Individualising the use of radiotherapy for the treatment of people with Hodgkin lymphoma
<p>Hodgkin lymphoma is a cancer of the lymphatic system that typically affects young adults. Chemotherapy and radiotherapy are both highly effective treatments, and 80-90% of patients now become long-term survivors, living long enough to experience late toxicities. Radiotherapy in particular h...
| Main Author: | |
|---|---|
| Other Authors: | |
| Format: | Thesis |
| Language: | English |
| Published: |
2022
|
| Subjects: |
| _version_ | 1797111778298036224 |
|---|---|
| author | Shakir, R |
| author2 | Cutter, D |
| author_facet | Cutter, D Shakir, R |
| author_sort | Shakir, R |
| collection | OXFORD |
| description | <p>Hodgkin lymphoma is a cancer of the lymphatic system that typically affects young adults. Chemotherapy and radiotherapy are both highly effective treatments, and 80-90% of patients now become long-term survivors, living long enough to experience late toxicities. Radiotherapy in particular has been shown to increase the long-term risk of cardiovascular disease and second malignancies, and recent trials have attempted to identify patients in whom radiotherapy can be omitted. Omission of radiotherapy has, however, been shown to substantially increase the chance of Hodgkin lymphoma recurrence. The decision about whether or not to use radiotherapy for an individual patient therefore involves weighing up the proven benefit against the potential risks of late toxicity.</p>
<p>The aim of this thesis is to understand the decision-making process about radiotherapy, and provide data that can be used to inform patients and clinicians at various steps. I explore patients’ and clinicians’ experience of radiotherapy decision-making, and propose a new decision-making model that fits this context. I present a comprehensive summary of the late toxicities of radiotherapy, including the dose-response relationships that can be used to estimate risks from modern radiotherapy. I report the radiation dose received by abdominopelvic organs in a historic cohort of Hodgkin lymphoma survivors, and show how the data has been used to estimate the dose-response relationship for the risk of colorectal cancer. Finally, I present a multivariable linear regression model that estimates the dose a patient’s heart would receive from radiotherapy using measures available at the time of their diagnosis. I use the model to estimate individual patient’s risk of ischaemic heart disease, and show its accuracy is greatest in the medium heart dose range, where the balance of the benefits and risks of radiotherapy are most uncertain.</p>
<p>Overall, this thesis helps inform individualised decision-making about radiotherapy by highlighting how clinicians can support patient involvement in decisions and providing methods to help individualise risk estimates of radiotherapy late toxicity.</p> |
| first_indexed | 2024-03-07T08:15:09Z |
| format | Thesis |
| id | oxford-uuid:192961fb-d886-4c06-89e8-37a79658be15 |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-07T08:15:09Z |
| publishDate | 2022 |
| record_format | dspace |
| spelling | oxford-uuid:192961fb-d886-4c06-89e8-37a79658be152024-01-03T09:30:19ZIndividualising the use of radiotherapy for the treatment of people with Hodgkin lymphomaThesishttp://purl.org/coar/resource_type/c_db06uuid:192961fb-d886-4c06-89e8-37a79658be15HematologyRadiotherapyMedicineDecision makingOncologyEnglishHyrax Deposit2022Shakir, RCutter, DPeters, MNtentas, GRamroth, JShaw, SMikhaeel, G<p>Hodgkin lymphoma is a cancer of the lymphatic system that typically affects young adults. Chemotherapy and radiotherapy are both highly effective treatments, and 80-90% of patients now become long-term survivors, living long enough to experience late toxicities. Radiotherapy in particular has been shown to increase the long-term risk of cardiovascular disease and second malignancies, and recent trials have attempted to identify patients in whom radiotherapy can be omitted. Omission of radiotherapy has, however, been shown to substantially increase the chance of Hodgkin lymphoma recurrence. The decision about whether or not to use radiotherapy for an individual patient therefore involves weighing up the proven benefit against the potential risks of late toxicity.</p> <p>The aim of this thesis is to understand the decision-making process about radiotherapy, and provide data that can be used to inform patients and clinicians at various steps. I explore patients’ and clinicians’ experience of radiotherapy decision-making, and propose a new decision-making model that fits this context. I present a comprehensive summary of the late toxicities of radiotherapy, including the dose-response relationships that can be used to estimate risks from modern radiotherapy. I report the radiation dose received by abdominopelvic organs in a historic cohort of Hodgkin lymphoma survivors, and show how the data has been used to estimate the dose-response relationship for the risk of colorectal cancer. Finally, I present a multivariable linear regression model that estimates the dose a patient’s heart would receive from radiotherapy using measures available at the time of their diagnosis. I use the model to estimate individual patient’s risk of ischaemic heart disease, and show its accuracy is greatest in the medium heart dose range, where the balance of the benefits and risks of radiotherapy are most uncertain.</p> <p>Overall, this thesis helps inform individualised decision-making about radiotherapy by highlighting how clinicians can support patient involvement in decisions and providing methods to help individualise risk estimates of radiotherapy late toxicity.</p> |
| spellingShingle | Hematology Radiotherapy Medicine Decision making Oncology Shakir, R Individualising the use of radiotherapy for the treatment of people with Hodgkin lymphoma |
| title | Individualising the use of radiotherapy for the treatment of people with Hodgkin lymphoma |
| title_full | Individualising the use of radiotherapy for the treatment of people with Hodgkin lymphoma |
| title_fullStr | Individualising the use of radiotherapy for the treatment of people with Hodgkin lymphoma |
| title_full_unstemmed | Individualising the use of radiotherapy for the treatment of people with Hodgkin lymphoma |
| title_short | Individualising the use of radiotherapy for the treatment of people with Hodgkin lymphoma |
| title_sort | individualising the use of radiotherapy for the treatment of people with hodgkin lymphoma |
| topic | Hematology Radiotherapy Medicine Decision making Oncology |
| work_keys_str_mv | AT shakirr individualisingtheuseofradiotherapyforthetreatmentofpeoplewithhodgkinlymphoma |