Introduction: Although cervical cancer can be prevented through known interventions it still remains a major cause of mortality in developing countries. Currently in South Africa there is little literature on cervical cancer radiotherapy treatment and its prognostic factors. Knowledge of prognostic factors helps in understanding the determinants of a disease better and optimize treatment strategies. The aim of this study was to determine overall survival rate and to investigate potential prognostic factors for cervical cancer in patients who underwent radiotherapy during the period of 1 January 2004 to 31 December 2006 at the Division of Radiation Oncology, Charlotte Maxeke Johannesburg Academic Hospital. Methods: This was a retrospective cohort study of 900 patients who were treated with radiotherapy between 1 January 2004 and 31 December 2006. Patient and treatment related data was obtained from the hospital treatment records. Follow-up was then censored as of 31st of December 2008. Subjects of this study had either mono-therapy or a combination of therapies: external beam radiotherapy, brachytherapy and chemotherapy. A Cox regression model was fitted to determine the prognostic and predictive factors of cervical cancer. Kaplan Meier methods were used to establish the effect of different socio-demographic and clinic-pathological factors on overall survival. The overall two year survival was also determined. Results: At 2 years post-treatment for each individual patient, 26 out of 900 patients had died, 281 were still alive and 593 lost to follow up leaving 307 patients available for analysis. The overall 2 year mortality rate was 45 per 1000 person years and highest in the period of 0-6 months. In the final model, completion of brachytherapy remained a significant predictor of survival (HR=0.04, 95% CI: 0.01-0.11, p<0.001) after adjusting for all other factors. Furthermore, HIV status was the only significant prognostic factor (HR=3.23, 95% CI: 1.04- 10, p=0.042). Patients who had brachytherapy treatment prescribed and completed the prescription were 96% less likely to die compared to those who didn’t complete it at any point in time, after adjusting for age and HIV status. Patients who were HIV positive were approximately three times more likely to die as compared to HIV negative patients at any point in time after adjusting for age and completed brachytherapy. The overall 2-year survival rate was 92% for this group of patients. Conclusion: Completion of the brachytherapy prescription was a significant predictor of treatment outcome, while the patient’s HIV status was also a significant prognostic factor for treatment. Patients who were HIV positive were three-times more likely to die compared to HIV negative patients. The overall 2-year survival rate was 92%, however, these results need to be interpreted with caution due to the large loss to follow-up in this patient population. Prospective clinical trials are recommended in the future to confirm the validity of the findings of this work in a representative patient population. In addition this work puts forward some suggestions to optimize treatment of cervical cancer patients in typical university teaching public health centres in South Africa.

Diss. (sammanfattning) Stockholm : Karol. inst. / Härtill 5 uppsatser.

Diss. (sammanfattning) Uppsala : Uppsala universitet, 2006. / Härtill 6 uppsatser.

Thesis (Ph. D.)--University of Washington, 1998. / Vita. Includes bibliographical references (leaves [110]-117).

Since the release of the Cyberknife Multileaf Collimator (CK-MLC), it has been a constant concern on the realistic dose differences computed with its early-available Finite Size Pencil Beam algorithm (FSPB) from those computed by using industry well-accepted algorithms such as the Monte Carlo (MC) dose algorithm. In this study dose disparities between FSPB and MC dose calculation algorithms for selected CK-MLC treatment plans were quantified. The dosimetry for planning target volume (PTV) and major organs at risks (OAR) was compared by calculating normalized percentage deviations (Ndev) between the two algorithms. It is found that the FSPB algorithm overestimates D95 of PTV when compared with the MC algorithm by averaging 24.0% in detached lung cases, and 15.0% in non-detached lung cases which is attributed to the absence of heterogeneity correction in the FSPB algorithm. Average dose differences are 0.3% in intracranial and 0.9% in pancreas cases. Ndev for the D95 of PTV range from 8.8% to 14.1% for the CK-MLC lung treatment plans with small field (SF ≤ 2x2cm2). Ndev is ranged from 0.5-7.0% for OARs. / Includes bibliography. / Thesis (M.S.)--Florida Atlantic University, 2018. / FAU Electronic Theses and Dissertations Collection

Lam Wai-man Wynnie. / "April 2002." / Thesis (M.D.)--Chinese University of Hong Kong, 2002. / Includes bibliographical references (p. 109-134). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Mode of access: World Wide Web.

Dissertation (Ph.D.).--University of Texas Graduate School of Biomedical Sciences at San Antonio, 2007. / Vita. Includes bibliographical references.

by Mei Chun Cheung. / Thesis (M.Phil.)--Chinese University of Hong Kong, 1999. / Includes bibliographical references (leaves 34-41). / Abstract and questionare in English and Chinese. / ABSTRACT --- p.ii / ACKNOWLEDGEMENTS --- p.iii / TABLE OF CONTENTS --- p.iv / LIST OF TABLES --- p.v / Chapter CHAPTER I - --- INTRODUCTION --- p.1 / Chapter CHAPTER II - --- METHOD --- p.7 / Chapter CHAPTER III - --- RESULTS --- p.17 / Chapter CHAPTER IV - --- DISCUSSION --- p.29 / REFERENCES --- p.34 / APPENDIX --- p.42

Ng Kenway. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2003. / Includes bibliographical references (leaves 169-189). / Abstracts in English and Chinese ; questionnaire also in Chinese. / ABSTRACT --- p.I / 摘要 --- p.IV / ACKNOWLEDGEMENT --- p.V / TABLE OF CONTENTS --- p.VII / ABBREVIATION --- p.XI / LIST OF TABLES --- p.XIII / LIST OF FIGURES --- p.XIV / Chapter CHAPTER 1 --- INTRODUCTION --- p.1 / Chapter CHAPTER 2 --- LITERATURE REVIEW --- p.4 / Chapter 2.1 --- SIDE EFFECTS OF RADIATION THERAPY IN HEAD & NECK CACNER PATIENTS --- p.6 / Chapter 2.2 --- NUTRITIONAL ALTERATIONS IN CANCER PATIENTS --- p.9 / Chapter 2.3 --- FACTORS INFLUENCING ALTERATION IN CALORIE INTAKE IN CANCER PATIENTS --- p.12 / Chapter 2.3.1 --- Evidence for impaired calorie intake in cancer patients --- p.12 / Chapter 2.3.2 --- Anorexia --- p.13 / Chapter 2.3.2.1 --- Mucositis of upper food passage --- p.13 / Chapter 2.3.2.2 --- "Change in saliva and taste, food aversions" --- p.14 / Chapter 2.3.2.3 --- Psychological and emotional factors --- p.14 / Chapter 2.3.2.4 --- Cytokines --- p.15 / Chapter 2.4 --- FACTORS INFLUENCING ENERGY EXPENDITURE IN CANCER PATIETNS --- p.17 / Chapter 2.4.1 --- Introduction --- p.17 / Chapter 2.4.2 --- Components of total energy expenditure --- p.22 / Chapter 2.4.2.1 --- Measurement of Basal metabolic rate --- p.22 / Chapter 2.4.2.2 --- Energy cost of physical activity --- p.25 / Chapter 2.4.2.3 --- Thermic effect of food (TEF) --- p.26 / Chapter 2.5 --- METHODS FOR NUTRITIONAL ASSESSMENT --- p.27 / Chapter 2.5.1 --- Body weight and body composition --- p.27 / Chapter 2.5.2 --- Dietary intake --- p.30 / Chapter 2.6 --- METHODS FOR ENERGY EXPENDITURE MEASUREMENT --- p.35 / Chapter 2.7 --- CYTOKINES AND LEPTIN CHANGES IN CANCER PATIENTS --- p.40 / Chapter 2.7.1 --- Cytokines --- p.40 / Chapter 2.7.1.1 --- Tumor necrosis factor --- p.40 / Chapter 2.7.1.2 --- Interleukin 1 and interleukin 6 --- p.44 / Chapter 2.7.2 --- Leptin --- p.45 / Chapter 2.8 --- THE IMPACT OF MALNUTRITION ON CANCER SURVIVAL --- p.49 / Chapter CHAPTER 3 --- OBJECTIVES OF STUDY --- p.53 / Chapter CHAPTER 4 --- METHODS --- p.55 / Chapter 4.1 --- RETROSPECTIVE STUDY --- p.56 / Chapter 4.1.1 --- Patients --- p.56 / Chapter 4.1.2 --- Cancer staging --- p.56 / Chapter 4.1.3 --- Cancer treatment --- p.57 / Chapter 4.1.4 --- Outcome endpoints --- p.57 / Chapter 4.1.5 --- Determinants --- p.58 / Chapter 4.1.6 --- Statistical analysis --- p.58 / Chapter 4.2 --- PROSPECTIVE STUDY --- p.59 / Chapter 4.2.1 --- "Patients, oncological treatment, and assessment time points" --- p.59 / Chapter 4.2.2 --- Assessment of nutritional intake by food record --- p.60 / Chapter 4.2.3 --- Assessment of radiotherapy-induced symptoms --- p.61 / Chapter 4.2.4 --- Assessment of Basal metabolic rate --- p.62 / Chapter 4.2.5 --- Assessment of total energy expenditure and energy balance --- p.63 / Chapter 4.2.6 --- Assessment of body composition --- p.65 / Chapter 4.2.7 --- Measurement of cytokines --- p.68 / Chapter 4.2.7.1 --- Serum TNF-α --- p.69 / Chapter 4.2.7.2 --- Serum Human Leptin --- p.72 / Chapter CHAPTER 5 --- RESULTS --- p.80 / Chapter 5.1 --- RETROSPECTIVE STUDY --- p.81 / Chapter 5.1.1 --- The 5-year profile of bodyweight change during and after the end of radiotherapy --- p.81 / Chapter 5.1.2 --- Analysis on relation between weight loss and survival --- p.82 / Chapter 5.1.2.1 --- Patient and cancer stage --- p.82 / Chapter 5.1.2.2 --- Percentage of patients with weight loss at end of radiotherapy --- p.82 / Chapter 5.1.2.3 --- Cancer treatment outcome --- p.82 / Chapter 5.1.2.4 --- Univariate analysis --- p.82 / Chapter 5.1.2.5 --- Multivariate analysis --- p.83 / Chapter 5.2 --- PROSPECTIVE STUDY --- p.84 / Chapter 5.2.1 --- The profile of nutritional measurements during radiotherapy --- p.84 / Chapter 5.2.1.1 --- Bodyweight and body composition before and during RT --- p.84 / Chapter 5.2.1.2 --- Calorie intake before and during RT --- p.85 / Chapter 5.2.1.3 --- Energy expenditure before and during RT --- p.86 / Chapter 5.2.1.4 --- Energy balance before and during RT --- p.88 / Chapter 5.2.2 --- The profile of nutritional measurements during the 6-month period after radiotherapy --- p.88 / Chapter 5.2.2.1 --- Body weight and body composition during the 6 months after radiotherpay --- p.88 / Chapter 5.2.2.2 --- Calorie intake during the 6 months after radiotherapy --- p.90 / Chapter 5.2.2.3 --- Energy expenditure during the 6 months after radiotherapy --- p.91 / Chapter 5.2.2.4 --- Energy balance during the 6 months after radiotherapy --- p.92 / Chapter 5.2.3 --- Radiotherapy-induced Symptoms --- p.92 / Chapter 5.2.3.1 --- Profile of symptoms after RT --- p.92 / Chapter 5.2.3.2 --- Detailed profile of symptoms during RT --- p.95 / Chapter 5.2.4 --- The profile of cytokines during and after completion of RT --- p.95 / Chapter 5.2.4.1 --- SerumTNF-α --- p.96 / Chapter 5.2.5.2 --- Serum leptin --- p.96 / Chapter CHAPTER 6 --- DISCUSSION --- p.144 / Chapter 6.1 --- RETROSPECTIVE STUDY --- p.145 / Chapter 6.2 --- PROSPECTIVE STUDY --- p.147 / Chapter 6.2.1 --- The magnitude of the problem --- p.147 / Chapter 6.2.2 --- The potential determinants of weight loss --- p.147 / Chapter 6.2 3 --- Is weight loss due to the cancer or due to its treatment? --- p.148 / Chapter 6.2.4 --- "Is the weight loss influenced by pre-treatment factors, i. e. anthropometrical data?" --- p.148 / Chapter 6.2.5 --- "Is the pattern weight loss compatible with the model of calorie-protein malnutrition, similar to a starvation state?" --- p.149 / Chapter 6.2.6 --- Is the weight loss due to increased energy expenditure? --- p.150 / Chapter 6.2.7 --- Is the weight loss due to reduced calorie intake? --- p.151 / Chapter 6.2.8 --- Is weight loss during radiotherapy due to negative energy balance? --- p.151 / Chapter 6.2.9 --- What causes reduced calorie intake: Are radiotherapy-induced symptoms contributive? --- p.152 / Chapter 6.2.10 --- What are the observations on and implications of cytokine changes? --- p.155 / Chapter 6.2.11 --- What determines the recovery of body weight during 6 months after end of radiotherapy? --- p.158 / Chapter 6.2.12 --- Is the weight loss in the post RT recovery period due to negative energy balance? --- p.159 / Chapter 6.2.13 --- What are the implications on nutritional intervention? --- p.159 / Chapter 6.2.14 --- Limitations and future studies --- p.164 / Chapter CHAPTER 7 --- CONCLUSIONS --- p.166 / REFERENCES --- p.169 / APPENDIX 1 CONSENT FORM I (IN ENGLISH) --- p.190 / APPENDIX 2 CONSENT FORM I (IN CHINESE) --- p.193 / APPENDIX 3 CONSENT FORM II (IN ENGLISH) --- p.196 / APPENDIX 4 CONSENT FORM II (IN CHINESE) --- p.199 / APPENDIX 5 3-DAY DIET RECORD --- p.202 / APPENDIX 6 24-HOUR DIETARY RECALL --- p.206 / APPENDIX 7 SUBJECTIVE NUTRITIONAL ASSESSMENT --- p.208 / APPENDIX 8 PHYSICAL ACTIVITY QUESTIONNAIRE --- p.210 / APPENDIX 9 BONE SCAN REPORT --- p.215

Advanced-stage nasopharyngeal carcinoma (NPC) presents very difficult scenarios for radiation therapy (RT) planning. The infiltration of tumor to the skull base and beyond means that the tumor is very close to critical normal organs (organs at risk, OARs). Despite the advent of intensity-modulated radiotherapy (IMRT) treatment technique---the state-of-art RT technique, conflicting requirements between organ protection and target dose conformity is still problematic. The objectives of the present research are (1) to investigate the dosimetry properties of IMRT treatment in advanced-stage NPC in respect of its dosimetric limitations and planning problems, (2) to develop new methods and tools to resolve such problems, in particular to improve the quality of treatment plans and efficiency of the dose planning and optimization process. A series of four inter-linked studies were conducted to address these issues. / In conclusion, the solutions to several major problems in IMRT planning for advanced-stage NPC were investigated and established. It has been demonstrated in this research that, by applying these methods and tools, significant improvement in the dosimetry and efficiency of IMRT treatment planning can be accomplished as compared with conventional IMRT planning techniques. It is expected that such would translate into an improvement in treatment throughput, better tumor control and reduction in normal tissues complications. The methods developed have potential to be applied to all stages of NPC and to other tumor sites. / The first study was to improve the efficacy in target coverage and organs sparing using an "organ-splitting" approach. The OARs which overlapped with targets were split into target-overlapping and non-overlapping segments and each segment was assigned with different constraints parameters to increase the degree of flexibility during optimization. As a result, a steep gradient in the dose distribution at the regions of interface between the targets and normal critical organs could be achieved and treatment quality was improved. In the second study, a thorough dosimetric comparison between conventional 2-dimensional (2D) RT and IMRT plans was conducted to determine, with reference to outcome of 2D treatments, the extended tolerance dose limits for the critical organs, especially that of the brainstem and spinal cord, and their planning organ at risk volume. Such data could then serve as reference in IMRT planning when the dose of critical organs need be exceeded in order to allow adequate dose to a very close by target. In the third study, the feasibility of using interpolated contours for segmentation of targets and OARs in IMRT planning was investigated. The result indicated that the use of interpolated contours in IMRT planning could significantly reduce the contouring time by about 50% without degrading the target coverage and OARS sparing. In the final study, an array of dose constraint templates that could accommodate different degrees of overlap between the targets and OARs, together with a template selection program, were developed to improve the efficiency of IMRT planning. By applying the methods and tools developed, IMRT treatment planning of advanced NPC could become more efficient and less dependent on planner's experience. / Chau, Ming Chun. / Adviser: Anthony Chan Tak Cheung. / Source: Dissertation Abstracts International, Volume: 69-02, Section: B, page: 0948. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2007. / Includes bibliographical references (leaves 118-128). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract also in Chinese. / School code: 1307.