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Treating cancer with advanced radiotherapy technology

Research led by the King’s Technology Evaluation Centre (KiTEC) has shown that an advanced form of radiotherapy, known as stereotactic ablative body radiotherapy (SABR), is a safe and effective treatment for some patients with oligometastatic cancer.

Approximately 140,000 patients are diagnosed with metastatic cancer in England every year. Some of these patients have oligometastatic cancer, which is when patients have cancer which has spread beyond its primary site to a small number of other locations.

SABR – stereotactic ablative body radiotherapy – delivers high radiation doses through a focused beam to a precise area. Other conventional radiotherapy treatments give patients small amounts of radiation each day over a period of time, however SABR uses imaging technologies such as MRI scans, to locate the precise point for radiation delivery. Conventional radiotherapy, which has a wider beam, hits healthy cells around the tumour, which can cause side-effects.

Another benefit of SABR is that it works well for small tumours on the edge of organs, such as the prostate or liver. It also requires patients to attend hospital less than other radiotherapy treatments.

To assess whether SABR technology was an effective treatment for oligometastatic cancer, a large-scale trial was needed. King’s was an ideal institution to undertake this work as research underpinning this area began here in the 2000s. KiTEC, was set up at the School of Biomedical Engineering and Imaging Sciences at King’s in 2011. KiTEC is embedded within King’s Health Partners (KHP), which is an Academic Health Sciences Centre involving collaboration between King’s and three major NHS Foundation Trusts (Guy’s and St Thomas’ NHS Foundation Trust, King’s College Hospital NHS Foundation Trust and South London and Maudsley NHS Foundation Trust). KiTEC specialises in evaluation of novel medical technology, including imaging technology.

KiTEC received funding from the National Institute for Health and Care Excellence (NICE) to investigate the potential of SABR as a treatment as part of NHS England’s Commissioning through Evaluation (CtE) programme. Researchers at King’s recruited 1,422 patients with oligometastatic cancer from 17 NHS radiotherapy centres to assess the treatment. Researchers assessed the clinical effectiveness of SABR, toxicity, and cost-effectiveness. Importantly, the study was carried out on patients receiving their treatment in a real-world clinical situation, not a clinical trial in which conditions often differ from normal clinical practice.

This research was essential as there was a lack of high-level evidence to provide a basis for policy makers.

The trial found overall survival was 92% at one year post treatment and 79% at two years. The most common adverse effect was fatigue, and the most serious was liver enzymes. No treatment-related deaths were reported.

As a result of this real-world evidence, in 2020 NHS England concluded SABR should be recommended for patients with extracranial oligometastatic disease.

This project was a great example of what KiTEC can offer as a health technology assessment centre focusing on medical technology and technology-based interventions. The Centre’s multidisciplinary expertise in medical engineering, real-world data analysis and health economics, combined with the clinical expertise of our collaborators in King’s Health Partners and other NHS organisations, led directly and rapidly to the commissioning of these advance radiotherapy treatments by the NHS, with demonstrable benefit to cancer patients.– Professor Stephen Keevil, the Director of KiTEC at the time.

KiTEC has continued its work, having undertaken more than 20 Medical Technology Evaluation Projects in the last 5 years. KiTEC also partners on evaluation projects with the AI Centre for Value Based Healthcare at King’s and has set up a specialist unit AI evaluation unit dedicated to this emerging field. The AI Centre is dedicated to transforming innovative AI solutions from concept to clinic for the benefit of patients.

Dr Anna Barnes, Director of KiTEC, said: “This is an exciting time to be involved in Healthcare Technology Assessment. Since the launch of the people plan report by NHS-England and Improvement there has been a big push to create a digital savvy workforce and use digital data to provide a backbone to evidence based healthcare policy decisions. KiTEC have positioned themselves to be right at the centre of this shift to digital healthcare evaluation by making strong collaborations with similarly oriented groups throughout King’s College London and Guy’s and St Thomas’ Foundation Trust.”

Read more about KiTEC here: http://www.kitec.co.uk/

In this story

Stephen Keevil

Stephen Keevil

Professor of Medical Physics