Advanced Lung Cancer Treatment Targets Tumor, Spares the Heart

A new study presented at ESTRO 2025 introduced the RAPID-RT trial, which uses a rapid-learning approach to evaluate how changes in radiotherapy affect patient outcomes. Unlike traditional clinical trials, which are often time-consuming and limited by strict eligibility criteria, RAPID-RT is designed to be faster and more representative of real-world patient populations.

Researchers at The Christie NHS Foundation Trust in Manchester, UK, applied this method to lung cancer patients to investigate whether lowering the radiation dose to the top of the heart, a region thought to be at higher risk, could reduce cardiac toxicity and improve survival rates.

Radiotherapy remains a highly effective treatment for lung cancer, but the proximity of the heart to the tumor site means it can be exposed to harmful radiation. Prior studies in Manchester identified the top of the heart as particularly sensitive to radiation, with dose levels in this area linked to overall patient survival. In response to these findings, a "heart-sparing" technique was introduced into routine clinical practice to help protect this vulnerable area and enhance treatment safety.

"RAPID-RT represents a shift towards more inclusive research, designed to reflect the realities of everyday clinical practice and ensure that all patients, not just those who meet narrow trial criteria, benefit from innovation in radiotherapy," said co-lead investigator Dr Gareth Price, senior lecturer and medical physicist, at the University of Manchester. "We also hope that by reducing cardiac exposure, we may improve both survival and quality of life for patients."

Key Study Findings

The RAPID-RT study analysed data from 1,708 patients with stage I–III lung cancer who received curative-intent radiotherapy between January 2021 and February 2025:

• Standard curative-intent radiotherapy treatment was given to 922 patients treated before April 2023.
• The new heart-sparing technique was applied prospectively to 786 patients from April 2023 onwards, using two key innovations:
• An inclusive rapid-learning study design: this approach enables fast recruitment by including all patients treated at the institution, unless they actively opt out of data collection.
• Limiting radiation to a defined Cardiac Avoidance Area (CAA): Radiation dose to sensitive parts of the heart was limited to at 19.5 Gy (or equivalent) over 20-33 sessions, unless this restriction compromised adequate tumor coverage
• Early results show that the rapid-learning method is highly inclusive as to date all patients with stage 1-3 NSCLC treated with conventional curative-intent radiotherapy received the new technique, with only 1 out of 786 patients choosing to opt out of the study. Initial findings suggest a modest improvement in 12-month survival following implementation of a dose limit to the top of the heart.

Unlike traditional clinical trials, which can take years to deliver results, the RAPID-RT study used a "rapid-learning" model to evaluate and adapt treatments in real time using routine anonymized data from the electronic care record. This approach allows researchers to refine treatment strategies more quickly, bringing effective innovations to patients faster.