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Educational Grant Winner- Dr Stephen Robinson, ESTRO 2023

Updated: May 22, 2023

In order to support NOTCH project leads to present their work on the international stage, we are delighted to offer a single educational grant of up to £500 to help with conference fees and travel costs.

Our latest winner, Dr Stephen Robinson, describes his experience presenting our Thymoma project at ESTRO 2023.

Congratulations to him!

"On the 12th-14th May I was fortunate enough to attend the ESTRO conference in Vienna to present my research on behalf on NOTCH.

This was my first ESTRO conference and so I was unsure of what to expect from the pre-eminent European radiotherapy conference. Thankfully I knew at least one person who was also going to be attending the conference and we had agreed to meet up for coffee on the Saturday morning. In fact, I needn’t have worried, as shortly after arriving at the Friday evening networking session I bumped into a colleague who I had only previously met on zoom. The whole conference was similarly characterised as much by the informal meetings and conversations with current, former, and maybe future colleagues as the excellent variety of scientific talks.

The scientific programme kicked off on the Saturday morning, and I chose to attend he symposium on personalising radiotherapy. As with much of the programme, there was an emphasis on presenting cutting edge science and then relating it to the patients we treat. This session highlighted the different ways that radiotherapy could be altered for different patients, whether that’s through more effective and targeted systemic therapies in addition to radiotherapy, adjusting your radiotherapy dose based on individualised genetic features, adapting radiotherapy doses/volumes during treatment depending on real-time anatomical changes or using AI modelling to improve radiotherapy and radiotherapy-drug combinations. Whilst these techniques are not quite ready for the clinic, this session demonstrated how far along we are, and that these techniques will likely come in during our clinical career. One of the key take home messages for me was “why make our patient look like the planning scan, why not make the plan suit the patient?”.

Following this I had my poster discussion session to present my work. This was a new concept for me, as previous poster presentations had been standing in front of a physical poster and talking to interested passers-by. In fact, this format required me to present my poster on a large screen in a packed room with a queue to get in extending out the door! I had been given 2 minutes to present followed by 2 minutes of questions. This rapid run through of the work you have done requires you to really understand the topic to pull out the key points in such a short amount of time. I overran, taking almost the full 4 minutes to present my work, but the talk seemed to go down well with positive feedback received from the listeners who came up to discuss after all the talks had finished.

Now that my presentation was over, I could relax into the rest of the conference, spending my time listening to world leading speakers and interacting with my peers. As expected, there was several significant immuno-oncology talks throughout the conference. These talks highlighted how complex the interactions between the tumour – the immune system – the tumour microenvironment and our treatments were, and the difficulties in combining immune-therapeutics (IO) with radiotherapy given the immune stimulating and immune inhibitory effects seen following radiotherapy. Professor Harrington (Institute of Cancer Research, London) presented an excellent talk highlighting the trial and laboratory data on IO-radiotherapy combinations contrasting the successful Pacific trial in non-small cell lung cancer (concurrent chemoradiotherapy plus adjuvant immunotherapy) with several unsuccessful head & neck cancer trials (concurrent IO+chemoradiotherapy) to conclude that simply adding IO to chemoradiotherapy is unlikely to be successful.

Other highlights for me included attending the Lower GI proferred papers session, hearing about the excellent organ preservation rate (60%) and much less toxicity in the phase 2 STAR-TREC trial which investigated mesorectal RT for early-stage rectal cancers. Also presented were: quality of life data following a total neoadjuvant therapy trial comparing chemo-> chemorad->surgery to chemorad->chemo->surgery [no significant differences]; Long term overall survival data following recurrence of locally advanced rectal cancer [less correlation between recurrence and overall survival over recent decades highlighting impact of improving systemic therapies]; comparing immediate and delayed surgery following short course radiotherapy in rectal cancer [similar surgical toxicities with either approach, more chance of non-operative management with delayed RT].

For me, Sunday entailed lots of talks on brain cancers. Starting with the ESTRO-EANO symposium on the multidisciplinary treatment of brain metastases, followed by the Haematology-CNS proferred papers session. These were data heavy sessions with lots of Kaplan-Meier graphs (as expected at an oncology conference!). It started with a run through of the evidence of stereotactic radiotherapy for brain metastases in the context of IO (short answer upfront stereotactic radiotherapy is probably better), followed by a discussion on how many brain metastases are too many for stereotactic radiotherapy compared to offering whole brain radiotherapy (short answer it’s the volume of metastases rather than the number, and whole brain radiotherapy is only for fit patients who are technically not suitable for stereotactic radiotherapy). A talk on the use of hippocampal sparing radiotherapy emphasised the importance of understanding your outcome measures and the timepoints for assessing them to get a true answer, whilst a quick poll following the talk demonstrated only 5-10% use of memantine as a neuro-cognitive protector during RT despite reasonable trial evidence on its benefit.

The proferred paper session presented data on different aspects of Primary CNS lymphoma including recurrence patterns depending on time of recurrence and how consolidation treatment changed overtime in different patient risk groups. As well as the results of smaller trials looking at stereotactic spine radiotherapy for inoperable metastatic cord compression (promising results), pre-operative stereotactic radiotherapy for brain metastases (very promising results), and longitudinal imaging and quality of life follow up following proton radiotherapy to the brain focussing on radiation induced contrast enhancement (increased risk with re-irradiation, minimal impact on quality of life).

And that was it for me, a quick lunch followed by a rush to the airport to fly home ready for work on the Monday. I had an excellent time at ESTRO, heard some inspiring and thought-provoking talks, “networked” with peers and luminaries. Working with NOTCH allowed me to really push my research further than I could have done alone and helped me get to ESTRO to present my research to an international cohort of interested listeners. I would therefore highly encourage anyone with a research idea to get in contact with their local NOTCH rep or the NOTCH committee to discuss how NOTCH might be able to help."

-Dr Stephen Robinson, May 2023

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