Upright radiotherapy: rapidly realising clinical and economic benefits

目前，放疗患者都是仰卧治疗。重达至少6吨的复杂机械围绕着它们旋转。当它旋转时，这个机器从不同的角度发射辐射光束。Leo Cancer Care是一家英国小公司，他们采用了“设计思维”的方法来重新构想和简化放射治疗。他们与人体工程学专家一起开发了一种灵活舒适的机器人定位系统，可以让直立的病人旋转。放疗束保持固定。该项目利用该研究员的国际临床经验和强大的科学记录来优化Leo Cancer Care的简化放疗解决方案，以供临床使用。这将使他和Leo癌症护理中心能够提供更好、更便宜、更有效和更容易获得的癌症治疗。更好的治疗方法：放疗的副作用可能是毁灭性的。对于某些类型的癌症，直立治疗患者将使我们能够更好地靶向放射治疗光束，减少正常组织的损伤。对于乳腺癌来说，坐直并向前倾斜会使乳房远离心脏和肺部，从而改善光束的进入。对于前列腺癌，膀胱充盈和直肠气体的日常变化对直立患者的影响较小。对于肺癌，当患者直立时，肺体积更大，肺运动减少，从而更好地保留心脏。此外，直立体位会使许多患者在身体上感觉更舒适（例如，使肺癌患者更容易呼吸），帮助他们忍受治疗。更便宜的治疗：LCC直立x光治疗室的费用是传统仰卧治疗室的一半：200万英镑对400万英镑。更有效的治疗：LCC更简单的技术将导致(1)降低设备维护成本(2)更容易升级光束输送技术(3)更简单的机器QA，从而降低专业障碍(4)大幅减少屏蔽治疗室的体积(5)由于直立定位提高了患者的吞吐量。更容易获得的治疗：全世界获得放射治疗的机会低得令人无法接受。到2035年，通过获得最佳的放射治疗，每年有可能挽救100万人的生命。80%的癌症患者生活在低收入和中等收入国家，这些国家仅拥有世界上约5%的放射治疗资源。通过将x射线治疗室的费用减半，并提供更高效的放射治疗，LCC解决方案将使放射治疗更实惠、更容易获得，从而提高全球癌症患者的生存率。为了开展这项研究，他将在Leo癌症护理中心、NHS和世界各地的大学/医院之间建立新的合作伙伴关系。合作伙伴包括：伦敦大学学院NHS基金会信托、克拉特桥癌症中心、皇家萨里NHS基金会信托、马萨诸塞州总医院、lsamons - bsamrard中心、伦敦大学学院、萨里大学、谢菲尔德哈勒姆大学、拉夫堡大学和悉尼大学。共同的目标是将直立放射治疗的益处迅速传递给患者。要做到这一点，将解决一些关键的科学挑战：挑战1：必须开发患者固定系统。这些必须使患者在每次放射治疗中舒适地坐/站约20分钟。放疗每天进行，分30个治疗“部分”，每次持续约20分钟。挑战2：必须简化直立放射治疗工作流程（用于患者治疗和机器测试）。简化的工作流程将减少与治疗相关的专业知识障碍，改善可及性。挑战3：必须开发算法将生物数据从MRI/PET转移到直立放疗。挑战四：将未来的成像技术整合到直立RT中，将实时mri引导带到我们的治疗室。这将进一步提高肿瘤靶向性。

Currently, radiotherapy patients are treated lying on their backs. Complex machinery weighing at least six tonnes is rotated around them. As it rotates, this machinery delivers radiation beams from different angles. Leo Cancer Care are a small British company who adopted a "design thinking" approach to re-imagine and simplify radiotherapy. Together with ergonomics experts, they developed a flexible and comfortable robotic positioning system that rotates an upright patient. The radiotherapy beam remains fixed.This project draws upon the fellow's international clinical experience and strong scientific track-record to optimise Leo Cancer Care's simplified radiotherapy solution for clinical use. This will enable the fellow and Leo Cancer Care to deliver cancer treatments that are better, cheaper, more efficient and more accessible.Better treatments: radiotherapy side-effects can be devastating. For certain types of cancer, treating patients upright will enable us to better target radiotherapy treatment beams, reducing normal-tissue damage. For breast cancer, sitting upright with a forward tilt moves the breast away from the heart and lungs, improving beam access. For prostate cancer, day-to-day variations in bladder filling and rectal gas will have less impact for upright patients. For lung cancer, lung volumes are greater and lung motion is reduced when patients are upright, enabling better sparing of the heart. Additionally, upright positioning will make many patients feel physically more comfortable (e.g. by enabling patients with lung cancer to breathe more easily) helping them to tolerate their treatment.Cheaper treatments: the cost of a LCC upright X-ray treatment room is half that of a conventional, supine treatment: £2m compared to £4m.More efficient treatments: LCC's simpler technology will lead to (1) reduced equipment maintenance costs (2) easier upgrades of beam delivery technology (3) simpler machine QA & therefore lower expertise barriers (4) substantial reductions in shielded treatment room volume (5) improved patient throughput due to upright positioning.More accessible treatments: worldwide access to radiotherapy is unacceptably low. There is potential to save one million lives per year by 2035 through optimal access to radiotherapy. 80% of cancer patients live in low- and middle-income countries which host only around 5% of the world's RT resources. By halving the cost of an X-ray treatment room and also delivering more efficient RT, LCC solutions stand to make RT more affordable and accessible, improving cancer survival worldwide.To conduct this research the fellow will build new partnerships between Leo Cancer Care, the NHS and universities/hospitals worldwide. Partners include: University College London NHS Foundation Trust, Clatterbridge Cancer Centre, the Royal Surrey NHS Foundation Trust, Massachusetts General Hospital, Centre Léon-Bérard, University College London, the University of Surrey, Sheffield Hallam University, Loughborough University and the University of Sydney. The shared goal is to rapidly deliver the benefits of upright radiotherapy to patients. To do this, a number of key scientific challenges will be addressed:Challenge 1: patient immobilisation systems must be developed. These must enable the patient to sit/stand comfortably for ~20 mins for each radiotherapy treatment. Radiotherapy is delivered daily, in up to 30 treatment 'fractions', each lasting ~20 mins. Challenge 2: upright radiotherapy workflows (for patient treatments and machine testing) must be streamlined. Streamlined workflows will reduce the expertise barrier associated with treatments, improving access. Challenge 3: algorithms must be developed to transfer biological data from MRI/PET to upright radiotherapy. Challenge 4: to incorporate tomorrow's imaging technologies into upright RT, bringing live MRI-guidance to our treatment rooms. This will further improve tumour targeting.