Each year the EORTC offers an Emmanuel van der Schueren Fellowship to a promising early career scientist involved in radiation therapy quality assurance (RT QA). This Fellowship, supported by the Vlaamse Liga tegen Kanker, provides a unique opportunity to conduct radiation oncology research under the mentorship of members of the EORTC Radiation Oncology Group. For 2012 – 2013, Dr. Warren Grant was the EORTC Emmanuel van der Schueren Fellow.
Dr. Grant, a native of Leeds in the United Kingdom, did his medical studies at the University of Bristol. Before coming to the EORTC he specialized in Clinical Oncology at The Oxford Cancer Centre. During his tenure as EORTC Emmanuel van der Schueren Fellow, Dr. Grant pursued research activities in radiation therapy quality assurance, assisted in the design of two EORTC clinical trials, analyzed models of Quality of Life assessment in EORTC studies involving radiation therapy, and contributed to the initiation of the EORTC Synergy of Targeted Agents and Radiotherapy (STAR) Platform.
Cancer Clinical Trial Design
The EORTC 22113-08113 LungTech trial is being developed by the EORTC Radiation Oncology Group in collaboration with the EORTC Lung Cancer Group in order to assess the effectiveness of stereotactic body radiotherapy in patients with medically inoperable early stage, centrally located non-small cell lung cancer as well as in patients who decline surgical treatment. This trial has a number of highly innovative aspects. Dr. Grant was involved in compiling the protocol and worked closely with the EORTC Statistics, Data Management and RT QA Departments.
Warren also developed a template protocol for a phase I trial involving a novel agent plus radiation therapy for patients diagnosed with soft tissue sarcoma during the joint ECCO-AACR-EORTC-ESMO Workshop on Methods in Clinical Cancer Research, FLIMS 15. This protocol template provides the basis of an EORTC Radiation Oncology Group platform for further trials of novel agents plus radiation therapy.
Review of Facility Questionnaire
The EORTC Facility Questionnaire is a primary level of RT QA, and its completion is required of all sites wishing to enroll patients into EORTC trials using radiotherapy. Dr. Grant conducted a review of the Facility Questionnaire database and summarized information on treatment simulation, delivery, verification and quality assurance for over 150 centers across the EORTC’s worldwide network. He then compared these data to previous reviews published in 1996 and 2008 and hopes the new review will add to the evidence used for radiotherapy capacity planning on national and international levels.
On another note, Warren analyzed the RT QA in EORTC trial 22033-26033. The seminal questions asked here were first, does the success or failure of pre-treatment RT QA affect outcome (based on the radiation therapy case report form and with respect to progression-free or overall survival), and second, what were the rates of radiation therapy case report form deviation in the radiation therapy delivered in this study? Further questions included: what is the role of ‘pre-treatment’ RT QA, and how should we define a tiered RT QA process? He hopes to add to the evidence showing that the EORTC RT QA platform, first developed in 1982, has now developed into an efficient and effective program of center, trial and patient specific activities, each focused on ensuring safe and standardized delivery of technically advanced radiation therapy.
Quality of Life questionnaires in radiation therapy clinical trials
In collaboration with the EORTC Quality of Life Department, Warren looked into the affect the time of completing the EORTC QLQ-C30 can have on the scores assigned by patients. Scores can vary significantly depending on whether these were completed before, during or after chemotherapy, so, together with a team from the Quality of Life Department, Warren sought to determine the effect of radiation therapy. Data were analyzed in 1125 questionnaires from 358 patients in three EORTC trials. A worldwide network of Quality of Life experts is now collaborating to review the data and aims to define a ‘time window’ model within which quality of life data in radiation therapy trials remain reliable.
EORTC STAR Platform
The EORTC STAR initiative is a novel European multicenter clinical trial platform for combined radiation therapy strategies. Radiotherapy is extremely important in treating patients with cancer; it is used in approximately half of all cancer treatments and in about four out of every ten patients cured. In this light, the STAR platform will be instrumental in accelerating successful development of targeted as well as novel therapies.
STAR has assembled an advisory board with key opinion leaders in radiobiology and radiotherapy and has an infrastructure to support new opportunities for collaboration between industry and academia. It provides access to state-of-the-art clinical and preclinical radiotherapy modalities, molecular diagnostic tools and imaging platforms, integrates the expertise of world class radiobiology and radio-oncology centers, and the well-established EORTC RT QA program.
Warren now joins the staff in the Cheltenham General Hospital Oncology Department, where he will take up a post as Consultant Clinical Oncologist on his return to the UK. ‘I’ve had a fantastic year. The EORTC offers its fellow an incredibly broad experience of clinical trial design and implementation. The support of the Vlaamse Liga tegen Kanker and the EORTC Radiation Oncology Group has enabled me to analyze key aspects of the RT QA process in depth, hopefully for the benefit of cancer patients in the future. I’m very grateful to them, and to everyone affiliated to the EORTC who has helped me during my year in Brussels.’
Dr. Melissa Christiaens succeeds Dr. Grant as the 2013 – 2014 Emmanuel van der Schueren Fellow. Melissa graduated cum laude from KU Leuven in 2009 with her degree in general medicine. Following her studies she trained as a Specialist Radiation Oncology for two years at the Limburgs Oncologisch Centrum in Hasselt, Belgium, and returned to KU Leuven for an additional two years of training.
John Bean, PhD
EORTC, Medical Science Writer