As many facilities move back towards normal operations after COVID restrictions, Professor Pat Price, a leading expert on radiation oncology, discusses what that means for adaptive radiotherapy.
As hospitals around the world emerge from the strain and restrictions of the COVID pandemic, a large number are looking at ways to catch up with advances in patient treatment and find improved methods to manage patient care.
When Varian introduced Ethos™ therapy at ASTRO in 2019, few imagined the events of the following year and their impact. Nevertheless, the number of Ethos systems deployed around the world—and hence, the number of adaptive treatments delivered—has continued to grow, with compelling early results (see Ethos™ Adaptive Radiotherapy Redefining Cancer Treatment).
Pat Price, Visiting Professor in the Department of Surgery and Cancer at Imperial College, London, currently chairs the UK’s national charity, Action Radiotherapy, and is the chief advisor to the All-Party Parliamentary Group on Radiotherapy. She has published more than 300 research papers and was the first Ralston Paterson Professor of Radiation Oncology at the Christie Hospital in Manchester. She established the European Organization for the Research and Treatment of Cancer (EORTC) Functional Imaging group, developing strategic links between oncologists and imagers and guidelines for PET in clinical trials. In this Q&A, Professor Price shared her thoughts, experiences, and predictions on adaptive radiotherapy and its future fighting cancer.
Professor Price, what have been your most notable observations around radiotherapy over the past few years?
I've been working in oncology now for 33 years and I’ve had a top-level view of radiotherapy’s progression, from the introduction of CT planning back in the 80s to stereotactic, and now online 4D adaptive and that has been just brilliant. The technology from the past ten years or so has completely transformed the field, and there are such a lot of gains to be had in terms of improving outcomes, protecting normal tissue, and quality control. Now adaptive radiotherapy treatment puts even more technology advances within our reach.
What do you see as some of the biggest challenges facing radiotherapy clinics today?
Radiotherapy is very much a multidisciplinary field. It takes effort to line everything up—imaging, patient positioning, dosimetry and so on—and involves a specialist workforce, digital skills and technology. For many clinics, this means it’s been more challenging to implement all the technology changes that are necessary.
What has been the impact of the recent COVID pandemic on the field of radiotherapy?
COVID also showed the world the clear link between healthcare and economics. For a healthy economy, we must focus on access to good, well-funded healthcare and prioritize access to cancer treatment technology. Radiotherapy has been prioritized due to its curative potential and has been the standout cancer therapy which has been able to adapt, use the most of technology solutions and continue during COVID, often substituting for surgery. COVID has taught us that we must implement the necessary changes and make use of the digital technologies such as artificial intelligence and machine learning, sooner rather than later to make massive gains. Adaptive radiotherapy is an excellent example of the need to move forward quickly. We also saw that we have a fantastic workforce that is up for the challenge, so as we come out of the pandemic, we should seize the initiative, and take advantage of adaptive to increase capacity and quality. That way, not only are we moving forward and dealing with the backlog but we’re building for the future, too. A lot depends on healthcare situations internationally, there is a backlog in surgeries, too, but cancer patients shouldn’t be COVID collateral.
How can we move adaptive radiotherapy forward faster?
Bringing in other disciplines can help with features such as AI, data collection, and data assessment because these technologies can take us far and are accessible. Ethos therapy is a fantastic way forward in terms of the speed and clarity of what you can do with AI to help support personal judgment and automation to improve quality wherever possible. The speed and efficiency is exactly what we need and demonstrates progress in a lot of fields. There’s plenty of evidence that the better quality your planning and delivery, the better outcomes, and the direction forward should be quality planning, more accuracy, smaller volumes—and this is adaptive. Adaptive brings together the quality, speed, and precision we need, particularly now, as we have more patients to treat with cancer services being disrupted by the pandemic.
What do you see as the most important next step?
Over the last year or so, there's been a lot of positive problem solving in radiotherapy work. Now we’re in less of a reactive position, it’s time to engage with the potential of adaptive as a solution, conduct more research and plan future services. There are technology solutions to help us with some of the workforce issues, and we all need to be defining and communicating the emerging advantages of 4D adaptive precision radiotherapy solutions around the world, to clinicians and healthcare providers. We know that there is a very exciting future for 4D adaptive radiotherapy.
Use the links below to access each profile/interview:
- The Treatment Adapts so the Patient Doesn’t Have To: Ethos at Queens Hospital, Romford, UK
- Icon Group, Australia: Choosing Adaptive Fractions 98 Percent of The Time
- Royal North Shore Hospital, Sydney, Australia: Adapting to Changes in the Target
- Henry Ford Health System, Detroit, Michigan: Looking Towards Adaptation During Five-Fraction SBRT
- Royal Surrey NHS Foundation Trust, Guildford, UK: Focusing on Patients Who Will Benefit Most
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The information captured herein represents the genuine experience of the attributed individuals and may not necessarily represent the views of Varian or the above-referenced institution. Individuals were not compensated for their participation. Radiation treatment may not be appropriate for all cancers. Individual results may vary. For more information, please visit www.varian.com/safety.