UCL Discovery
UCL home » Library Services » Electronic resources » UCL Discovery

Optimisation of cervical cancer radiotherapy with a focus on improving the therapeutic ratio and reducing ureter toxicity

Sarwar, Asma; (2023) Optimisation of cervical cancer radiotherapy with a focus on improving the therapeutic ratio and reducing ureter toxicity. Doctoral thesis (M.D(Res)), UCL (University College London). Green open access

[thumbnail of Sarwar_10166324_Thesis_redacted.pdf]
Preview
Text
Sarwar_10166324_Thesis_redacted.pdf

Download (9MB) | Preview

Abstract

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.

Type: Thesis (Doctoral)
Qualification: M.D(Res)
Title: Optimisation of cervical cancer radiotherapy with a focus on improving the therapeutic ratio and reducing ureter toxicity
Open access status: An open access version is available from UCL Discovery
Language: English
Additional information: 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.
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Cancer Institute
URI: https://discovery.ucl.ac.uk/id/eprint/10166324
Downloads since deposit
5Downloads
Download activity - last month
Download activity - last 12 months
Downloads by country - last 12 months

Archive Staff Only

View Item View Item