In the clinical department of Radiation Oncology, more then 25% of the patients are included in studies that are in line with the research themes of GROW. In order to maximise the proportion of patients that enter into clinical trials, a plan was made to make sure patients are asked to participate to the most suitable study for them.
One main research project studies the role of functional imaging with CTPET in radiation oncology. For example, we published that in the group of clinical CT Stage N2-N3 NSCLC patients, use of FDG-PET-CT scanning information in radiotherapy planning reduced the radiation exposure of the oesophagus and lung, and thus allowed significant radiation dose escalation while respecting all relevant normal tissue constraints. This, together with a reduced risk of geographic misses using PET-CT, led to an estimated increase in tumor control probability from 13% to 18%.
The study of the added value of targeted drugs e.g.targeting COX2 or EGFR, together with radiation to improve the therapeutic index of the treatment, namely to increase tumor control without increasing toxicity which is systematically and prospectively scored together with specific biological markers (e.g. citrulline, gene polymorphism studies).
A multicentric "Doelmatigheidsonderzoek" funded by the ZonMW studies various innovative methods to follow patients after treatment.
In the field of radiation physics, our main research concerns the investigation of a pre-treatment verification procedure based on the use of an Electronic Portal Imaging Device (EPID) for all non-palliative patient treatments at one linear accelerator. With this procedure, geometric and dosimetric radiation parameter values were verified for each individual patient, thus eliminating dose delivery errors caused by erroneous data transfer between treatment planning system and accelerator, which is done by hand in our department. Further improvement with 2D and 3D dosimetry are under investigation.
In order for a tumour to grow in the host it must escape the surveillance of the immune system. The reversal of immune tolerance has, therefore, become the main focus of research in the field of tumor immunology.
Two major protects are currently undertaken: Transplantation biology and vaccine development. The transplantation program is closely related to the clinical transplantation program. To extend the allogeneic transplant program - in which HLA-identical transplants are performed - we started a pre-clinical transplantant program using haploidentical donors. Haploidentical donors will enlarge the opportunity to select donors for patients. In the laboratory we have established a non-myeloablative transplant protocol. Partly based on this program permission was given to start a haploidentical clinical program. Also due to our efforts GMP facility will be realized. The dendrite cell program to vaccinate patients is focusing on both hematological malignances as well as solid tumors. For this Mucine-1 has been chosen as a tumor antigen. We discovered that Mucine-1 is already present on dendritic cells both in vitro and in vivo. Therefore there must be a physiological or pathofysiological role for Mucine-1 on dendritic cells, but its function is not yet clear. Mucin-1 on dendritic cells is however not of the tumor type glycosylation pattern. Therefore the program focuses on tumor specific expression of Mucin-1 on dendritic cells.
Imaging of rectal cancer:
A major problem in the treatment of rectal cancer is obtaining appropriate tumor free margins during surgery and accurately determining the nodal status. This problem is analyzed by preoperative imaging of rectal cancer by CT-PET. This method enables probably to identify between low risk and high risk groups and corresponding tailored therapy especially in and adjusting the radiotherapy. This project is funded by KWF.
Studies in breast cancer:
Research within this field is directed to improve diagnostic, therapeutic and follow up procedures. Four projects in this context are funded by ZonMW:
- Fast track surgery): with optimal use of modern peri-operative techniques the physical and psychological impact of surgery is minimised, resulting in a shorter recovery period after surgery. After a succesful breast cancer surgery fast track program in the University Hospital Maastricht, this is now a project in cooperation with four other Dutch hospitals.
- Evidence based application of ultrasonography in the diagnostic procedure of breast carcinoma.
- Improving the efficiency and quality of follow up after curative treatment for breast cancer. In this randomised multicentre project it is analyzed which follow up strategy is the most cost-effective in this group of patients.
- The development of a shortened recovery program to reduce the hospital stay.
- Translating molecular knowledge into early breast cancer management. In this study patient subgroups are identified by DNA micro-array gene expression in order to aim for patient tailored therapy.
The treatment of locally advanced and metastatic colorectal cancer:
In this study the concept that an optimal combination of aggressive surgery, radiotherapy and chemotherapy can cure more patients, is analyzed. For this goal a close cooperation exists between the departments of Surgery, Radiotherapy and Medical Oncology. In colorectal surgery also an international cooperation on fast track surgery is ongoing.
Cancer cachexia:
In this project the mechanisms of cancer cachexia are studied and interventions related to it. These studies have resulted in a randomised trial with anti-inflammatory fatty acids in patients with advanced pancreatic cancer.
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