Professor of Gastrointestinal Cancer Imaging
Imperial College London
email: gina.brown@imperial.ac.uk
My research in colorectal cancer staging has set the national and global benchmarks for imaging assessment of colon and rectal cancer patients before and during treatment . These improved staging methods have reduced local and distant failure in high risk patients whilst avoiding overtreatment of low risk patients and has resulted MRI based strategies being incorporated into several guidelines such as peer review measures, UK NICE and guidelines.
I graduated from King’s College Hospital School of Medicine, London in 1988, and my research career began at the University of Wales, Cardiff in 1997 with my investigating and establishing optimal MRI techniques for staging and assessment of primary rectal cancer.
I defined other markers of tumour aggression venous invasion and peritoneal ulceration not previously assessed by imaging techniques, and showed that MRI has significant clinical and cost benefits over traditional methods of staging and published the importance of multidisciplinary team discussion of imaging in preventing recurrence. These have now become a global standard of care for the primary evaluation of rectal cancers.
In 2009 I identified factors predicting positive-margins in low rectal cancer as I had previously showed patients undergoing abdominoperineal excision have worse outcomes from higher involved margin rates. I developed a staging model describing the anatomical and surgical planes for low rectal cancer for planning radical surgery and the type of chemoradiotherapy given. I initiated investigation of imaging prognostic factors in colon and rectal tumours with outcome data. I initiated and led a large prospective multicentre observational study (MERCURY); subsequent analysis of the data showed that MRI scans could be used to predict those patients with a high risk of positive margins in low rectal cancer and this also correlated with survival outcomes.
I developed and published a staging model describing the anatomical and surgical planes of low rectal cancer so that future outcomes for high risk patients could be improved through imaging derived selective planning of radical surgery and chemoradiotherapy.
I also developed an MRI compartmental classification scheme to improve radiology reporting in patients with very advanced pelvic cancer to reduce incomplete resection rates validated in the Beyond TME trial. Analysis of final results (2019) show high local cure rates for very advanced cancers.
In 2015 I developed an MRI methodology to assess tumour regression and predict patients that can be safely operated on after chemoradiotherapy. This was validated as a prognostic and predictive biomarker and will enable the preoperative stratification of patients to further intensive therapy or less radical treatment (e.g. watch and wait). 2021 results show that over 40% of UK patients treated for advanced bowel cancer randomised in the trial successfully avoided surgery. This has never previously been achieved by an imaging intervention.
I have built on my research in rectal cancer to develop and validate a CT prognostic staging system for high risk colon cancer showing the potential benefits of preoperatively treating high risk colon tumours and I have published on the advantages of preoperatively treating high risk colon tumours. I have recently validated a new staging system that is superior to TNM for assessing colon cancers using CT based T substaging tumours using measured extramural spread, tumour deposits and EMVI.
In 2019, I published an MRI method to identify the junction of the sigmoid mesocolon (ie, the “sigmoid take-off”) was tested and shown to help classify tumours into rectal, rectosigmoid, or sigmoid based on location relative to the take-off. A global Delphi expert panel supported this approach which is now being implemented in several countries to improve consistency.
In 2020 I advanced methods to identify previously unseen and poorly understood pathways of spread of colorectal cancer in vivo. I characterised tumour deposits and venous invasion on imaging (40% prevalence) and showed greater significance for cancer outcomes than lymph nodes.
I have successfully supervised 21 PhD and MD students and I have trained and mentored Specialist GI Cancer Radiologists in Barcelona. I have held meet the professor and workshops at ASCO,ASCRS,(2009, 2011, 2016), Melbourne (biannually 2008 to date), Laparoscopic surgery course. Strasbourg, National Danish TME and low rectal courses 2009-2011, FICARE 2009, 2011 Brazil, , European Congress of Radiology (2019, 2020), GI ESMO (2022, 2023).
Formal radiology training is embedded in many of the trials for which I am CI and I run dedicated teaching workshops for radiologists, surgeons and oncologists which are internationally attended. I have collaborated with international research groups at Ontario Cancer Care (linking in with MERCURY study, the RCR CASPAR initiative, and the Beyond TME collaboration). Sao Paolo, McGill Universities Hospitals and the MD Anderson. I have been invited as the Radiology Faculty Expert for colorectal cancer quality improvement initiatives in Denmark and Norway, training several hundred multidisciplinary clinicians in colorectal cancer management Through my links with the Pelican Cancer Foundation, I have been the radiology faculty lead in many international outreach educational courses including the Dutch colorectal group, and MDT group, Israel..
I have contributed to the NHS workforce development through teaching on large scale national training initiatives funded through the Department of Health: the National TME Multidisciplinary Team Development Programme (2003-6), teaching the role of high resolution MRI in staging to 180 MDT teams; I was Faculty lead in Radiology for the Low Rectal Cancer National Development programme (National Cancer Action Team), (2010/2013) for improving outcomes in patients with low rectal cancers (147 colorectal MDTs and 151 NHS trusts); Invited faculty lead in Imaging of Significant Polyps and Early Colorectal Cancer national SPECC programme and the IMPACT initiative for improving MDT decision making and cancer care. I am Imaging Lead for the National Cancer Intelligence Network to improve cancer reporting standards and datasets in NHS cancer care and I was Imaging Lead for the first UK-wide NHS initiatives to improve Bowel Cancer care: National TME MDT development I was an invited expert and co-author of pan-European consensus guidelines for optimal treatment of colorectal cancer, EURECCA colorectal (2014). Author of imaging standards for the latest European (ESMO) 2017 Oncology guidelines for the management of rectal cancer. Invited to expert panel for ASCO Neoadjuvant Therapy Guideline for Rectal Cancer 2023. I am the Imaging Representative on ACPGBI Council – embedding imaging into surgical quality improvement initiatives.
I have mentored junior colleagues and supported my contemporaries throughout my career as it is important to me not just to promote academic success but support anyone who feels unable to discuss their career path with senior colleagues. I give space and time to reassure colleagues that there is no single route or pathway to success, as I share my own journey of embedding research into my daily working practice. I actively invite opinion in my teaching, collaborations and daily working as I am acutely aware that, in particular, there is a cultural/female reticence to speak up. I have found that colleagues quite often just don’t know where to start and I am always happy to be a sounding board to help them develop in confidence and purpose. I am open about the challenges I have faced in my career as it is important for me to develop mutually supportive working communities, and to help others do the same.