Seed Grant Recipients Collaborating Across Ontario: Joelle Helou and Christiaan Stevens

THIS IS AN EXCERPT FROM THE 2016-2017 ANNUAL REPORT.

In 2013, the Department of Radiation Oncology at the University of Toronto (UTDRO) launched the Collaborative Research Seed Grant – an annual competition that awards grants to researchers who are collaborating across different cancer centres.

The projects funded by this grant have the potential to significantly impact the science of radiation medicine and improve patient outcome. To date, UTDRO has awarded eight grants to teams comprised of researchers from two or more cancer centres in Southern Ontario.

The latest project to be funded through this program is “Stereotactic Ablative Radiotherapy for Renal Tumors” which is being co-led by UTDRO Assistant Professors, Dr. Joelle Helou from the Princess Margaret Cancer Centre (PM) and Dr. Christiaan Stevens from the Simcoe Muskoka Regional Cancer Program (SMRCP) at the Royal Victoria Hospital (RVH).

UTDRO staff writer, Sarah Khan, spoke with Joelle and Christiaan to find out more about their research project.

Q: Why did you decide to study SBRT for kidney tumours?

Joelle: Stereotactic Body Radiotherapy, or SBRT, is an emerging and evolving treatment modality with a rapidly growing role. For instance, SBRT has been adopted as the standard of care for patients with inoperable early stage non-small cell lung cancer as it enables the non-invasive ablation of the tumor. Researchers have been exploring SBRT for other organs including the kidney, which has been pioneered by the Australians.  At the PM, we have a well-established SBRT program. Dr. Laura Dawson is one of the world’s foremost experts on liver SBRT due to her extensive research in this field. Based on Laura’s experience, I wished to explore SBRT as a nephron-sparing modality for kidney tumors. 

Christiaan: We are growing our SBRT program at the SMRCP.  We have been successful in setting up robust lung, brain and bone metastases SBRT programs, and are developing SBRT for other sites. When Joelle approached us about participating in a study of SBRT for kidney tumours, we felt that it aligned with our program’s SBRT growth plan as well as our goal to grow clinical research, in order to offer the highest level of care to our patients locally.

Q: What are you hoping to explore in this study?

Joelle: Surgery is the standard treatment for kidney tumours; however, older patients and those with medical co-morbidities cannot undergo surgery have limited options, such as nephron-sparing radiofrequency ablation (RFA) or cryoablation. SBRT enables non-invasive ablation and can mimic surgery; however is still experimental in the setting of kidney tumors. The SBRT experience in other sites suggested very high local control rates with low toxicity. As such, we aim to explore SBRT as a potential nephron-sparing modality in the treatment of kidney tumor. 
We also want to assess the motion of the kidney during treatment and the relationship between motion and renal function.

Christiaan: Since SBRT for the kidney is still an evolving experimental treatment modality, it is best to explore this in the context of a study with well-defined outcomes. The data generated will help contribute to the burgeoning literature in this field.

Q: What is the benefit of having different hospitals participate in this study?

Joelle: Having different hospitals participating will increase accrual rates; kidney SBRT is an excellent opportunity to collaborate with other sites. 

Christiaan: Collaborating on this study will be of mutual benefit to the collaborators, to our institutions, to UTDRO at large, and to our patients. At RVH, radiation oncologists, physicists and radiation therapists benefit from the experience of PM in this field, which help to accelerate the development of our SBRT program. Our patients will have access to a treatment modality otherwise not available. For PM, understanding the slightly different realities of community radiation oncology practice may help shape the study in a way that may inevitably make it more center agnostic. Obviously, access to a larger potential study patient population will also help accrual.

Q: What challenges do you anticipate in the next two years as the study progresses?

Christiaan: Our biggest challenge will be accruing patients. We are introducing a new treatment modality in a space where other modalities, such as surgery and RFA are better established. Urologists are the key “gate-keepers” for management, and they really do not have a vested interest in supporting the study other than academic interest. It will therefore be imperative to engage them upfront to ensure this study is on their radar.

Q: What is next on your radar in terms of this study?

Joelle: I would like to bring other centres on board such as the Carlo Fidani and Stronach Cancer Centres. If it is successful, the next step would be to compare this to other nephron-sparing modalities in a randomized trial.

Christiaan: If we are successful in patient accrual, it would show that we can establish a research relationship with our urological colleagues at the RVH. If successful, hopefully the data will provide a platform to launch a randomized study comparing SBRT to standard modalities. This would truly help establish SBRT as an alternative treatment modality.

Q: What do you think of the seed grant process?

Joelle: It is an excellent initiative because it pushes different centres to collaborate. UTDRO is a very strong department, and if we all collaborate on a regular basis, we would be unbeatable. Collaborating through these seed grants is an excellent way to conduct strong studies in our field.

Christiaan: I sit on the panel that reviews grant applications, so I have experienced both sides of the process. It is a fair and robust process. One of my observations thus far is that the research collaborations tend to flow one way. Most of the projects are conceived at our academic hospitals and then collaborators from the community hospitals are brought in to strengthen and develop the study. While this is understandable, I hope to see more projects where the genesis of the research idea begins as a true collaboration between the myriad UTDRO sites. I believe this could result in very high quality and ‘practical’ research.