Survive and thrive Toxicity and prognosis in women treated with radiotherapy for gynaecological cancer

This thesis investigates patient- and treatment-related factors that influence outcomes in women with gynaecological cancer undergoing pelvic radiotherapy, with a particular focus on cervical cancer and late bowel toxicity. By combining clinical, imaging and epidemiological research, it aims to improve both treatment effectiveness and long-term quality of life.
The research demonstrates that advances in MRI-guided adaptive brachytherapy, including the use of interstitial needles, have significantly improved local tumour control and survival while reducing severe treatment-related toxicity. In addition, a novel 3D cine-MRI technique was developed to visualise and quantify bowel motion during radiotherapy. This work demonstrated that bowel loop motion decreases over the course of treatment, providing new opportunities to personalise treatment planning and minimise radiation exposure to healthy tissue.

Several studies identified independent, modifiable risk factors associated with severe late bowel toxicity, highlighting opportunities for preventive interventions and more personalised supportive care. Furthermore, malnutrition and sarcopenia were shown to be common during and after treatment and malnutrition was independently associated with poorer survival, emphasising the importance of early nutritional assessment and intervention.
Overall, this thesis supports a personalised approach to radiotherapy for gynaecological cancer by integrating advanced imaging with early identification of clinical and nutritional risk factors. Such a multidisciplinary strategy has the potential to improve oncological outcomes, reduce long-term complications and enhance patients' quality of life.