Current Research

South West Area Mesothelioma and Pemetrexed Trial (SWAMP trial) for patients with asbestosis (a form of lung cancer)

Total £150,720 over 2-3 years.  Pilot study commenced July 2008 led by Prof Iain Lyburn undertaking PET-CT and MRI scans at CIC

Malignant Mesothelioma is an incurable cancer of the outer lining of the lungs (pleura). In almost all cases it is caused by previous asbestos exposure.  The incident of Mesothelioma will continue to increase in the UK until 2020.  Patients with a diagnosis of Mesothelioma have an average life expectancy of only 9 months.  Surgery can help, but it has not been shown to improve survival.  The use of chemotherapy (Pemetrexed) has been shown to improve survival from 9 to 12 months.

We know that the individual's quality of life declines steeply after the first 4 months following diagnosis of Mesothelioma, preserving this early period of good quality of life is therefore very important.  At present, chemotherapy, with its toxic side effects (such as nausea and vomiting) will be prescribed to the majority of patients with Mesothelioma over a 4-5 month period.  However, 60% of those patients will not derive a benefit from it.

The SWAMP trail uses new tests, for example, PET/CT, MRI and blood tests to try to indentify which group of patients will respond to chemotherapy.  Treatment will be better targeted to specific groups of patients with the aim of improving quality of life benefits to patients at a crucial time.

This will also result in costly chemotherapy treatment not being given to patients who will not derive benefit from the treatment.

Radiotherapy treatment planning for patients with Oesophageal Cancer

Working with Cheltenham General Hospital on targeting radiotherapy treatment for patients with Oesophageal cancer.

Cobalt Health undertook a new project as Positron Emission Tomography/ Computerized Tomography (PET/CT) takes on a role in Radiotherapy Planning.

The PET/CT scanner was used on an exciting new collaboration project with the Oncology department, at Cheltenham General Hospital, to help plan optimum radiotherapy treatments for patients with Oesophageal cancer.

Before beginning treatment, a course of radiotherapy is very carefully planned.  This means working out how much radiation is needed to treat the cancer and where exactly it is needed.  The area of the body exposed to radiation is called the 'radiotherapy field'.  There may be between 1 and 4 beams aimed at the cancer from different angles and the point where the beams overlap is where the highest dose of radiotherapy is given.  Doctors call this the 'target volume'.

The radiotherapy treatment has to be carefully planned to make sure the cancer gets the prescribed dose of radiation while normal body tissues have as little as possible.  Some normal tissue will be exposed to the same dose as the tumour but the radiotherapy doctors try to keep this as low as possible.

Traditionally, CT has been the imaging modality of choice for staging and treatment planning.  However, some published studies have shown that PET/CT is proving particularly useful for planning radiation therapy in several areas of the body including the oesophagus.  As PET uses functional imaging it detects areas of metabolically active tumour which allows smaller fields of radiation to be used, helping to reduce the amount of damage to normal tissue.

In order to use the PET/CT images for radiotherapy planning the patients were positioned within the scanner with the use of a flat bed insert, which we have already purchased.  We also needed to acquire wall and ceiling mounted lasers which cost £10,000.

The use of these devices ensured exact localisation of the tumour on the resultant images leading to very accurate treatment planning for each patient.

This use of PET/CT is ground breaking and could change the radiotherapy planning process for a number of different cancers.