the radiosensitivity parameters (α/β ratio) of prostate tumours.

We propose that stratification of patients according to their tumour microenvironment may represent a strategy for optimal management of prostate cancer patients. Furthermore, we propose that characterization of the tumour microenvironment may facilitate the determination of the α/β ratio of prostate tumours. Finally, maximizing the killing effect of low-doses of radiation may activate specific signaling pathways such as Notch in a number of cellular models participate in improved treatment outcome.

Current Research

Hypoxia-inducible factors have been shown. The expression of Notch family members was investigated in a panel of prostate cancer specimen and validated in a variety of prostate cell lines. Preliminary data suggest deregulation of this pathway may be involved in prostate tumorigenesis and androgen-independence, potentially though preferential selection of hypoxic clones.

We are also currently characterizing the role of hypoxia on the radioresponse of prostate tumours. Preliminary data suggest hypoxia-induced radioresistance may be time-dependent, cell type specific and directly associated with the single-hit component (alpha parameter) of the linear-quadratic model of cell killing by radiation. Current research involves further determination of the impact of hypoxia on the α/β ratio of prostate tumours.

Finally, we are investigating a novel molecular mechanism for low dose hyperradiosensitivity (LDHRS). LDHRS is the phenomenon whereby cells exposed to radiation doses of less than ~0.5Gy exhibit increased cell kill relative to that predicted from back-extrapolating high-dose survival data using a linear quadratic model. Preliminary data indicate possible involvement of MMR-dependent processing of damage induced by low-dose radiation in prostate cancer cells, which may allow us to identify those tumours that may benefit from a low-dose fractionated radiotherapy regimen in the clinic.

Research and Development in the Radiotherapy Department at St. Luke’s Hospital

The Radiotherapy Dept has a very active research and development programme. Radiation Therapists directly and indirectly lead, design, co-ordinate and support all clinical trials that are conducted in St. Luke’s Hospital.  These clinical trials involve research in prostate, lung, spinal cord compression, head & neck and breast cancer. 

Prostrate

• A randomised trial comparing the bladder volume consistency achieved with two bladder-filling protocols in prostate conformal radiotherapy.  ICORG 05-04.  PI Prof John Armstrong & Dr Pierre Thirion. 
• CHHiP – Conventional or hypofractionated high dose intensity modulated radiotherapy prostate cancer.  Cancer Research UK.  ICORG 08-18.  PI Dr Pierre Thirion
• A Formal Evaluation of Prostate Verification Procedures in the Simulator.  (In-house only.)  PI Dr Pierre Thirion & Evelyn O’Shea

Lung

• Prospective evaluation of PET-CT scan in patients with non-operable or non-resectable NSCLC treated by radical 3-DCRT. ICORG 06-35.  PI Dr Pierre Thirion
• Radiation dose escalation for non-small cell lung cancer using hypofractionated 3-dimensional conformal radiation therapy.  ICORG 99-09  PI Dr Pierre Thirion
• A prospective randomised controlled clinical trial to evaluate three immobilisation devices for intra-thoracic radiation therapy.  (In-house only.)  PI Dr Pierre Thirion
• An investigation into the placement of tattoos on stable skin for the treatment of thoracic radiotherapy patients.  (In-house only.)  PI Evelyn O’Shea

Spinal Cord Compression

• A randomised phase III trial of two fractionation schemes in the treatment of malignant spinal cord compression.  ICORG 05-03.  PI Dr Pierre Thirion
• A phase II trial evaluating the efficacy of a radio-biological based re-irradiation strategy for patients with malignant spinal cord compression. ICORG 07-11.  PI Dr Pierre Thirion

Head and Neck

• A prospective randomised controlled clinical trial to evaluate standard versus customised headrests for head and neck radiotherapy patients. ICORG 08-09.  PI Dr Pierre Thirion

Breast

• Phase II randomised clinical trial of accelerated partial breast irradiation (APBI) comparing 3-dimensional conformal radiation therapy and multi-catheter interstitial brachytherapy.  ICORG 06-33.  PI Dr Pierre Thirion
• A randomised phase III study of conventional whole breast irradiation (WBI) versus partial breast irradiation (PBI) for women with stage 0, I or II breast cancer.  NSABP B-39.  ICORG 08-06.  PI Dr Pierre Thirion

Future planned clinical trials in St. Luke’s Hospital include:

• A Prospective Randomised Phase II Trial evaluating Adjuvant Pelvic RT using either IMRT or 2-D Planning for Early Stage Endometrial Car.  PI Dr Charles Gillham
• An investigation into the use of Reformatted CT Images in CCU Patients receiving HDR Brachytherapy Treatment.  PI Dr Charles Gillham
• A study into the potential of Raman spectroscopy for the diagnosis and treatment of cervical cancer. PI Dr Charles Gillham
• IMRT for Head and Neck Cancer PI Prof Donal Hollywood

Other research and development projects in the radiotherapy dept include areas such as treatment delivery, new treatment techniques, new technology, imaging - Imaging Image Guided Radiotherapy (IGRT) and Electronic Portal Imaging (EPI), Intensity Modulated Radiotherapy (IMRT), treatment accuracy, immobilisation equipment and treatment techniques evaluation. 

Radiation Therapists from St. Luke’s Hospital have in the past and are currently undertaking Masters through Research (MSc) and Postgraduate Diploma in Statistics in Trinity College Dublin.  Candidates are supervised by a clinical staff member from the department and a member of the lecturing staff at Trinity College.

The Radiotherapy Dept has research and development links with numerous Radiotherapy Centres (all Radiotherapy centres in Ireland, Belfast and many international centres in Europe), national and international research organisations including the EORTC, ESTRO, ICORG, ICS, HRB, NSABP and Cancer Research UK, and a number of equipment manufacturers.