Professor Beate Timmermann, Medical Director of the West German Proton Therapy Centre Essen (WPE), Director of the Clinic for Particle Therapy, and Work Package leader in the HARMONIC project, answers some questions concerning her work, her life, and her role in HARMONIC.
- Can you please tell us, briefly, who you are and what you do?
My name is Beate Timmermann. For more than 20 years, I have been involved in the care of brain tumors and sarcomas, particularly in children.
My scientific and clinical fields are brain, bone and soft tissue tumors in children and adults, as radiotherapy quality, long-term health effects, and quality of life. Another field I have been working on is proton beam therapy for childhood cancer. Our pediatric RT program is offering proton beam therapy to more than 300 children per year, most of them with brain or spinal cord tumors, sarcomas, neuroblastomas, lymphomas and retinoblastomas.
During my career, I have had the opportunity to establish a network with many scientific and clinical partners and experts. Fortunately, we have numerous societies to enable strong collaboration, such as the German Association for Pediatric Radiation Oncology (APRO) and the Society for Pediatric Oncology and Hematology (GPOH). Furthermore, the Society for international Pediatric Oncology (SIOP) is an important platform that links us to pediatric oncologists worldwide. Together with ESTRO (European Society for Radiotherapy and Oncology) we have set up a course on pediatric radiation oncology. I believe that training is crucial for improving medical care and also teamwork. At WPE, our team is extremely multidisciplinary, involving highly qualified physicians, medical physicists, radiographers, nurses, health care and technicians who work closely together. We also have a study office, consisting of research scientists, documentation assistants and biologists, since research is an important part of our work. In fact, I have had the opportunity to be part of well-funded scientific projects aimed at optimising pediatric radiation therapy, as for example the ongoing EU Horizon project HARMONIC on late effects of radiation in children.
- This sounds interesting. What is HARMONIC?
HARMONIC aims at better understanding the long-term health effects of medical exposure to ionising radiation in children. This relates specifically to cancer patients treated with modern radiotherapy techniques and cardiac patients receiving diagnostic dose exposure from X-ray guided imaging procedures. The use of radiation for medical diagnostics and therapeutic interventions has significantly improved the survival of children with cancer. Although the benefits of these techniques largely outweigh the risks, there is a need to better assess the long-term health effects of such exposures in order to minimize the risk for late effects in these young patients.
The HARMONIC project will fill important gaps in knowledge about long-term outcomes of radiotherapy (and cancer therapy in general) in paediatrics, with the ultimate goal of improving cancer care in children, adolescents and young adults.
To meet the objectives, the project is structured into six Work Packages (WPs): One WP on radiotherapy, one on cardiology, two interconnected WPs on dosimetry and biology, as well as two crosscutting WPs that ensure the project coordination as well as the dissemination and uptake of its results.
- This sounds very ambitious. How will HARMONIC reach these goals?
The strength and uniqueness of HARMONIC is that it involves a multi-disciplinary collaboration between experts involved in paediatric care, including radiation protection researchers. Additionally, HARMONIC is supported by international radiation oncology and cancer societies and benefits from the advice of an international advisory committee.
The consortium includes institutions with solid experience in childhood cancer that can recruit a high number of children with cancer over time. Within 3 years, we will analyse data of up to 2500 children, many of them treated at WPE. The database will cover all sorts of modern proton or photon beam technologies. Dose distributions will be gathered and recalculated by physics experts, including out-of-field doses even if they are quite low. To ensure we have high quality data, the consortium has elaborated standard operation procedures and defined all variables that need to be collected. This will ensure all data in our registry are comparable. In addition, we have made sure that the HARMONIC registry can be linked to other databases like the American PPCR (Paediatric Proton/Photon Consortium Registry, also hosting more than 3000 paediatric patients’ files) or other European national childhood cancer registries.
- How did you come to participate in this project?
I always felt that there is a true need to learn more about possible late effects of cancer therapy. However, this is a difficult task and you need an appropriate structure to succeed. This is why we established HARMONIC – an impressive consortium of 24 scientific and medical institutes from 13 countries joining efforts to investigate cancer and non-cancer outcomes in two European paediatric cohorts. It is unique in its integrated approach of conventional epidemiology complemented by non-invasive imaging and molecular epidemiology, and the development of methods for patient-specific dosimetry.
Together with Dr. Neige Journy from INSERM, France, I have the honour of leading the Work Package on radiotherapy. Specifically, it has the purpose to set up a pan-European registry of paediatric cancer patients treated with particle therapy, thereby providing the medical community with an infrastructure to investigate medium and long-term effects. It will assess different outcomes, such as hormonal, cardiovascular or neurovascular disorders, or the appearance of other types of cancer later in life. We will also evaluate the quality of life, and the social and academic performance of the children.
- Can you briefly explain again, why is this project so important?
This is the first study of its kind in Europe that will provide all necessary information on the effects of low to high doses of radiation exposures in a high number of children and adolescents treated for cancer. In addition, it will establish the basis of a pan-European, long-term registry complemented by a biobank. To date, no such registry exists within Europe. The knowledge we can derive from this project will be important to improve radiation protection in medicine. Furthermore, the close collaboration between clinicians, radiation protection scientists, sociologists and patients will ensure the study is really meaningful not only in terms of clinical effectiveness but also in terms of late effects and well-being of the patient after therapy.
- And now, some personal questions. What is the most difficult part of your job?
Political discussions are needed to move our field forward. However, unfortunately this is a recurrent part of my job. It is often tedious to manage these discussions properly. Another challenge is conflict management, e.g. among employees and researchers, and to mediate these conflicts in the best interest of all.
- And the most rewarding?
The positive feedback from patients is always extremely encouraging in our demanding work field. I also feel privileged to have the chance of setting up new treatment standards based on scientific findings. And of course, good professional discussions with other experts in the fields of (paediatric) oncology and radiotherapy, which help to further improve patient care, are always valuable and enriching. I typically work with friends and feel like being in a family.
- What do you enjoy doing, besides research?
I enjoy spending time with my family, and we love to go cycling and discovering new locations. I also love to work in the garden and relax with a good book. In the evening, I enjoy watching TV and keeping my hands busy with some needlework. My family is therefore equipped with all sorts of warm handmade socks!
Interview by Suzan Botzenhardt