Transforming Prostate Cancer Radiotherapy

Nachi Palaniappan, Consultant Clinical Oncologist

John Staffurth, Consultant Clinical Oncologist


Velindre University NHS Trust


Industry Partners

Boston Scientific

Bobby Badesha, Urology Space OAR Division

Background

Radiotherapy for localised prostate cancer is currently delivered over four weeks. More recently, studies have confirmed the safety and efficacy of treatment over five to seven days (extreme hypofractionation).


Long-term morbidity associated with radiation therapy are due to close proximity of rectum, urethra and bladder. Insertion of biodegradable gel between prostate and rectum prior to radiation therapy reduces rectal morbidity and improves quality of life.


We propose to combine extreme hypofractionation and insertion of biodegradable and fiducial markers to reduce rectal morbidity and improve patient experience.

Project Aims


  • To explore the feasibility to reduce the number of visits to hospital for treatment and reduce rectal morbidity associated with the treatment by combining extreme hypofractionation and insertion of biodegradable gel.

  • To pilot the implementation of extreme hypofractionated radiotherapy for localised prostate cancer patients at Velindre Cancer Centre with and without biodegradable gel insertion and collect data for 12 months.

  • Our first cohort of patients will receive alternate day radiotherapy for five days without biodegradable gel and second cohort of patients will receive the same radiation schedule after biodegradable gel and fiducial marker insertion.

Challenges

  • Identify resources

  • Develop new clinical protocol and patient pathway and standard operating procedures

  • Educate team

  • Be readily available for queries

  • COVID 19 pandemic

Key Outcomes

  • Identify costs for implementation

  • To map patient pathway

  • Identify resources and expertise needed for routine clinical practice.

  • Collect patient experience and outcomes

Image: Patient with (L) and without (R) biodegradable gel (pink)


The above cross sectional CT scan images show the prescription dose in green and blue line in patients with and without biodegradable gel. The blue line is not including any rectum(brown outline) in patient with biodegradable gel on the left.

Next Steps

The first cohort of patients have completed their treatment without biodegradable gel. We are now recruiting patients to our second cohort and aim to complete recruitment in the next three to six months.


We will complete collecting data, analyse and write up. We plan to use the data gathered and develop a business case to present to the commissioners for routine implementation across Wales. This project would not have been possible without the generous support from Moondance foundation and Prostate Cymru.

Our Exemplar Experience

This project and being Bevan Exemplar has enabled me to understand the processes involved in developing and implementing a new service in NHS. The exemplar programme gave the impetus to implement this project despite the difficult circumstances that we are in due to the pandemic.

Bevan Exemplar Showcase 2021

Contact

Nachi.palaniappan@wales.nhs.uk

John.staffurth@wales.nhs.uk