RAPID-RT: New study aims to improve survival rates for lung cancer patients

The Christie NHS Foundation Trust in Manchester is running the world’s first research project to determine whether sparing the top of the heart during radiotherapy can help patients with lung cancer live longer.

The innovative ‘opt out’ study is made possible thanks to a £2.3 million grant from the NIHR (National Institute for Health and Care Research) and is sponsored by The Christie.

The aim of the study is to help improve the survival of patients who have been successfully treated for lung cancer but may go on to experience serious heart problems as a result of the cancer treatment. The Christie lung team is using a new approach to do this that means all patients treated with radiotherapy for lung cancer can take part. This is much more inclusive than traditional clinical trials where participation is often restricted to small, selected groups and means the study team can learn from every patient with lung cancer treated with radiotherapy.

The study is the first of its kind anywhere in the world, and the culmination of more than seven years work by the radiotherapy research team at The Christie.  Radiotherapy is one of the most effective and common treatments for lung cancer, but it is known that when the top of the heart is irradiated it can lead to heart disease including heart attacks and irregular heartbeat. The aim of the research is to change clinical practice by understanding how best to treat lung cancers with radiotherapy without causing damage to the heart.

Lung cancer is the leading cause of death from cancer in the UK with 35,000 people dying and 48,000 people are diagnosed annually. Five-year survival is low at 15%. Manchester has one of the worst lung cancer mortality rates in England, double the national average.  Radiotherapy is recommended for half of patients and it cures 40% of those treated.

Patients eligible for the study include those with stage 1, 2 and 3 lung cancer that hasn’t spread to other parts of the body who are receiving radiotherapy with the aim of curing them of cancer.

The Christie team is recruiting patients at a rate of 50 per month to the RAPID-RT study, with the aim of gathering data from at least 2000 people by 2027. To manage the large numbers, the team has developed special AI (artificial intelligence) auto-contouring software to define the part of the heart to spare, which is two and half times faster than doing the task manually. Without this AI tool, doctors have to draw a line around healthy organs on scans ahead of radiotherapy to protect the healthy tissue surrounding the cancer from being exposed to radiation. It can take between 20 minutes and three hours to do this for each patient. This new technology, design specifically for treating lung cancer, can identify the areas that need to be spared and the oncologist just needs to check the scan before performing the procedure.

Corinne Faivre-Finn, a Professor of Thoracic Radiation Oncology at The University of Manchester and Honorary Consultant Clinical Oncologist at The Christie, who is a world-leader in lung cancer radiotherapy research, said: “Lung cancer treatment has improved dramatically over the last decade. However, we now need to reduce the serious side-effects of treatment for cancer survivors. This is a unique study in that all patients with lung cancer stage 1-3 treated with standard of care radiotherapy are eligible. That way we can include everyone. Clinical trials usually only recruit people in general good health. Here, we’re able to examine the effectiveness of a reduced dose of radiotherapy to the heart for a much wider group of people including the elderly, people from all backgrounds and ethnicities and those that have other health conditions in addition to lung cancer.

“In addition, patients opt out instead of opting in, which also helps make this study more inclusive. And no extra hospital visits or procedures are required.  The real-world data from this large numbers of patients allows us to learn very quickly, be more agile in altering the dose, and improve results far faster than we would be able to do with a traditional trial design. We hope this study will pave the way for new standard of care for lung cancer patients receiving radiotherapy to treat their disease. Study results may also benefit other cancers affecting the chest area such as lymphoma or oesophageal cancer in the future.”

“With the recent announcement by Government that they are introducing a national targeted lung cancer screening programme for people 55-74 who are at high risk of lung cancer in England, we are likely to see 900 patients diagnosed a year through the screening programme just in Greater Manchester alone. Therefore, using AI as a resource to plan treatment for each individual patient is becoming more vital.” Professor Faivre-Finn added.

Great-grandfather Alan Featherstone, 71, from Wigan in Greater Manchester is one of The Christie patients who is taking part in the study, having been diagnosed with primary lung cancer in each lung in March this year. “I had a persistent cough and lost weight so went to the doctor and they found I had a tumour in each lung. Surgery wasn’t an option so after chemo, which reduced the tumours, I’ve started a six-week course of radiotherapy.  I’m very comfortable being part of the trial and my data being used. I believe if you’re offered the chance to be on a trial you take it. It’s not about me. Without research we wouldn’t have the advances in cancer care.”

Grandmother Betty Mullen, 70, from Wigan in Greater Manchester is another The Christie patients who is taking part in the study and has had radiotherapy along with chemotherapy, having been diagnosed with stage 3 lung cancer three months ago. “I was getting more and more tired, and we knew something wasn’t right, but after the treatment I’m back to normal and feel much better. It was important to treat the cancer as soon as possible, so we felt radiotherapy was a better option than surgery.  It was no problem getting it done although it did mean a daily visit. You just have to crack on with it don’t you?  I felt very well cared for. I’m happy to play my part in the study by having my data used for research to help others in the future.”

Any patients interested in taking part in clinical trials should discuss this option with their consultant or GP. Not all patients will fit the criteria for a specific trial. While clinical trials can be successful for some patients, outcomes can vary from case to case. More information about taking part in clinical trials can be found here.