Gastrointestinal Clinical Oncology Group

We are collaborating with Dr Gert Meijer of the Department of Radiation Oncology at UMC Utrecht, looking at the potential clinical benefit of MRI-guided radiotherapy for oesophageal cancer and highlighting key areas of research for future trials concerning MRI-guided oesophageal cancer treatment.

In conjunction with this collaboration we are currently doing a service evaluation looking at use of MRI to assist in radiotherapy planning for patients with oesophageal and oesophago-gastric cancer.

We are also considering the following future research areas:

• MR response and evaluation
• exploration of adaptive planning strategies with MRI (REACT trial)

the possibility of a clinical trial to test effectiveness of MR-guided radiotherapy.

Chemoradiation in gastrointestinal malignancy has evolved over the past 10-15 years and is an ideal area for the application of new technologies. Gastrointestinal tumours have significant adjacent normal tissues and a key focus of our research is to spare these healthy tissues from the effects of treatment. For instance, in upper gastrointestinal malignancy our research has looked at avoiding the heart using intensity-modulated radiotherapy (IMRT).

Precision radiotherapy requires image guidance to ensure accurate treatment and this is a key area of focus for our research. These studies lead into the current focus on the application of MRI in radiotherapy planning, accuracy of treatment delivery and assessment of response - which is core to the MRI Linac project.

Radiotherapy is effective in rectal cancer and can produce complete responses. We have therefore developed a programme to monitor patients to detect those who can safely defer or avoid surgery. We have addressed the optimal timing of surgery, if it occurs, in a randomised study and the analysis is ongoing and will form the focus of further work. In the pelvis, anal cancer patients have been treated with IMRT techniques for some years and we have worked to establish the toxicity profile of treatment and to improve the delineation of the genitalia as a critical normal tissue.