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Leeds Cancer Centre, UK

Leeds Cancer Centre, UK. June 2013. Leeds Cancer Centre. Provides comprehensive cancer services for 750,000 population of Leeds 2.7 million population of Yorkshire Supra-regional services for 5.4 million population of Yorkshire-Humber. Leeds Cancer Centre.

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Leeds Cancer Centre, UK

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  1. Leeds Cancer Centre, UK June 2013

  2. Leeds Cancer Centre • Provides comprehensive cancer services for • 750,000 population of Leeds • 2.7 million population of Yorkshire • Supra-regional services for 5.4 million population of Yorkshire-Humber

  3. Leeds Cancer Centre • Cancer services co-located at St James’s University Hospital • St James’s Institute of Oncology – clinical care / trials • Opened in 2008, £220 million development • 3rd largest cancer centre in the UK (66,000m2, 350 beds) • Leeds Institute of Molecular Medicine – laboratory research • £21M development, opened 2005 • >7,000m2 building linked to existing research laboratories

  4. St James’s Institute of Oncology • 11 floors, 12 wards, patient hotel • Excellent transport links (airport 20 minutes) • Unites • Non-surgical oncology (including TYA cancer) • State of the art imaging and radiotherapy • Specialist Cancer Surgery • Haematology • Clinical pathology • Cancer registry • Protected research beds

  5. UK cancer incidence, 2009

  6. Leeds Cancer Centre • Comprehensive cancer services • Surgery, chemotherapy, radiotherapy • Radiology and pathology • Clinical research • Academic research • 24 site specific multi-disciplinary teams • Common cancers - breast, colorectal, lung • Intermediate cancers – gynaecology, urology, upper GI, H&N • Others – liver, CNS, melanoma, skin, thyroid • Haematological malignancies

  7. Multi-disciplinary teams • Site-specific teams basis of cancer care • Weekly meeting to review all new and relapsed cases • Leeds and Yorkshire • Central, specialist review of all radiology, pathology • Electronic transfer of radiology • Working towards digital pathology • Patients managed according to clinical guidelines • Guidelines agreed across Yorkshire Cancer Network • Site specific teams subject to annual peer review • Measures defined by National Cancer Action Team

  8. Our workload • 12,500 new cancer diagnoses in Yorkshire each year • 6,500 radiotherapy patients • 90,000 fractions of radiotherapy • 5,000 cycles of chemotherapy • 120 bone marrow transplants • 11,700 elective NSO admissions • 3,500 acute NSO admissions • Significant specialist surgery workload

  9. Leeds Cancer Centre • 1240 nurses • 100 radiographers • 60 medical physicists • 20 allied health professionals • Includes • dieticians • occupational therapists • physiotherapists • speech and Language therapists • social workers • 430 consultants • Including: • 31 clinical oncologists • 24 medical oncologists • 22 haematologists • 33 histopathologists • 42 radiologists • 70+ surgeons • 35 general surgeons • 4 thoracic surgeons • 5 gynaecology surgeons • 12 urology surgeons • 4 head and neck surgeons • 8 plastic surgeons • 6 neurosurgeons

  10. Cancer surgery • First class Service Delivery incorporating state of the art technologies RoboticSurgery LaparoscopicSurgery

  11. Chemotherapy • Comprehensive range of chemotherapy services • Intravenous / Oral • Intra-peritoneal / Intra-vesical / Intra-arterial • Rapid access to modern drugs • Modern cytoxic chemotherapy drugs • Targeted therapies

  12. Antibodies inhibiting VEGF receptors Soluble VEGF receptors (VEGF-TRAP) Antibodies inhibiting VEGF(e.g. bevacizumab) Small-molecules inhibiting VEGF receptors (TKIs)(e.g. PTK-787) Ribozymes (Angiozyme) New agents targeting the VEGF Pathway  Permeability VEGF VEGFR1 FLT1 Cation channel VEGFR2 KDR – P P– – P – P P– P– – P P– P– P– – P – P Migration, permeability, DNA synthesis, survival Angiogenesis Lymphangiogenesis

  13. Radiotherapy • Linear accelerators • 10 NHS, 2 research • 4 Planning CTs • Brachytherapy unit • State of the art technology • Image guided radiotherapy • Intensity-modulated radiotherapy • Volumetric Modulated Arc Therapy • Stereotactic radiosurgery unit • UK lead in stereotactic body radiation • World first clinical use of Agility (beam shaping device) and use with SABR technique – October 2012

  14. Haematology • Supra-regional service (3.8 million) • Treats both adults and TYA • 43 beds, +ve pressure hepa-filtered • Bone marrow transplantation • 50 allografts, 55 autografts • On-site stem cell harvest • National lead for PNH • Prof Peter Hillmen • Strong research record • Myeloid – Dr David Bowen • Lymphoid – Prof Pete Hillmen • Myeloma – Prof Gordon Cook

  15. Paediatric and adolescent cancer • Designated treatment centre for 3.8 million population • Paediatric oncology • Paediatric haematology • Teenage and Young Adult • Bone marrow and stem cell transplantation • Services located at Leeds General Infirmary • 3 in-patient wards, 25 beds • Dedicated day care unit and out-patient clinic • One of the most active research centres in UK • National leadership roles throughout • International leadership in TYA and cancer survivorship

  16. Clinical Informatics • PPM • All cancer diagnoses since 1990 • ChemoRx and RadioRx since 1995 • All clinic letters, MDT reviews since 2002 • Clinical outcomes • Early morbidity/mortality • Overall survival • Open-source EHR in development • Trust-wide clinical portal • Links to primary care • SystmOne and EMIS

  17. Pathology • Standard light microscopy plus antibodies • Molecular phenotyping • HER2 over-expression in breast cancer • EGFR mutations in lung cancer • K-Ras mutations in colorectal cancer • Part of CR-UK Stratified Medicine Programme • Aiming to deliver Next Generation Sequencing • Cancer Genome in 4 hrs for $1000

  18. Clinical trials - Recruitment • Strong clinical trial recruitment across LTHT • 33% of all patients recruited to trials • 10% of patients recruited to randomised controlled trials • Large, dedicated trial support team • Nurses, co-ordinators, data clerks, administrative/finance • Leadership profile • Colorectal cancer; ovarian cancer; breast cancer

  19. Clinical trials - Leadership • Chief Investigator on large international phase III trials • ICON3 – Dr Tim Perren, NEJM, 2011 • FOCUS2 – Prof Matt Seymour, Lancet, 2011 • EMBRACE – Prof Chris Twelves, Lancet 2011 • CR07 – Prof Sebag-Montefiore, Lancet 2009 • Leeds Clinical Trials Unit • Prof Julia Brown • Co-ordinating centre for phase 1 Myeloma UK Network • NCRN – national co-ordinating centre for cancer research • Prof Matt Seymour

  20. Cancer Research UK Clinical Centre • Director – Prof Tim Bishop • Formal partnership between • University of Leeds, LTHT, Cancer Research UK • 4 core programmes • Genetics and epigenetics of cancer • Targeted therapies • Early phase and randomised prospective clinical trials • Biomarkers and pathology • Aims to harness the scientific power of Leeds-based cancer researchers in order to deliver improvements in cancer therapy at local, national and international level. 

  21. Leeds Institute of Molecular Medicine • Director Prof Peter Selby • Level 9 - Genetics; Molecular Gastroenterology • Level 8 - Neurosciences • Level 7 - Experimental Cancer Therapeutics • Level 6 - Experimental Haematology • Level 5 - Targeted Cancer Therapies • Level 4 - Cancer Pathology, Tumour Biology • Level 3 - Support services

  22. Radiation research • Prof David Sebag-Montefiore • Dedicated research facility • Collaboration with Elekta • UK consortium with Elekta • Christie, Manchester • Marsden, Sutton • International consortium • Netherlands Cancer Institute • Princess Margaret (Toronto) • AlgemeinesKrankenhaus (Vienna)

  23. Imaging Research • Leadership in both PET and MRI • Dr Andrew ScarsbrookProf David Buckley • Involvement with CR-UK • Large portfolio of oncology projects (>150) • Dedicated research PET/CT machine

  24. Surgical research • Led by Prof David Jayne TISSUE-DEVICE INTERACTIONS INTRA-ABDOMINAL PLATFORMS INTRACORPOREAL ROBOTICS Surgical Technologies Stratified Surgery FLUORESCENCE-GUIDED SURGERY BIOSENSORS

  25. Surgical research • MRC/EME/NIHR ROLARR Trial • Robotic vs Laparoscopic Rectal Cancer • £1.2m over 5 years • Pan-World randomised control trial Intraoperative fluorescence for Stratified colon cancer surgery • MRC/EME/NINR GLiSten Trial • £1m over 3 years • Multicentre UK randomised • controlled trial • Fluorescence guided surgery

  26. Any questions ?

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