In MAASTRO, patients are included in studies that, preferentially, are in line with the research themes of the MAASTRO clinic, MAASTRO lab and GROW. In order to maximise the proportion of patients that enter into clinical trials, a strategy was made to make ensure that patients are asked to participate within the most suitable study for them. In 2007, 28.3 % of all new patients were enrolled in biobank clinical trials and 6.8% in therapeutic trials. This is well above the European average of 3% or less.
In 2006 we started a major project, "Computer-Assisted-Theragnostic" with Siemens Medical. Our objective is to create Prediction Models of survival and complications for various pathologies and treatments. Ultimately, this will allow us to implement a strategy of individualized treatment based on objective data. We are setting up a prospective database allowing us to collect anonymously, a large amount of data from all the treated patients. Machine learning techniques and advanced statistical methods will be used to handle missing data to improve the methodology. A prototype for lung cancer has already been presented in Philadelphia at the ASTRO meeting.
One of our papers attracted significant attention from the scientific community (De Ruysscher et al. JCO 2007). The objective was to identify time factors for combined chemotherapy and radiotherapy predictive for long-term survival of patients with limited-disease small-cell lung cancer (LD-SCLC). Using meta-analysis methodology to compare results amongst trials, the influence of the timing of chest radiation and the start of any treatment until the end of radiotherapy (SER) on local tumour control, survival, and esophagitis was analyzed. We concluded that a short time between the first day of chemotherapy and the last day of chest radiotherapy is associated with improved survival in LD-SCLC patients. The novel parameter SER, which takes into account accelerated proliferation of tumour clonogens during both radiotherapy and chemotherapy, may facilitate a more rational design of combined-modality treatment in rapidly proliferating tumours.
In the field of physics, our main research concern the use of (4D)-CTPET simulation in lung cancer and the investigation of a pre-treatment and in-vivo dose verification procedure based on the use of an Electronic Portal Imaging Device (EPID) for all non-palliative patient treatments. This approach is named Dose Guided radiotherapy (DGRT). With DGRT, geometric and dosimetric radiation parameter values were verified for each individual patient, thus eliminating dose delivery errors caused by erroneous data transfer, bad functioning of the linear accelerator and patient related delivery errors Further improvement using 3D dosimetry is under investigation.
Selected publications
De Ruysscher D, Pijls-Johannesma M, Bentzen SM, Minken A, Wanders R, Lutgens L, Hochstenbag M, Boersma L, Wouters B, Lammering G, Vansteenkiste J, Lambin P.
Time between the first day of chemotherapy and the last day of chest radiation is the most important predictor of survival in limited-disease small-cell lung cancer.
J Clin Oncol. 2006 Mar 1;24(7):1057-63. I.F. 11.810 (Paper published with an Editorial).
G. Bosmans, A. van Baardwijk, A. Dekker, M. Öllers, L. Boersma, A. Minken, P. Lambin, D. De Ruysscher.
Intra-patient variability of tumour volume and tumour motion during conventionally fractionated radiotherapy for locally advanced non-small cell lung cancer. A Prospective Clinical Study.
Int J Radiat Oncol Biol Phys 2006 Nov 1;66(3):748-53, I.F. 4.556
Baumert BG, Rutten I., Dehing-Oberije C, Twijnstra A., Dirkx MJM, Debougnoux-Huppertz MTL, Lambin P, Kubat B.
A pathology-based substrate for target definition in radiosurgery of brain metastases.
Int. J. Radiation Oncology Biol. Phys. 2006 Sep 1;66(1):187-94, I.F. 4.556
Figure 1: The survival at 5 years of patients with Small Cell Lung Cancer included in randomized trials related to the Start of any treatment until the end of Radiotherapy (SER). Each dot represent one arm of a randomized trial (De Ruysscher et al. JCO 2007).
Research group
Dr. D. de Ruysscher, project leader
Prof.dr. P. Lambin
Dr A. Dekker
Prof.dr. B. Wouters
Dr. L. Boersma
Dr. G. Lammering
Dr. B. Baumert
Bas Nijsten
Post-doctoral fellows
Michel Oellers
PhD students
Dr. A. van Baardwijk
Dr. G. Bosmans
Mr H. Aerts
W. van Elmpt.
B. Nijsten