Eminowicz, GKD;
(2016)
Standardisation and optimisation of radical radiotherapy for cervical cancer.
Doctoral thesis , UCL (University College London).
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Abstract
Cervical cancer is a significant worldwide health burden despite primary and secondary prevention measures in developed countries. Survival rates for locally advanced cervical cancers treated with radical chemoradiation (FIGO stage IB2 to IVA) ranges from 10 to 85% at 5 years. A significant proportion of patients relapse within the pelvis and therefore the quality and accuracy of radiotherapy delivery is paramount. This thesis aims to review the extent of potential uncertainties within cervical cancer radiotherapy with the aim of developing and assessing methods to optimise and standardise those uncertainties. To date, the INTERLACE trial radiotherapy quality assurance (RTQA) programme has been completed by over half of United Kingdom (UK) centres treating cervical cancer. Using these RTQA test cases, I analysed one of largest known uncertainties in radiotherapy planning; target volume delineation. Having quantified the variation in comparison to a gold standard I investigated the dosimetric impact of the observed variation. I also produced a step-by-step pictorial delineation atlas, having reviewed all available published guidance, and assessed its impact on delineation variation. Daily variation in pelvic organ position is the second uncertainty investigated within this thesis. By retrospectively reviewing computed tomography (CT) imaging during chemoradiation for cervical cancer I analysed the variation of bladder and bowel filling and its relationship with target volume position and coverage. The movements that I measured allowed me to calculate margins necessary to maintain acceptable coverage. However, by understanding the variation observed I propose methods of standardisation that can be applied in UK clinical practice without the need to increase margin size. I also estimated the dosimetric impact of this variation and the subsequent potential dosimetric gain of the standardisation methods.
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