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Developing the Role of Proton Beam Therapy in Oesophageal Cancer / OWEN NICHOLAS

Swansea University Author: OWEN NICHOLAS

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DOI (Published version): 10.23889/SUthesis.59824

Abstract

Oesophageal cancer continues to be associated with a poor prognosis. Proton beam therapy’s distinct physical characteristics widen the therapeutic ratio in oesophageal cancer and has the potential to improve outcomes. This thesis aims to examine how proton beam therapy may improve outcomes in oesoph...

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Published: Swansea 2022
Institution: Swansea University
Degree level: Doctoral
Degree name: M.D
Supervisor: Hugtenburg, Richard; Gwynne, Sarah H. ; Fegan, Greg W.
URI: https://cronfa.swan.ac.uk/Record/cronfa59824
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first_indexed 2022-04-13T17:27:16Z
last_indexed 2022-04-14T03:32:01Z
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spelling 2022-04-13T18:34:13.9496536 v2 59824 2022-04-13 Developing the Role of Proton Beam Therapy in Oesophageal Cancer 929f2e4c9c7f43876a83058d0a434326 OWEN NICHOLAS OWEN NICHOLAS true false 2022-04-13 Oesophageal cancer continues to be associated with a poor prognosis. Proton beam therapy’s distinct physical characteristics widen the therapeutic ratio in oesophageal cancer and has the potential to improve outcomes. This thesis aims to examine how proton beam therapy may improve outcomes in oesophageal cancer and documents efforts to expand its role. In Chapter 2, a comprehensive systematic literature review demonstrates the paucity of high-quality evidence in this field. Following this, a series of radiotherapy planning studies investigates potential dosimetric advantages of proton beam therapy for distal oesophageal cases. In chapter 3, proton beam therapy is shown to reduce lung and heart dose compared to photon radiotherapy. Normal tissue complication probability modelling establishes that this may reduce the risk of treatment related pulmonary and cardiac toxicity. Chapter 4 demonstrates that spleen dose constraints may successfully be introduced in oesophageal cancer for proton and photon plans, potentially resulting in lower lymphopenia rates and greater immune sparing. Chapter 5 highlights the impact of different beam arrangements on dose to organs at risk and individual cardiac substructures. The latter half of the thesis highlights work underpinning the development of novel clinical trials of proton beam therapy in oesophageal cancer. Chapter 6 details the work of creating a radiotherapy delineation protocol by comparing two established protocols in a delineation comparison study, showing that geometric expansion of volumes results in more consistent target volumes compared to ‘free-hand’ delineation. In chapter 7, public and patient involvement work is shown to inform and refine the design of a two new trials of proton beam therapy in oesophageal cancer. A final chapter discusses and summarises the current areas of interest in this field, expanding on current trial development work and future directions. E-Thesis Swansea Radiotherapy, proton beam therapy, oesophageal cancer, esophageal cancer, radiobiological modelling, technical radiotherapy, patient involvement, clinical trials 13 4 2022 2022-04-13 10.23889/SUthesis.59824 ORCiD identifier: https://orcid.org/0000-0002-6099-2107 COLLEGE NANME COLLEGE CODE Swansea University Hugtenburg, Richard; Gwynne, Sarah H. ; Fegan, Greg W. Doctoral M.D South West Wales Cancer Fund, Swansea Bay University Health Board 2022-04-13T18:34:13.9496536 2022-04-13T18:24:17.4925105 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Medicine OWEN NICHOLAS 1 59824__23853__9d6a17a7193e4e8182d9450090599a8d.pdf Nicholas_Owen_J_A_MD_Thesis_Final_Redacted_Signature.pdf 2022-04-13T18:32:52.8735381 Output 2537534 application/pdf E-Thesis – open access true Copyright: The author, Owen J. A. Nicholas, 2022. true eng
title Developing the Role of Proton Beam Therapy in Oesophageal Cancer
spellingShingle Developing the Role of Proton Beam Therapy in Oesophageal Cancer
OWEN NICHOLAS
title_short Developing the Role of Proton Beam Therapy in Oesophageal Cancer
title_full Developing the Role of Proton Beam Therapy in Oesophageal Cancer
title_fullStr Developing the Role of Proton Beam Therapy in Oesophageal Cancer
title_full_unstemmed Developing the Role of Proton Beam Therapy in Oesophageal Cancer
title_sort Developing the Role of Proton Beam Therapy in Oesophageal Cancer
author_id_str_mv 929f2e4c9c7f43876a83058d0a434326
author_id_fullname_str_mv 929f2e4c9c7f43876a83058d0a434326_***_OWEN NICHOLAS
author OWEN NICHOLAS
author2 OWEN NICHOLAS
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publishDate 2022
institution Swansea University
doi_str_mv 10.23889/SUthesis.59824
college_str Faculty of Medicine, Health and Life Sciences
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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 - Medicine{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Medicine
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description Oesophageal cancer continues to be associated with a poor prognosis. Proton beam therapy’s distinct physical characteristics widen the therapeutic ratio in oesophageal cancer and has the potential to improve outcomes. This thesis aims to examine how proton beam therapy may improve outcomes in oesophageal cancer and documents efforts to expand its role. In Chapter 2, a comprehensive systematic literature review demonstrates the paucity of high-quality evidence in this field. Following this, a series of radiotherapy planning studies investigates potential dosimetric advantages of proton beam therapy for distal oesophageal cases. In chapter 3, proton beam therapy is shown to reduce lung and heart dose compared to photon radiotherapy. Normal tissue complication probability modelling establishes that this may reduce the risk of treatment related pulmonary and cardiac toxicity. Chapter 4 demonstrates that spleen dose constraints may successfully be introduced in oesophageal cancer for proton and photon plans, potentially resulting in lower lymphopenia rates and greater immune sparing. Chapter 5 highlights the impact of different beam arrangements on dose to organs at risk and individual cardiac substructures. The latter half of the thesis highlights work underpinning the development of novel clinical trials of proton beam therapy in oesophageal cancer. Chapter 6 details the work of creating a radiotherapy delineation protocol by comparing two established protocols in a delineation comparison study, showing that geometric expansion of volumes results in more consistent target volumes compared to ‘free-hand’ delineation. In chapter 7, public and patient involvement work is shown to inform and refine the design of a two new trials of proton beam therapy in oesophageal cancer. A final chapter discusses and summarises the current areas of interest in this field, expanding on current trial development work and future directions.
published_date 2022-04-13T04:17:25Z
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score 11.02167

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