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Aims: The primary aim of this thesis was to explore the role of palliative\udradiotherapy in the treatment of pain in malignant pleural mesothelioma (MPM).\udThe effect of radiotherapy on other symptoms was also examined. Biomarkers\udwhich might predict response to radiotherapy (Quantitative Sensory Testing –\udQST) were explored and objective evidence of response was sought via\udinterpretation of Computed Tomography (CT) scans. The thesis also examined\udthe role of Positron Emission Tomography (PET)-CT in radiotherapy planning\udand characterising pain in MPM.\udMethods: A narrative review of the challenges of pain management in MPM and\uda systematic review of the evidence supporting the use of palliative radiotherapy\udfor pain control in MPM, were undertaken. In addition, a multi-centre, single arm\udphase II trial was conducted which examined the role of radiotherapy in pain\udcontrol in MPM. This trial also assessed the role of PET-CT in radiotherapy\udplanning and allowed for a characterisation of MPM-related pain. These\udcomponents form the basis of this thesis.\udResults: Palliative radiotherapy at a dose of 20 Gy in five daily fractions using 6\udMegavoltage (MV) photons improves pain in a significant proportion of patients\udwith MPM. It does not have a beneficial effect on other symptoms or on quality\udof life. QST does not appear to be a useful clinical biomarker indicating\udlikelihood of response to radiotherapy. Objective evidence of response via CT is\udlow. Incorporation of PET-CT in the radiotherapy planning process alters the\udanatomical location of the target volume in patients with MPM. There is also an\udassociation between the Standard Uptake Value (SUV) uptake and pain, with the\udareas with highest SUV uptake being associated with the areas of pain. PET-CT results in upstaging of a significant proportion of patients. Pain is often severe\udand debilitating for patients with MPM and it has often a combination of\udneuropathic and nociceptive mechanisms. The presence of a neuropathic\udcomponent to the pain is not associated with an increased likelihood of response\udto radiotherapy.\udConclusions: Radiotherapy is effective at relieving pain in a proportion of\udpatients with MPM and should be considered for all patients with MPM-related\udpain. PET-CT improves multiple parameters in the radiotherapy planning process\udcompared with CT alone. QST parameters have not been shown to predict those\udpatients who are likely to respond to radiotherapy

reports of radiotherapy and oncology

F-18 FDG PET-CT Influences Target Delineation When Combined With Standard CT-Based Radiotherapy Planning in the Palliative Setting in Malignant Pleural Mesothelioma; an Exploratory Study