Steven Brown was only too aware of the life-saving work medics carry out at The Christie NHS Foundation Trust in Manchester – his mother, father and aunt had all been treated by cancer care experts at the hospital.
So, following his own diagnosis of cancer in his throat and tonsils last August after becoming aware of a strange sensation at the back of his throat, the 54-year-old truck driver was only too happy to put himself forward for a potentially ground-breaking clinical study.
Mr Brown, a father of one from Poynton, Cheshire, has now become one of the first patients in the world to take part in a study by researchers at The Christie to measure the amount of oxygen in their tumour.
“My cancer diagnosis news knocked me to the floor”, Mr Brown said.
“I was referred to The Christie for chemotherapy and radiotherapy that September. My mum, dad and auntie were all treated at The Christie, so I knew it was a world leader and that I was in the right place to be seen by the right people. I felt in safe hands and that I was getting the best available treatment.”
Tumours starved of oxygen, known as hypoxic cancers, are more challenging to treat successfully, particularly when radiotherapy is given. By measuring the amount of oxygen in a tumour in real-time, it is hoped that cancer treatment can be altered to target hypoxic tumours more effectively.
Mr Brown is one of 11 head and neck cancer patients taking part in the trial. The breakthrough combines two cutting-edge technologies: the research team adapted the highly sophisticated MR-linac machine at The Christie to measure tumour oxygen levels. The MR-linac combines an MRI scanner with the delivery of cancer-busting radiotherapy to ensure that treatment is incredibly precise.
“On one of my early visits, I was approached by Dr John Gaffney to see if I would be interested in taking part in the research study,” Mr Brown said. “He explained that they wanted to combine a normal MR scan with the introduction of oxygen to hopefully learn more about cancer and be able to treat it better. Having lost my mum and dad to cancer, I wanted to do something to help people in the future.
“I agreed to have the voluntary MR scans done. The first was as I was starting my radiotherapy treatment, then one when I was midway through, and one as my treatment ended.”
Mr Brown first breathed room air through a mask and then pure oxygen to bathe the tumour with the gas. He was scanned on the MR-Linac machine during this, and maps of oxygen levels were obtained. The technique – called oxygen-enhanced MRI – reveals which parts of a tumour are oxygen starved and likely to be resistant to radiotherapy.
The technology provides an extra tool to help doctors in several ways: patients can be arranged for treatment by coming up with a risk level based on oxygen levels, more appropriate treatments can be chosen, and consultants can work out who is responding well or not well and adjust any care accordingly.
Professor James O’Connor, senior group leader at The Christie, The University of Manchester, and The Institute of Cancer Research, who led the study, said: “Any toxic treatment [radiotherapy and/or chemotherapy] that is not helping can be stopped and an alternative treatment can be added or used instead. The main goal of the research is better prognosis for patients, but it can also achieve better quality of life if doctors can avoid unnecessary toxicity during treatment.”
Mr Brown said: “Although I won’t directly benefit from this study, I know that taking part will help cancer patients in the future, and that’s a great thing. It is only through people volunteering to participate in clinical studies in the past that doctors and scientists have been able to develop the cancer treatments we have today.
“My last treatment was on 11 November 2022, and I felt very tired after that and couldn’t eat or drink properly. My taste buds stopped working, and I craved the taste of a cup of filtered coffee. I had a PET scan [Positron emission tomography scans are used to produce detailed three-dimensional images of the inside of the body] recently, but the result was inconclusive, as my throat is still very inflamed, so I will have another scan soon.
“I returned to work in January, and I’m feeling a lot better now and can eat properly again. My boss at work has been amazing throughout the whole thing as well as all my family and friends.”
Professor O’Connor said: “Though it’s clear more work needs to be done, we’re very excited about the potential this technology has to enable daily monitoring of tumour oxygen, and we hope to be at a point soon when the technology will guide cancer doctors in how they can best deliver radiotherapy.
“This imaging lets us see inside tumours and helps us understand why some people with cancer need an extra boost to get effective treatment. This is an important step towards the goal of changing treatment based on imaging biology.”
Michael Dubec, MRI clinical scientist from The Christie and The University of Manchester, said: “The MR-linac is an exciting technology that combines highly precise imaging and radiotherapy delivery with real-time imaging. We are tremendously excited about what is the first application in humans of ‘oxygen-enhanced MRI’, developed as a result of a multi-disciplinary team working across the country.”
Two further oxygen-enhanced MRI studies will take place on the MR-linac at The Christie. The Bio-CHECC study will focus on patients with locally advanced cervical cancer, and the Hyprogen study, which will carry out imaging in patients with advanced prostate cancer.
The research team said any patients interested in taking part in clinical trials should discuss this option with their consultant or GP. Not all patients will fit the criteria for a specific trial and while clinical trials can be successful for some patients, outcomes can vary from case to case, they said.
