Tumour tracking reshapes the future of cancer treatment

Professor Paul Keall has changed the course of cancer treatmen­­­­t. He and his research team have developed technology that could revolutionise current practice and improve patients’ quality of life.

Cancer is an enormous public health problem. In 2016 one Australian died from cancer every 12 minutes, according to Australian Institute of Health and Welfare (AIHW) statistics. Globally, the numbers are even more staggering – World Health Organization estimates show that 18 people die every minute from cancer.

Improving patients' quality of life

Radiotherapy is the recommended treatment in 50 percent of cases in Australia, with around 63,500 courses delivered in 2016-17, according to the AIHW. However, radiotherapy is not an exact science, because the human body’s routine movements – such as breathing, digesting and swallowing ­­­– move and rotate the tumour during the time the patient is being treated. This motion – if not detected and corrected – can move the tumour away from the treatment beam and bring healthy tissue into the beam’s path.

Professor Keall, the Director of the University’s ACRF Image X Institute, has created software to both detect and correct this motion. Using this software reduces the margin for error and prevents unnecessary radiation of healthy tissue surrounding the tumour.

At the moment clinicians typically use x-rays to locate cancer tumours before patients start their radiotherapy and rely on that imaging to guide the radiation beams that attack cancer cells.

Professor Keall’s tumour tracking systems allow clinicians to precisely pinpoint a tumour using x-rays in real-time – to within 0.5 mm – and then the systems use a mathematical algorithm to reshape the radiation beam, so radiotherapy is always focused on the tumour.

“What we’re adding is the ability to see the cancer in real time and adapt the treatment to target the moving tumour,” he adds. “And that’s something that is not currently part of standard modern radiotherapy. Hopefully it will soon be.”

Professor Keall’s systems are unique and remarkably simple to implement. They can be added to existing technology in almost any cancer centre around the world. The cost will be minimal, particularly if he can gain support from industry partners to commercialise the software.

“The game changer is that you don’t need any more equipment – you’re just adding software to make the system smarter and to convert existing equipment into real-time radiotherapy systems,” Professor Keall says.

“There is massive potential for global adoption of these technologies, because the equipment already exists.”

Human trials

Human trials have shown that the technology is safe and robust when applied to prostate cancer. Professor Keall’s next clinical milestones will be a liver cancer trial and treating multiple cancers. The latter presents complex guidance problems because the tumours often don’t move in sync with each other.

Overseas expansion is due to start with a clinical trial in Denmark in 12 months.  In Australia, commercialisation of healthcare technologies tends to move slowly, Professor Keall adds, so a national rollout of the software in Australia could be five to 10 years away.

However, he is optimistic that in 15 years' time the majority of patients with cancer will be treated with real-time tumour tracking technology. It’s a relatively short-term wait that could potentially deliver a long-term gain for hundreds of thousands of patients with cancer.