The Royal Marsden

Surgery trials focus on women's cancers

The Royal Marsden has opened two innovative surgical trials with the aim of improving outcomes for gynaecological and breast cancer patients.

FRIENDS study leaders Miss Marielle Nobbenhuis, Mr Thomas Ind and Mr John Butler

In the FRIENDS study, gynaecological cancer surgeons Mr Thomas Ind, Miss Marielle Nobbenhuis and Mr John Butler are using the da Vinci Xi surgical robot and a fluorescent green dye to identify sentinel lymph nodes (SLNs) in patients with cervical or endometrial cancer.

Miss Nobbenhuis, Consultant Gynaecological Oncology Surgeon, said: “In early cervical and endometrial cancer, a total pelvic lymphadenectomy – where all the lymph nodes are removed to assess the spread of the disease – is the standard course of action. However, most patients have negative nodes, and the total lymphadenectomy may expose them to the risk of lymphoedema.

“We’ve launched the FRIENDS feasibility study to carry out an SLN biopsy using the da Vinci Xi and a green dye, to better identify women who do not require a radical lymphadenectomy.”

During an SLN biopsy, the sentinel lymph node is identified, removed and examined to determine whether cancer cells are present. A negative result indicates that the cancer has not spread to nearby lymph nodes or other organs. A positive result indicates that cancer may be present in other nearby lymph nodes, and further treatment – such as radiotherapy or chemotherapy – is usually recommended.

PRADA study

The Primary Radiotherapy and DIEP flap reconstruction (PRADA) study for breast cancer patients is due to open soon. This is a multi-centre surgical trial and will be undertaken at both The Royal Marsden and Imperial College Healthcare NHS Trust.

The PRADA study alters the traditional treatment pathway for breast cancer: chemotherapy, followed by surgery, then radiotherapy. In the study, radiotherapy will be given after chemotherapy, but before surgery. This ensures that radiotherapy does not damage the ‘new’ reconstructed breast.

Administering radiotherapy at this point has been shown to be safe and effective in other types of cancer. Our researchers want to assess the feasibility of performing breast surgery after radiotherapy.

The DIEP flap reconstruction is a complex operation during which the breast is removed and reconstructed using transplanted abdominal fat, which retains a natural breast-like appearance. Breast reconstruction has been shown to be hugely important to a woman’s emotional and psychological recovery.

Principal Investigator Miss Fiona MacNeill, Consultant Breast Surgeon at The Royal Marsden, said: “This is an innovative study to address a very important question regarding the timing of radiotherapy and breast reconstruction, and may allow more women to have breast reconstruction in the future.

“We are pleased to collaborate with Charing Cross Hospital’s breast and plastic surgery teams to answer this question as soon as possible.”