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An Evaluation of Novel Strategies to Improve Radical Radiotherapy in Non-small Cell Lung Cancer
Asad Qureshi
出版King's College, London, 2016
URLhttp://books.google.com.hk/books?id=BOCO0AEACAAJ&hl=&source=gbs_api
註釋Lung cancer is the second commonest cancer in the UK, with 42,000 new cases diagnosed each year. Outcomes remain poor with 1-year survival below 30%. Efforts are continuously being made to improve on these figures, with particular emphasis on the role radiotherapy can play. This thesis examines the current position of radical radiotherapy in early and locally advanced nonsmall lung cancer (NSCLC) and appraises the role of a variety of novel interventions and techniques in improving current treatment strategies. Molecular targeted agents have become established in treating a number of tumour types. This thesis describes the rationale for combining targeted agents with radiotherapy or chemoradiotherapy in NSCLC. A systematic review of the literature is presented. Cetuximab has shown promise in combination with radiotherapy in squamous cell carcinomas of the head and neck. This thesis presents the results of a multi-centre pilot study combining cetuximab with concurrent chemoradiotherapy in patients with stage Ill NSCLC. Great progress has been made in recent years with the development of stereotactic ablative body radiotherapy (SABR) for patients with medically inoperable early stage NSCLC. This modality of treatment requires precise patient set-up and treatment delivery. This thesis explores how set-up errors should be assessed in the advent of cone-beam computerised tomography (CBCT) and assesses measurement of intra-fraction motion in SABR patients using CBCT. A study comparing AlignRT, a novel stereoscopic camera system to assess patient set-up, and CBCT is described. The final chapter discusses toxicity and changes in quality of life (QOL) associated with SABR. A review of the literature of QOL following SABR in NSCLC is presented. Even small improvements, when combined, can be of clinical significance and should not be overlooked. The value a patient may put on the magnitude of the improvement is often much larger than clinicians realise.