The Trans-Tasman Radiation Oncology Group is a clinical trials cooperative group established in 1989 to facilitate research into all cancers that can be treated with radiotherapy. Since its inception, TROG has made significant progress towards developing a comprehensive program of trials designed to better treatment outcomes in the many thousands of Australians who each year require radiotherapy, either alone or in combination with other treatments such as surgery or chemotherapy. As the title of the Group suggests this trials program benefits from collaboration with New Zealand, which experiences a similar range of cancer related problems. Cooperation between the two countries has proved particularly important in securing timely results from large scale multi-centre trials. The success of the program is reflected by the active participation of over 40 cancer treatment centres across Australia and New Zealand, involving the majority of the clinical radiation oncology specialist workforce.
TROG is a charitable body whose role is to act in the public interest.
TROG has now activated a total of 47 clinical trials in Australia and New Zealand with 17 trials currently still ongoing. Over half of these trials are randomised controlled trials (Phase II or III). In a majority of these trials, radiotherapy has been used in combination with other modalities such as surgery or chemotherapy and has involved the active participation of clinicians from other disciplines or from other trials groups. In addition, a number of trials have been approved for development and the activation of these trials will be rolled out once all the development requirements have been satisfied. Cancers studied by TROG include breast, rectum, prostate, oesophagus, lung, bladder, lymphoma, melanoma, brain tumours and bone metastases. Please refer to the trials section
of ‘Information for TROG members’,
‘Information for Health
Professionals’ or ‘Information
for Patients’ for more details on the type of clinical trials
TROG runs.
With the exception of two trials developed by the European Organisation for Research into the Treatment of Cancer (EORTC) and two trials developed by the National Cancer Institute of Canada (NCIC) which TROG contributes to in partnership, all of TROG’s trials have been developed independently in Australia and New Zealand by TROG alone or in collaboration with other Australian trials groups. TROG also has international collaborators in the United Kingdom, Singapore, Netherlands and Canada.
Penetration of the trials program to the public is reflected by the fact that since its inception over 6000 patients have participated in the various trials that TROG has run or is currently running.
To date over 50 publications describing TROG’s research have appeared in the scientific literature and numerous oral presentations have been delivered. The Group has won competitive funding support worth over $8 million to run its individual clinical trials and support TROG infrastructure.
Radiotherapy is an effective treatment for cancer when delivered with curative or palliative intent, and one benchmark for optimal practice accepted by Australian governments and WHO is that in excess of 50% of all patients with internal cancers should receive radiotherapy at some time over the course of their illness.
Despite its effectiveness, and its cost effectiveness in comparison to other treatment modalities, there is a gap between supply and demand for radiotherapy which has persisted throughout Australia, despite the expansion of government and private services. In 2000, only 38% of Australian patients diagnosed with cancer receive radiation treatment.
Prostate Cancer:
Completion of TROG 96.01, Australia and New Zealand’s largest cancer trial to date. This involved 818 men with prostate cancer and commenced in June 1996 and completed in February 2000. Radiotherapy is commonly used to treat prostate cancer but sometimes fails to produce cure because the prostate harbours too many cancer cells to kill off without producing serious side effects. This trial examined whether reduction in the number of cancer cells by hormone treatment prior to radiation could improve outcome. The first results will begin to come out later this year.
Establishment of quality assurance
procedures for the treatment of cancer using radiotherapy:
A level III dosimetric intercomparison, employing an anthropomorphic phantom, was performed to check the accurate delivery of dose to the clinical target volume in radiotherapy by mimicking the treatment pathway of a patient as closely as possible. 18 radiotherapy centres in Australia and New Zealand were visited and the phantom treated for two different treatment scenarios based on current clinical trials of the Trans Tasman Radiation Oncology Group (TROG): a two field treatment of a carcinoma of the tonsil (TROG 91.01), and a four field prostate treatment (TROG 96.01). This study confirmed that the dose delivered by all participating centres in the two clinical trials was as intended. In addition, it provided reassurance to the oncology community and the general public that all participating centres were able to deliver the prescribed dose to the target volume.
Rectal Cancer:
The largest Intergroup cancer trial involving all three forms of cancer therapy in Australia and New Zealand was completed in June 2006. 326 patients with stage 3 rectal cancer were randomized to receive either short course radiotherapy followed by surgery or long course chemoradiotherapy followed by surgery. This trial follows the recent published study TROG 98.01 (Dis Colon Rectum 2005; 48: 1389 - 1396) in which the long course therapy was assessed in a multicentre setting. The toxicity in both arms of the trial has been acceptable. It is anticipated that a final analysis of the trial results will be available in 2009.
Skin Cancer:
(Post-operative concurrent chemoradiotherapy versus post-operative radiotherapy in high-risk cutaneous squamous cell carcinoma of the head and neck) has just received a major funding boost. A grant from the Queensland Government Smart State Initiative has recognised the importance of skin cancer in Queensland and has given $325,000 over 5 years towards the study. It is hoped this boost in funding will help with accrual and funding of data management in contributing centres.
Other cancers:
Refer to abstracts provided under Publications
and News for other significant achievements.
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