Exploring novel solutions of radiotherapy delivery and using biology, imaging, new fractionations and radiobiological models to improve TCP/NTCP ratio

Around half of patients with oesophageal or pancreatic cancer who cannot have surgery see their tumours return within the radiation treatment field. Standard radiotherapy doses already cause severe toxicity when increased, so simply turning up the power is not an option. This research aims to make radiotherapy more personal by tailoring it to each patient’s tumour biology and anatomy. The team will use functional imaging—MRI and PET scans—to identify which parts of a tumour need higher radiation doses, then deliver those doses precisely using focused techniques such as stereotactic ablative radiotherapy. They will also combine radiation with new drugs that laboratory studies show enhance tumour cell killing. If successful, the work could shift clinical practice in two ways: better local tumour control for patients who currently have few options, and fewer side effects from radiation. The impact would be felt directly by patients and clinicians, not by infrastructure or supply chains. This is applied clinical research with a clear endpoint—improving the ratio of tumour control to normal tissue complications in upper gastrointestinal cancers.