Implementing research in to clinical practice; A report of the implementation of the printout trial at the Edinburgh cancer centre

Abstract

Keywords: Stereotactic Body Radiotherapy Prostate; Printout; Breath Analysis. Introduction: The Printout (Using breath analysis to PRedIct Normal TissUe and Tumour response during prostate SBRT) [1] Trial is a prostate stereotactic body radiotherapy (SBRT) pilot study currently being undertaken at the Edinburgh Cancer Centre. The primary objective is to establish the possibility of measuring biomarkers in breath samples to monitor an individual’s response to radiotherapy . It is hoped to gain enough data from the pilot to progress to a larger scale study. Responsibility for the running of the trial including patient screening, recruitment, treatment delivery, data collection and management has been delegated to radiographers. Method and Materials: Printout patients attend for a multi parametric MRI scan, transperineal implantation of the raypilot prostate tracking device [2] and a planning CT scan as an outpatient during one day. A SBRT treatment plan is constructed using the rigidly fused MRI and CT scan. A dose of 36.25Gy is delivered in 5 fractions by a Varian Trubeam linear accelerator over 7 days, with breath samples acquired before and after each session. Kilovoltage imaging, CBCT and raypilot are used to monitor and verify treatment position. Patient reported outcome measures (PROMS) questionnaires are completed prior to treatment delivery, immediately on completion of treatment and at regular follow up appointments. Results: 5 patients have participated in the trial. Early data suggests hypofractionated SBRT can be delivered safely to the prostate gland using the Raypilot Device as a motion management system. PROMS have reported toxicities which are well tolerated, with the regime itself a very welcome alternative to conventional fractionation. Data regarding heterogeneity factors has yet to be reported. Conclusion/ Discussion: The Printout Trial is the first time radiographers in the department have been involved in both the technical and administration part of trial set up and design. Recruitment, although slow initially, has improved and it is hoped that one patient per month will now be enrolled. The trial has demonstrated the vital role radiographers play in radiotherapy research and also problems which can arise from the regulations surrounding research governance. Numerical References 1 Scottish Cancer Research Network south East edinburgh cancer centre wetsern general hospital . Using Breath Analysis to PRedIct Normal TissUe and Tumour response during prostate cancer SBRT[cited july 2019] available from http://www.sescrn.org.uk 2 Raypilot Micropos Medical Limited .www.micropos.se/products/