E-Thesis 267 views 364 downloads
Developing the Role of Radiotherapy for Inoperable Gastric Cancer / AMY CASE
Swansea University Author: AMY CASE
DOI (Published version): 10.23889/SUthesis.70216
Abstract
Gastric cancer (GC) is a leading cause of mortality worldwide, resulting in 4,000 deaths per year in the UK. Surgical resection is the only cure, but 60-70% of patients are unsuitable for surgery, for whom palliative treatment is limited to systemic anti-cancer therapy and/or low-dose radiotherapy o...
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Swansea, Wales, UK
2025
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| Institution: | Swansea University |
| Degree level: | Doctoral |
| Degree name: | M.D |
| Supervisor: | Hutchings, Hayley; Gwynne, S. |
| URI: | https://cronfa.swan.ac.uk/Record/cronfa70216 |
| Abstract: |
Gastric cancer (GC) is a leading cause of mortality worldwide, resulting in 4,000 deaths per year in the UK. Surgical resection is the only cure, but 60-70% of patients are unsuitable for surgery, for whom palliative treatment is limited to systemic anti-cancer therapy and/or low-dose radiotherapy on occurrence of local symptoms. Poor outcomes highlight the urgent need for novel treatment strategies. Therefore, this thesis explores whether radiotherapy could have a role in the management of non-metastatic, inoperable GC. Firstly, a retrospective service evaluation explores treatment patterns and outcomes in South West Wales, to inform potential sample size for future trials. A systematic review of definitive, pre-operative and high-dose palliative radiotherapy evaluates efficacy, safety, dose/fractionation schedules and techniques in use. A survey of UK oesophago-gastric clinical oncologists explores current opinion, practice, and appetite for future trials. During a study of interobserver variability (IOV) in gastric tumour volume delineation (TVD) using computed tomography and magnetic resonance imaging (MRI), conformity indices are analysed, and qualitative and quantitative effect of MRI evaluated. Finally, comparison of two pre-operative radiotherapy protocols evaluates user-experience and analyses the volumetric and dosimetric advantages of each. The results demonstrate a largely non-randomised evidence base supporting the efficacy and safety of gastric radiotherapy, but optimal dose/fractionation remains unknown and technique varies. The survey demonstrates infrequent use of gastric radiotherapy in the UK, due to limited evidence and toxicity concerns, but support for a future UK trial is high. Clinician confidence in TVD is low, further demonstrated by considerable IOV in delineation of gastric tumour volumes. The addition of MRI improves subjective TVD experience, though impact on IOV is conflicting. Dosimetric analysis of pre-operative protocols demonstrates substantial dose to organs-at-risk following elective nodal irradiation. The findings of this thesis have informed the development of the first UK trial of gastric radiotherapy, GastroSCOPE. |
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| Item Description: |
ORCiD identifier: https://orcid.org/0000-0001-9853-6521 |
| Keywords: |
Gastric cancer, Stomach cancer, Radiotherapy |
| College: |
Faculty of Medicine, Health and Life Sciences |
| Funders: |
Wales Cancer Research Centre, Swansea Bay University Health Board, South West Wales Cancer Fund |