Exploring novel solutions of radiotherapy delivery and using biology, imaging, new fractionations and radiobiological models to improve TCP/NTCP ratio

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Cancers of the upper gastro-intestinal tract (oesophagus, pancreas) have a poor outcome if surgery cannot be undertaken. Radical radiotherapy combined with chemotherapy are the standard of care, however a significant number of patients have tumour recurrence in the radiotherapy field. In the past increasing radiotherapy dose caused severe toxicity. There are now several technological advances in radiotherapy that permits further individualization of treatment using either functional imaging such as MRI and PET to guide the areas that need more radiotherapy or focused radiotherapy (such as Stereotactic ablative radiotherapy) to areas of tumour that cannot be removed by surgery.The aim of the research is to further personalise the way radiotherapy is delivered using characteristics specific to an individual patient and/or tumour. Novel drugs that have been shown in laboratory to enhance radiation will be combined with the radiation to further enhance tumour kill. The ultimate impact in clinical practice would be improvement in local tumour control and reduction in toxicity caused by radiation.