A Western oncologist is examining new radiation techniques that could avoid damaging the esophagus for millions of people with advanced lung cancer.
Through a clinical trial dubbed PROACTIVE, Lawson Health Research Institute scientist Dr. Alex Louie is exploring more targeted techniques that reduce the dosage of radiation absorbed by the esophagus – or swallowing passage – in hopes of improving quality of life for patients.
Radiation is used against lung cancer in various scenarios, but when patients have advanced and incurable lung cancer, radiation simply aims to ease pain and shrink things in the area of concern causing the symptoms.
“Part of cancer care isn’t just in terms of the cureability of cancer, but it’s also looking at quality of life,” said Louie, a radiation oncologist at the London Regional Cancer Program. “It is something, in the last decade or two, that has been a refocus and repurpose of research, to try and complement the treatment.
“You always want to try and increase longevity of life or potentially cure the disease. But it is equally important that you try to reduce the symptoms someone may experience or prevent the time to which some of these more serious things can happen – whether or not you are able to offer a curative type of treatment or if the treatment is without a curative attempt.”
PROACTIVE is funded by a Canadian Cancer Society Quality of Life Research Grant. First launched at the London Regional Cancer Program at London Health Sciences Centre in late 2016, it is now active at five centres across Canada, with more than 40 patients participating.
For his study, patients will be followed for one year after completing palliative radiation to assess their ability to swallow food and drink and eat nutritiously, said Louie, a Radiation Oncology professor at Western, with a cross appointment in Epidemiology and Biostatistics
The challenge with radiation, in general, is it traverses through the surface of the body to get to its target. That creates collateral damage along the way. In advanced stages, lung cancer can travel into lymph nodes in the middle of the chest. These lymph nodes happen to be close to the esophagus.
The standard technique currently used treats the cancer via a ‘flashlight effect,’ where doctors inject radiation into a patient. Wherever the ‘light’ shines via the treatment, whether on cancer cells or healthy cells, it can also cause side effects.
“That’s where the research comes in – to try and look at the trade-offs,” Louie explained, adding his current study is a “somewhat simple solution to a relatively common problem” faced within the cancer radiation world.
“If we apply the tools we use when looking at curative radiation, can we use those same techniques in an advanced stage (cancer), when we’re only giving a low to moderate dose of radiation, and still get the same benefit in terms of controlling the cancer,” questioned Louie. “It’s not reinventing the wheel, it’s more of an application of something that’s already existing.”
The study is also part of the Canadian Pulmonary Radiotherapy Investigators group, a collaborative group of Canadian researchers, led by Western professor and researcher Dr. David Palma, who coordinate nationwide radiation clinical trials to improve outcomes for lung cancer patients.
The research team will also look at a number of other outcomes including the cost-effectiveness of using these new radiation techniques.
“Let’s say this does work, and it’s helpful for patients. This is not a standard treatment so does it make sense, from a taxpayers’ point of view, to invest in this type of treatment?” said Louie, who is halfway through the study and expects results in the next year or two.
