ANDROMEDA Study
Research type
Research Study
Full title
A feasibility study iN Dose escalated treatment in Rectal cancer On Mr-Linac using mr guidED Adaptive radiotherapy
IRAS ID
322487
Contact name
Brian Ng-Cheng-Hin
Contact email
Sponsor organisation
The Royal Marsden Hospital NHS Trust
Duration of Study in the UK
4 years, 0 months, 0 days
Research summary
Colorectal cancer is the 3rd most common cancer in the UK with ~50% of cases being rectal cancer. Treatment consists of neoadjuvant chemoradiotherapy followed by total mesorectal surgery. However despite triple modality treatment overall survival (OS) at 5 years is 50-60%. A small cohort of patients (15-25%) treated with standard radiotherapy fractionation schedules achieve complete pathological response (cPR) which is found to prognostic; OS improves to >87% [8], whilst disease free survival (DFS) is as high as 92% [10,11] at 5 years. Dose escalating radiotherapy to rectal tumours is known to increase cPR rates. However attempts to dose escalate treatment have been unsuccessful due to concern of toxicity to organs at risk (OARs).
Limitations in dose escalation for rectal cancer are also due to uncertainties in the location of tumour on CT imaging. There is also large motion of the rectal tumour daily caused by gas distension and bladder filling; thus to ensure treatment does not miss the tumour, the treatment field remains large.The introduction of MR integrated linear accelerators (MR-Linac) allows for accurate localisation of tumour, as well as reducing motion with online adaptation to anatomy of the day. This allows for a smaller treatment field, and accurate delivery of radiotherapy. As well as this, studies looking at rectal cancer on MRI during treatment demonstrate that rectal tumours shrink by week 2-3. Thus, by delivering dose escalated treatment with shrinking boost technique chances of patients having organ preservation increases following treatment whilst keeping toxicity and improving quality of life for these patients.
However, to the best of our knowledge, there is currently no published literature performing this type of radiotherapy delivery. Therefore, this unit proposes a feasibility study combining dose escalation and shrinking boost volume to rectal cancer patients using the Elekta Unity MR-Linac.
REC name
Yorkshire & The Humber - Bradford Leeds Research Ethics Committee
REC reference
24/YH/0179
Date of REC Opinion
19 Sep 2024
REC opinion
Further Information Favourable Opinion