Hargreaves, Sarah
2022.
Deintensification of radiotherapy for HPV positive oropharyngeal squamous cell carcinoma through biological responsebased adaptation.
MD Thesis,
Cardiff University.
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Abstract
Human Papillomavirus associated Oropharyngeal Squamous Cell Carcinoma (HPV positive OPSCC) tends to affect younger and fitter patients and has a superior prognosis compared to the HPV negative OPSCC. Treatment of OPSCC can be surgical and/or non-surgical, and both modalities are associated with high levels of toxicity in the acute and chronic setting. Given the improved survival in a younger and healthier population of patients, contemporaneous HPV positive OPSCC research has largely focused on methods of de-intensifying treatment whilst retaining high cure rates with the aim of reducing the rate of long-term toxicity.As part of my thesis, I wrote a study protocol for a novel PET-based adaptive radiotherapy trial, PEARL. This is a phase 2 feasibility study for HPV positive OPSCC patients. It aims to look at the dosimetric advantages of adapting radiotherapy plans based upon primary tumour response after 2 weeks of concurrent chemoradiotherapy seen on Fluorodeoxyglucose Positron Emission Tomography CT (FDG PET-CT) scans. In my thesis I show the dosimetric impact of adaptation in a pilot study and the re-working of the initial planning method to improve the adaptive planning process. In addition, I look at whether Proton Beam Therapy - based radiotherapy offers an additional dosimetric advantage in this cohort of patients. Finally, I investigate whether more can be done to refine the Planning Target Volume (PTV) margins implemented for set-up error by exploring the relationship between the position of the hyoid bone and primary tumour volume as seen on verification imaging.
Item Type: | Thesis (MD) |
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Date Type: | Completion |
Status: | Unpublished |
Schools: | Medicine |
Date of First Compliant Deposit: | 26 July 2023 |
Last Modified: | 25 Jul 2024 01:30 |
URI: | https://orca.cardiff.ac.uk/id/eprint/161259 |
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