Radiotherapy remains an essential component of the treatment of many types of childhood cancer in the abdomen.

Lead investigator: Dr Mark Gaze, University College London Hospitals
Funded by the Little Princess Trust in partnership with CCLG
Awarded January 2019

Award: £82,643

Radiotherapy remains an essential component of the treatment of many types of childhood cancer in the abdomen. Although radiotherapy increases the chance of cure, it may damage healthy body parts such as the liver and kidneys. In planning radiotherapy, the care taken to avoid injuring these organs may result in under-treatment of the cancer. The art of radiotherapy is to balance achieving the best possible chance of cure with the lowest risk of harm to healthy tissues.

Proton beam therapy (PBT) is a new advanced form of radiotherapy that uses protons (small parts of an atom). This targets the tumour better, reducing treatment of normal tissues and therefore side effects. 

PBT is not a routinely recommended treatment for childhood abdominal tumours because it is susceptible to unpredictable changes through the treatment schedule. For example, daily differences in the position of the child during treatment, varying tissue density and breathing movement can potentially result in a higher dosage of radiation to normal healthy tissues or under-dosage to the tumour. The effect of these variations is poorly understood.

This pilot study aims to:

• Identify scenarios where PBT demonstrates an advantage over existing radiotherapy techniques.
  Identify the possibility of giving a higher dose to the cancer using PBT, while still keeping healthy tissue doses acceptably low.
• Investigate how the daily variations will clinically impact on the quality of radiotherapy given using PBT and design ways to improve this.

NHS England will open two proton beam centres in Manchester and London. The results from this study will help guide patient selection, pathway and protocol development in the set-up of national and international clinical trials much required to evaluate the efficacy, safety and potential dose escalation using PBT in childhood abdominal tumours. PBT has the potential to improve outcomes and reduce morbidity for childhood tumours.