%0 Thesis
%9 Doctoral
%A Sarwar, Asma
%B Cancer Institute
%D 2023
%F discovery:10166324
%I UCL (University College London)
%P 298
%T Optimisation of cervical cancer radiotherapy  with a focus on improving the therapeutic ratio  and reducing ureter toxicity
%U https://discovery.ucl.ac.uk/id/eprint/10166324/
%X Optimal treatment of locally advanced cervical cancer involves chemo radiation and image guided   brachytherapy. Technological advances with image guidance have improved the therapeutic ratio,   enabling more accurate dose delivery to the target volume and sparing organs at risk. Achieving doses   of > 85Gy to the high-risk clinical target volume results in 3-year local control rates of 86-94%. Strict   planning criteria for organs at risk are established to prevent long term toxicity and morbidity. Ureters   are a structure in the pelvis in close relation to the cervix which are not routinely contoured as organs   at risk, doses are not recorded, and no optimization constraints exist despite the significant risk of   radiation induced ureteric stenosis.  To date very little cohesive data exist on the effect of radiation to the ureters during radical   radiotherapy for cervical cancer. I have performed a comprehensive systematic review to summarise   the existing data on this subject and to identify important risk factors. I have also produced a step by   step pictorial atlas in conjunction with gynae radiologists to aid ureter identification and delineation   and assessed its use. Once a method for contouring ureters was established, I retrospectively   contoured ureters on brachytherapy MRI images to allow a novel dosimetric analysis of dose to ureters   during cervical brachytherapy. I also investigated the feasibility of ureter dose optimisation during   cervical brachytherapy. Finally, I assessed the dose to ureters and other organs at risk during RapidArc   external beam radiotherapy and proton beam therapy, to establish if any therapeutic advantages can   be gained.
%Z Copyright © The Author 2023.  Original content in this thesis is licensed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0) Licence (https://creativecommons.org/licenses/by-nc/4.0/).  Any third-party copyright material present remains the property of its respective owner(s) and is licensed under its existing terms.  Access may initially be restricted at the author’s request.