Protocol for the isotoxic intensity modulated radiotherapy (IMRT) in stage III non-small cell lung cancer (NSCLC): a feasibility study.

Introduction The majority of stage III patients with non-small cell lung cancer (NSCLC) are unsuitable for concurrent chemoradiotherapy, the non-surgical gold standard of care. As the alternative treatment options of sequential chemoradiotherapy and radiotherapy alone are associated with high local failure rates, various intensification strategies have been employed. There is evidence to suggest that altered fractionation using hyperfractionation, acceleration, dose escalation, and individualisation may be of benefit. The MAASTRO group have pioneered the concept of ‘isotoxic’ radiotherapy allowing for individualised dose escalation using hyperfractionated accelerated radiotherapy based on predefined normal tissue constraints. This study aims to evaluate whether delivering isotoxic radiotherapy using intensity modulated radiotherapy (IMRT) is achievable.

Methods and analysis Isotoxic IMRT is a multicentre feasibility study. From June 2014, a total of 35 patients from 7 UK centres, with a proven histological or cytological diagnosis of inoperable NSCLC, unsuitable for concurrent chemoradiotherapy will be recruited. A minimum of 2 cycles of induction chemotherapy is mandated before starting isotoxic radiotherapy. The dose of radiation will be increased until one or more of the organs at risk tolerance or the maximum dose of 79.2 Gy is reached. The primary end point is feasibility, with accrual rates, local control and overall survival our secondary end points. Patients will be followed up for 5 years.

Ethics and dissemination The study has received ethical approval (REC reference: 13/NW/0480) from the National Research Ethics Service (NRES) Committee North West—Greater Manchester South. The trial is conducted in accordance with the Declaration of Helsinki and Good Clinical Practice (GCP). The trial results will be published in a peer-reviewed journal and presented internationally.

Trial registration number NCT01836692; Pre-results.

Wave Fields around Wave Energy Converter Arrays

Wave energy converters, by their nature, extract large amounts of energy
from incident waves. If the industry is to progress such that wave energy
becomes a significant provider of power in the future, large wave farms will
be required. Presently, consenting for these sites is a long and problematic
process, mainly due to a lack of knowledge of the potential environmental
impacts. Accurate numerical modelling of the effect of wave energy extraction
on the wave field and subsequent evaluation of changes to coastal
processes is therefore required. Modelling the wave field impact is also
necessary to allow optimum wave farm configurations to be determined.
This thesis addresses the need for more accurate representation of wave
energy converters in numerical models so that the effect on the wave field,
and subsequently the coastal processes, may be evaluated. Using a hybrid
of physical and numerical modelling (MIKE21 BW and SW models) the
effect of energy extraction and operation of a WEC array on the local wave
climate has been determined.
The main outcomes of the thesis are: an improved wave basin facility, in
terms of wave climate homogeneity, reducing the standard deviation of wave
amplitude by up to 50%; experimental measurement of the wave field around
WEC arrays, showing that radiated waves account for a significant proportion
of the wave disturbance; a new representation method of WECs for use
with standard numerical modelling tools, validated against experimental
results.
The methodology and procedures developed here allow subsequent evaluation
of changes to coastal processes and sediment transport due to WEC
arrays.