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Intensity modulated radiotherapy for inoperable, locally-advanced non-small cell lung cancer : development and clinical outcomes at a cancer centre in Eastern India
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Shrimali, Raj Kumar (2021) Intensity modulated radiotherapy for inoperable, locally-advanced non-small cell lung cancer : development and clinical outcomes at a cancer centre in Eastern India. PhD thesis, University of Warwick.
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Official URL: http://webcat.warwick.ac.uk/record=b3856638
Abstract
Background
The submitted publications outline the sequential steps taken for clinical implementation of intensity modulated radiotherapy (IMRT) for lung cancer at a cancer centre in Eastern India. A literature review combined with a detailed risk assessment for IMRT in lung cancer guided the careful implementation for cases where three-dimensional conformal radiotherapy (3D-CRT) did not generate a safe radiotherapy (RT) plan with acceptable tumour coverage. With growing experience, IMRT was expanded to patients receiving concurrent chemoradiation (CCRT) and accelerated RT, including continuous hyperfractionated accelerated radiotherapy (CHART) as well as moderately hypofractionated accelerated radiotherapy. Survival outcomes from radical radiotherapy and chemoradiation (both sequential and concurrent) were audited and found to be comparable to contemporary published literature. In patients with large volume (>500ml) disease, IMRT resulted in non-inferior outcomes despite treating larger volumes and more advanced stage disease. A predictive model that estimates the probability that IMRT would be necessary to produce an acceptable and safe RT plan, was developed from the planning data of 202 patients.
Methods
An external prospective study was designed to validate this data-driven, decision aid in cohort of patients from multiple hospitals. Apart from assessing the accuracy of the developed predictive model, we are hoping to quantify the planning time saved by opting for IMRT without attempting a 3D-CRT plan. Updated systematic review of prospective studies was carried out to assess the efficacy and safety of IMRT for locally-advanced NSCLC. 9
Results and conclusion
No direct impact of IMRT or volumetric modulated arc therapy (VMAT) was seen on local control and survival for these patients, on updated systematic review. IMRT and VMAT was shown to be feasible and safe in the treated patient population. IMRT makes curative treatment possible for large-volume or complex-shaped, locally-advanced NSCLC, resulting non-inferior survival outcomes.
| Item Type: | Thesis (PhD) | ||||
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| Subjects: | R Medicine > RC Internal medicine > RC0254 Neoplasms. Tumors. Oncology (including Cancer) R Medicine > RM Therapeutics. Pharmacology |
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| Library of Congress Subject Headings (LCSH): | Radiotherapy -- India, Cancer -- Radiotherapy -- Planning, Radiation -- Dosage, Lungs -- Cancer -- Treatment | ||||
| Official Date: | December 2021 | ||||
| Dates: |
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| Institution: | University of Warwick | ||||
| Theses Department: | Warwick Medical School | ||||
| Thesis Type: | PhD | ||||
| Publication Status: | Unpublished | ||||
| Supervisor(s)/Advisor: | Hutchinson, Charles E. (Professor) ; Wan Hee, Siew ; Rogers, Jane Ann | ||||
| Format of File: | |||||
| Extent: | 262 leaves : illustrations | ||||
| Language: | eng |
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