Published: 12 September 2023
NIHR has awarded £2.3 million to The Christie NHS Foundation Trust in Manchester to conduct a study aimed at reducing heart damage caused by radiotherapy treatment for lung cancer patients. It will determine whether using artificial intelligence (AI) to spare the top of the heart during radiotherapy can help patients live longer.
A pioneering study
The RAPID-RT study is the first of its kind in the world and is a culmination of more than seven years’ work by The Christie. Radiotherapy is one of the most effective and common treatments for lung cancer. It is recommended for half of patients and it cures 40% of those treated. But, experts have known for many years that when the top of the heart is exposed to radiation it can lead to heart disease. This includes heart attacks and irregular heartbeat. The aim of the study is to change the way patients are treated by understanding how best to do lung cancer radiotherapy without damaging the heart.
Lung cancer is the leading cause of death from cancer in the UK. Annually, 48,000 people are diagnosed with lung cancer and 35,000 people die from it. Currently, five-year survival is low at 15%. Manchester, where The Christie is based, has one of the worst lung cancer mortality rates in England, double the national average.
The study intends to help improve the survival of patients who have been successfully treated for lung cancer but may go on to experience serious heart problems due to their treatment. The team is using an innovative approach to do this which means all patients being treated with radiotherapy can take part. Patients will be offered to opt out of the study rather than opt-in. This is much more inclusive than normal clinical trials which can often be restricted to small, selected groups. It means the study team can learn from every patient with lung cancer treated with radiotherapy. It also means patients won’t need extra hospital visits or procedures to take part.
New AI tool to streamline lung cancer radiotherapy
The RAPID-RT team is recruiting 50 patients per month with the aim of gathering data from at least 2000 people by 2027. To manage the large numbers the team has developed special AI (artificial intelligence) ‘auto-contouring’ software to help plan each patient’s radiotherapy treatment. The software is designed to define the part of the heart to spare.
The tool makes it two and a half times faster than doing the task manually. Without the tool, doctors have to draw a line around healthy organs on scans, ahead of radiotherapy. This is to help protect the healthy tissue surrounding the cancer from being exposed to radiation. It can take between 20 minutes and 3 hours to do this for each patient. This new technology designed specifically for treating lung cancer can identify areas that need to be spared. Oncologists will only need to check the scan before performing the procedure.
"Without research we wouldn’t have the advances in cancer care"
Great-grandfather Alan Featherstone, 71, from Wigan in Greater Manchester is one of The Christie patients who is taking part in the study, having been diagnosed with primary lung cancer in each lung in March this year. “I had a persistent cough and lost weight so went to the doctor and they found I had a tumour in each lung. Surgery wasn’t an option so after chemo, which reduced the tumours, I’ve started a six-week course of radiotherapy. I’m very comfortable being part of the trial and my data being used. I believe if you’re offered the chance to be on a trial you take it. It’s not about me. Without research we wouldn’t have the advances in cancer care.”
Reducing side effects for cancer survivors
Corinne Faivre-Finn, a Professor of Thoracic Radiation Oncology at The University of Manchester and Honorary Consultant Clinical Oncologist at The Christie, who is a world-leader in lung cancer radiotherapy research, said: “Lung cancer treatment has improved dramatically over the last decade. However, we now need to reduce the serious side-effects of treatment for cancer survivors.”
She also explained that AI research like this could have benefits for other patients receiving radiotherapy to the chest: “We hope this study will pave the way for new standard of care for lung cancer patients receiving radiotherapy to treat their disease. Study results may also benefit other cancers affecting the chest area such as lymphoma or oesophageal cancer in the future.”