Clinical Research Centre

Staff                  Radiation Oncology Services

The Clinical Research Centre (CRC), which has been envisaged as a 'model centre for clinical research' was formally inaugurated on the 30^th of March 2005 by Dr. Anil Kakodkar, Chairman, Atomic Energy Commission. In keeping with the overall mandate of the ACTREC, the CRC is focusing initially on paediatric cancers, brain tumours, head and neck cancer, cervical cancer, breast cancer, cancer genetics and technology evaluation.

Radiation Sciences: The Department of Radiation Oncology in the Paymaster Shodhika is a state-of-the-art department with fully developed facilities for planning, delivery and verification of conventional as well as high-precision radiotherapy. The dual energy Linear Accelerator with multi-energy electron capability is equipped with several beam modifying and directing devices including multi-leaf collimators (MLC), micro MLC, electronic portal imaging, virtual wedges and infra-red marker tracking - benchmarks for modern day radiotherapy practice. The presence of a simulator with CT connectivity and virtual simulation facility, a 3-D treatment planning system with inverse planning module, and an automated compensator cutting unit helps in precision treatment planning and verification. The commissioning of complex 3-D conformal radiation therapy (3D-CRT), intensity modulated radiation therapy (IMRT), stereotactic radiosurgery/ radiotherapy (SRS/ SRT), and arc therapy has been completed and some of these high-precision techniques have been successfully implemented in the clinic. From April 2005, the department has started treating patients on Institutional Review Board (IRB)-approved protocols, mostly on an out-patient basis.

The Integrated Brachytherapy unit (IBU), which houses the remote after-loading high dose rate brachytherapy facility, is also ready for clinical use. The first high-activity iridium source has been loaded in the unit and the quality assurance (QA) tests have been found acceptable. A stringent QA programme to monitor and maintain the high standards of the service has been put in place, as per internationally accepted norms.

The Radiology department has also started functioning and is currently offering diagnostic services in the form of CT scan, X-ray, USG and colour Doppler.

Technology Evaluation: In keeping with its mandate of developing, testing and promoting indigenous technology, the department of Radiation Oncology submitted its 1^st Technical Report on the Bhabhatron (indigenously developed telecobalt machine) to the AEC Chairman on the occasion of the inauguration of CRC. Design modifications based on these recommendations led to significant improvements in the performance of the unit, making it at par with the imported cobalt machines, resulting in successful type approval and commissioning approval from the regulatory authorities in June 2005.

Other projects include indigenous development and designing of wooden head-neck rests with minimal attenuation, for use in conventional and high-precision radiotherapy. The indigenisation of dosimetry phantoms and chamber holders for daily QA is being undertaken currently. Customisation of brachytherapy applicators is also under consideration, as a part of the technology evaluation programme.

Day-Care Ward and Ward Block: The day-care services were inaugurated in May 2005, with a view to administer simple chemotherapy on an out-patient basis. At present, an average of 5-7 patients are receiving chemotherapy daily in the day-care ward.

The Ward Block - re-christened as 'Jussawala Shodhika' has 50 fully-equipped beds and thus provides ample opportunity for carrying out clinical trials on newly developed anti-cancer drugs and bio-therapeutic agents, in the form of monoclonal antibodies and gene therapy. Several prospective clinical trial protocols have been approved by the IRB for ACTREC in all disciplines of Oncology, and enrolment on them has started in close collaboration with investigators from TMH. The intensive care unit (ICU) with isolation beds and state of the art monitors and ventilators has also been recently commissioned. The Bone Marrow Transplant (BMT) unit and the Stem Cell Bank are in an advanced state of commissioning. The operation theatre (OT) block, which has undergone major modification, is to be commissioned by the end of the year.

Composite Laboratory: The haematology and biochemistry analysers have been commissioned and made operational. Presently they cater to the needs of the radiation therapy, day-care ward and in-patients. Most of the equipment of the composite and the emergency laboratory has been installed, calibrated and tested, and is in an advanced state of commissioning.

Support Services: The prohibitive distance of the facility from the main city and the parent hospital has prompted the modification and renovation of the hostel block to provide quality accommodation to the patients and their care-givers, who would otherwise have had to commute long distances daily fir their treatment. For local residents and other patients who do not wish to avail of the on-campus accommodation services, a shuttle facility to carry them to and from TMH had been made operational. In addition, the Pharmacy has been made functional and is currently dispensing medication to patients being treated at the CRC. A Medical Social Worker - with the help of the nursing staff, the medical administration and volunteer groups, oversees the support service facility.

Clinical Trials Secretariat (CTS): Developmental therapeutics is borne out of scientific and ethical clinical research, which requires major support services in the form of a Secretariat. Still in the planning stage, the CTS - once it becomes operational, will become the hub of national multicentric trials in close association with the clinical trials unit of the Clinical Research Secretariat (CRS) at TMH. It would in future liaise and collaborate with international agencies such as NCI, WHO, IAEA, IARC for the conduct of multicentric trials.

Education: An important mandate of the CRC is the development of a structured post-doctoral educational programme in every clinical discipline of oncology. This includes Medical and Paediatric Oncology, Cancer Genetics, Bone Marrow and Stem Cell Transplant, Neuro-Oncology, Radiation Biology, High Precision Radiotherapy, Brachytherapy, Paediatric Surgical Oncology, and Clinical Research Methodology. The Homi Bhabha National Institute (a deemed university) is a first step in that direction, which would enable the education programme to take root successfully.