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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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Published: Swansea, Wales, UK 2025
Institution: Swansea University
Degree level: Doctoral
Degree name: M.D
Supervisor: Hutchings, Hayley; Gwynne, S.
URI: https://cronfa.swan.ac.uk/Record/cronfa70216
first_indexed 2025-08-22T09:39:50Z
last_indexed 2025-08-23T04:53:53Z
id cronfa70216
recordtype RisThesis
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spelling 2025-08-22T10:56:53.5051525 v2 70216 2025-08-22 Developing the Role of Radiotherapy for Inoperable Gastric Cancer b00fa8cc085b5c64ca85f16692f0ea8d AMY CASE AMY CASE true false 2025-08-22 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. E-Thesis Swansea, Wales, UK Gastric cancer, Stomach cancer, Radiotherapy 30 7 2025 2025-07-30 10.23889/SUthesis.70216 ORCiD identifier: https://orcid.org/0000-0001-9853-6521 COLLEGE NANME COLLEGE CODE Swansea University Hutchings, Hayley; Gwynne, S. Doctoral M.D Wales Cancer Research Centre, Swansea Bay University Health Board, South West Wales Cancer Fund Wales Cancer Research Centre, Swansea Bay University Health Board, South West Wales Cancer Fund 2025-08-22T10:56:53.5051525 2025-08-22T10:33:29.7626867 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Health Data Science AMY CASE 1 70216__34980__d64540a04efd414aa74493196ebe2d4f.pdf Case_Amy_MD_Thesis_Final_Cronfa.pdf 2025-08-22T10:50:28.7022771 Output 12926014 application/pdf E-Thesis – open access true Copyright: The Author, Amy Case, 2025. true eng
title Developing the Role of Radiotherapy for Inoperable Gastric Cancer
spellingShingle Developing the Role of Radiotherapy for Inoperable Gastric Cancer
AMY CASE
title_short Developing the Role of Radiotherapy for Inoperable Gastric Cancer
title_full Developing the Role of Radiotherapy for Inoperable Gastric Cancer
title_fullStr Developing the Role of Radiotherapy for Inoperable Gastric Cancer
title_full_unstemmed Developing the Role of Radiotherapy for Inoperable Gastric Cancer
title_sort Developing the Role of Radiotherapy for Inoperable Gastric Cancer
author_id_str_mv b00fa8cc085b5c64ca85f16692f0ea8d
author_id_fullname_str_mv b00fa8cc085b5c64ca85f16692f0ea8d_***_AMY CASE
author AMY CASE
author2 AMY CASE
format E-Thesis
publishDate 2025
institution Swansea University
doi_str_mv 10.23889/SUthesis.70216
college_str Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str Swansea University Medical School - Health Data Science{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Health Data Science
document_store_str 1
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description 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.
published_date 2025-07-30T06:49:04Z
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score 11.090362

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