“UMC Utrecht Researchers Study Cancer Treatment with MRI Guided Radiotherapy & Ultrasound”

The studies are made possible in part thanks to a grant from the Dutch Cancer Society totaling nearly 1.5 million euros

Researchers at UMC Utrecht are starting two new studies into the treatment of cancer with image-guided therapy. In one study they use MRI-guided radiotherapy, in the other they use ultrasound. The studies are made possible in part thanks to a grant from the Dutch Cancer Society totaling nearly 1.5 million euros.

Researcher Lois Daamen of UMC Utrecht studies how MRI-guided radiotherapy can be used for locally advanced pancreatic cancer. And Roel Deckers (assistant professor of image-guided molecular interventions) uses ultrasound to help fight head and neck cancer.

Pancreatic tumor image
Lois receives a subsidy of almost one million euros from KWF. She uses MRI-guided radiotherapy for her research. This image-guided, less invasive therapy can be given with the MR-Linac. This device was invented by UMC Utrecht and has been used in daily hospital practice since 2018 for various forms of cancer, such as non-metastatic prostate cancer.

With the help of MRI scans, the radiation area is continuously adjusted to the location of the tumor. As a result, many tumors can be irradiated with higher precision, even when they are very mobile. Due to the higher precision, the surrounding healthy tissue is less affected, which reduces the risk of complications of the treatment. It is also safer to give a higher daily or total dose. Result: patients need to go to hospital less often and the success rate of radiotherapy is increased. MRI-guided radiotherapy has now been embraced worldwide and is now also being used by other centers, both in the Netherlands and abroad.

surgery or chemotherapy
Pancreatic cancer is one of the deadliest cancers: only 4 percent of patients are still alive after 10 years. Unfortunately, the disease is often diagnosed late. At the time of diagnosis, 40 percent of patients already have locally advanced pancreatic cancer (LAPC). This means that the tumor has grown into the surrounding blood vessels. LAPC no longer requires surgery, but people first receive chemotherapy. This is used to try to make the tumor smaller in order to make surgery possible and/or prevent metastasis. This increases the chance of survival. Unfortunately, even after chemotherapy, patients only survive for an average of 15 months.

Add MRI-guided therapy
Pancreatic cancer was difficult to irradiate with traditional radiation techniques: the tumors were poorly visible and the tissue in the upper abdomen is very mobile. Fortunately, MRI-guided radiotherapy has changed that. That is why Lois will now for the first time investigate how the survival chances and quality of life of LAPC patients can be improved by adding MRI-guided radiotherapy to chemotherapy.

She does this with the LAPSTAR trial, which is being conducted in collaboration with a group of specialized radiotherapists from UMC Utrecht (Martijn Intven), Amsterdam UMC (Anna Bruynzeel), Radboud UMC (Hanne Heerkens) and Catharina Hospital (Heike Peulen), the Dutch Pancreatic Cancer Group and the Center for Human Drug Research.

LAPSTAR-trial
The higher dose of radiation in combination with chemotherapy will hopefully inhibit the growth of tumors, improving or maintaining quality of life and increasing the chance of longer survival. The results of the LAPSTAR trial could have a major impact on the global care of LAPC patients. And of course also for the treatment of other types of cancer where tumors have grown locally. Lois: “With this study, we hope to demonstrate that MRI-guided radiation has a beneficial effect on the survival and quality of life of patients with locally advanced pancreatic cancer, in order to improve the daily care of these patients all over the world.” says Lois.

Ultrasound against head and neck cancer
Just like Lois, Roel Deckers is also focusing on an image-guided, so less invasive, new treatment. He wants to use ultrasound to help fight head and neck cancer. He receives a subsidy of almost half a million euros from KWF for this. Every year, about 3,000 people in the Netherlands get head and neck cancer. In about 60 percent of them, the disease has already progressed locally. They must undergo intensive treatment that often consists of several components, such as surgery, radiotherapy and/or chemotherapy.

Improve blood supply
Despite this intensive treatment, the prognosis of this patient group is poor: 15 to 60 percent are still alive after 5 years, and there is a high chance (up to 40%) that the disease will recur locally. Chemotherapy and radiation work best in well-perfused, oxygen-rich tumors. The medication then reaches the tumor better, and oxygen enhances the effect of the radiation. Unfortunately, tumor blood vessels are often fragile and erratic. This impedes the blood supply and reduces the effect of the treatments. Roel will try to solve this with the aid of ultrasound.

Make microbubbles vibrate
We know ultrasound from, among other things, the ultrasound of pregnant women. Images are made of the unborn baby using high-frequency sound waves, which humans cannot hear. Roel is going to use ultrasound in a completely different, inventive way. He injects gas-filled microbubbles into the bloodstream, which he causes to vibrate with ultrasound in tumor blood vessels. In this way, he hopes to improve the blood flow to the tumors and to make chemotherapy and radiation work more effectively.

Also in other ailments
Roel’s research now focuses specifically on patients with head and neck cancer, but the results of his research will in principle be more widely applicable to other forms of cancer and perhaps other conditions. “Making medicines work more effectively, that is what I want. It is now my task to show in the coming years that ultrasound can play an important role in this”, says Roel.

Bron: UMC Utrecht

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