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Cancer imaging research increases curable surgery

Interview with Professor Gina Brown, MD FRCR at the The Royal Marsden and Imperial College London.

“We like to think that the trials we set up can be rolled out to be a standard of care across the country and world. The aims of these trials are always to improve clinical practice through participation.” - Professsor Gina Brown

Researchers, radiologists, pathologists, and surgeons collaborated on the Mercury II trial study and succeeded in reducing the incomplete removal of cancer tumors from 30% to 9% while also reducing the amount of unnecessary surgeries. This study not only resulted in  life-changing and life-saving results for rectal cancer patients in the UK, but it also has the potential to improve outcomes for patients across the globe. For ‘leading the way in the evolving field of imaging technology’ the cross-departmental group won the Imaging Team of the Year Award for 2015.

Evidence-Values CircleProfessor Gina Brown was chief investigator of the Mercury II trial study at The Royal Marsden hospital in London. In partnership with the Pelican Cancer Foundation, Professor Brown’s team used an MRI classification system for low rectal cancer to improve surgical outcomes for patients. While the MRI technology the team used has been around for a decade, their innovative approach examined the images much more closely than ever before. Professor Brown said, “I’m a strong believer in making the most out of what we have, and looking at things very carefully. This study was all about looking thoroughly and in detail – much more thoroughly than had been previously done.”

Surgeons and oncologists benefitted greatly from the study’s very detailed assessment of tumors. They could modify treatment to each patient’s exact situation, rather than erring on the side of caution and performing very radical and perhaps unnecessary surgeries. Before the study,  surgeons “weren’t certain how bad the tumor was and therefore they didn’t know how much to limit the surgery and radiotherapy.” The precise and detailed MRI imagery helped clinicians and surgeons to precisely tailor and accurately adjust their care. Patients benefitted directly from the study, which increased curable surgeries and lowered recurrence from incomplete tumor removal. 

Before this research, one in three patients with a low rectal cancer was having an incomplete removal, which resulted in recurrence and eventually the patient not surviving. We’ve halved the amount of incomplete surgeries and aim to improve even more. This is how the study has impacted patient’s lives. – Professor Gina Brown

However, the project also faced challenges. One challenge Professor Brown’s team faced was finding and securing funding in a harsh current economic climate. Professor Brown explained that the study’s successful track record and national recognition from The BMJ award “will undoubtedly make it easier to raise funds in the future.” Another challenge was expediting participation in the study across the NHS. Cooperation across hospitals was especially important to Professor Brown. She said, “we like to think that the trials we set up can be rolled out to be a standard of care across the country and world. The aims of these trials are always to improve clinical practice through participation. Winning this award definitely helps in maintaining the enthusiasm. It increases the momentum of hospitals, clinicians and other specialists who have collaborated with us over the years – and new ones who might wish to collaborate with us in the future.”

BMJ Pelican Award

Next steps for the programme include reporting on quality of life from a patient’s perspective at yearly intervals. “We’re going to be researching how the different operations impacted patients because we think this will help when those initial discussions are made with the patient. At the moment we don’t have enough information to tell patients what their quality of life will be like” says Professor Brown.  This information can be used by clinicians to help their patients make informed decisions.  It can also take away some of the fear and uncertainty patient’s face with this difficult diagnosis. The study will continue trying to improve across the board with imaging, surgery, and pathology for their patients.