Background and purpose: We evaluated the effect of block margin on small fields when point dose prescription (ICRU) or isodose line prescription (RTOG) formats are used.

Material and methods: A total of 11 clinical SBRT cases, one 4-field prostate case and 2 phantom cases using 0, 0.5 or 1 cm block margins were analysed. Integral dose and target coverage were compared using DVHs and isodose volumes for either isodose line prescription (100% Rx dose to 95% PTV volume) or isocenter point prescription (100% Rx dose to the isocenter) were calculated.

Results: Tight planning target margins using isodose line prescription leads to good target coverage but high dose heterogeneity with hot spots possibly exceeding 140% of the prescription dose for small target volumes. As block margin is increased, target coverage converges for the two methods but point dose prescriptions result in better dose homogeneity. For a given block margin, integral doses are consistently larger for isodose line prescription over point prescription, but are similar when block margins are adjusted to produce equal target coverage. As target size increases dose heterogeneity and integral dose differences disappear.

Conclusions: For small targets, the ICRU point prescription method can produce comparable PTV coverage to the isodose line prescription method with less dose heterogeneity and comparable integral dose. Reduction of hot spots in potentially normal tissue and reporting clarity makes this internationally recommended prescription standard preferable.

Aims: To obtain an estimate of dietary fibre and fluid intake in Australian men undergoing prostate radiotherapy and to establish feasibility and patient compliance with recording normal diet without intervention during the radical course of radiotherapy.

Methods: Eleven participants were enrolled and treated with 74–78 Gray (Gy) to the prostate over 8 weeks. Participants were instructed to record a diary of their food and fluid intake and bowel motions for the duration of treatment. Treating radiation therapists were instructed to initial the diet diary daily. Diet diaries were assessed for compliance by analysing the number of days over the treatment period and the number of diary pages submitted. The diet diaries were analysed for nutrient intake of fibre and fluids.

Results: A total of 10 of 11 participants submitted a diet record for the full duration of treatment with a median compliance of 100% (range 90.4–100%) of days recorded. The mean (standard deviation) of fibre and fluids recorded in the diets were 21.5 g (5.5) and 2227.1 g (733.1), respectively.

Conclusions: It is feasible for patients to record a diet diary over a radical course of prostate radiotherapy. In this study, most patients were highly compliant with submitting a diet record for each day during treatment.

Introduction: Benchmarking can be used to improve hospital performance. It is however not easy to develop a concise and meaningful set of indicators on aspects related to operations management. We developed an indicator set for managers and evaluated its use in an international benchmark of radiotherapy centres. The indicator set assessed the efficiency, patient-centeredness and timeliness of the services delivered.

Methods: We identified possible indicators from literature and professionals. Stakeholders’ feedback helped to produce a shortlist of indicators. For this indicator set, data were obtained in a pilot that included four European radiotherapy centres. With these data, the indicators were evaluated on definition clarity, data availability, reliability and discriminative value.

Results: Literature produced a gross list of 81 indicators. Based on stakeholder feedback, 33 indicators were selected and evaluated in the benchmark. Six negatively evaluated indicators were adapted, together with eight positively evaluated indicators 14 indicators seemed feasible. Examples of indicators concerned utilisation, waiting times, patient satisfaction and risk analysis.

Conclusions: This study provides a pragmatic indicator development process for international benchmarks on operations management. The presented indicators showed to be feasible for use in international benchmarking of radiotherapy centres. The pilot identified attainable performance levels and provided leads for improvements.

Background and aims: Current evidence suggests that acupuncture may provide some palliation of the symptoms and side effects of cancer and its treatments. Therefore, consideration of the potential benefit of the introduction of an acupuncture service in oncology at Cornwall was investigated. This study describes the experience of patients using the service.

Methods: Between April 2005 and October 2007, 107 oncology patients experiencing one or more of the following symptoms, such as nausea, vomiting, hot flushes, pain, breathlessness, dry mouth, anxiety, depression, fatigue, diarrhoea, constipation or difficulties in coping, were referred for up to 10 weekly acupuncture treatments. About 103 had acupuncture treatment. This observational study utilised responses to questionnaires and self assessment of symptoms at the start (baseline), on completion of treatment and at two months post-acupuncture treatment.

Results: Complete data were returned for 47 participants. Improvement in vasomotor symptoms was seen in 86% of patients presenting with hot flushes. There was a significant (p = < 0.001) reduction in anxiety following acupuncture. The mean difference between scores on the Fatigue Scale (18) across the study period showed improvement in patients experiencing fatigue (p = 0.039).

Conclusion: An acupuncture service for Oncology is practicable and is of benefit to patients. A future randomised controlled trial focusing on the use of acupuncture for hot flushes associated with hormonal treatments for cancer would be worthwhile as these patients form the bulk of referrals and many reported improvement in their hot flushes. A pilot study to compare acupuncture and Venlafaxine for hot flushes in breast cancer patients taking anti-oestrogen treatment is currently being planned. The results of this study demonstrate that acupuncture may benefit patients experiencing anxiety and/or fatigue associated with cancer. A larger randomised controlled trial would more adequately investigate this hypothesis.

Background: The role of radiotherapy for large and locally advanced non-melanoma skin cancer is unclear. In this report, we aimed to review our institutional experience with patients treated with radiation therapy for T2–T4 NMSC and analyze outcomes.

Methods: Seventy patients and 85 lesions were reviewed who received radiotherapy. Fifty-six lesions (65.9%) were untreated, 17 (20.0%) recurrent, and 12 (14.1%) post-operative. Forty-three (50.6%) were staged T2, 20 (23.5%) T3, and 22 (25.9%) T4. Median follow-up was 20 months.

Results: Thirty-nine living patients (59.0%) had no evidence of disease, of which 35 (89.7%) required no therapy following radiotherapy. Twenty-seven patients (41.0%) died, of which 10 deaths were attributed to disease progression. Achievement of complete response (CR) to all therapy and radiotherapy alone was, respectively, 95.3% and 86% for T2, 70% and 65% for T3, and 68.2% and 59.1% for T4. Statistically significant factors for CR included basal cell histology (p = 0.005) and tumour stage T2 (0.01).

Conclusions: Radiotherapy for T2–T4 NMSC is effective. Basal cell histology and T2 are statistically favoured to achieve CR to radiotherapy alone.

In prostate permanent implants using 131Cs seeds, the prostatic edema developed during the implantation procedure, increases the separation between the seeds. This leads to a decrease in the prostate coverage and thus causes an edema induced dose reduction, which results in an increase in tumour cell surviving fraction (SF) with a corresponding decrease in tumour control probability (TCP). To investigate the impact of edema on the SF and the TCP, the expression of the SF of the linear quadratic (LQ) model was extended to account for the effects of edema using the exponential nature of edema resolution and the dose delivered to the edematous prostate. The SF and the TCP for edematous prostate implants were calculated for 31 patients who underwent real time 131Cs permanent seed implantation. The dose delivered to the edematous prostate was calculated to compute the SF and the TCP for these patients for edema half lives (EHL) ranging from 4 days to 34 days and for edemas of magnitudes (M0) varying from 5 to 60% of the actual prostate volume.

A reduction in the dose delivered to the edematous prostate was found with the increase of EHL and edema magnitude which results in an increase of the SF, and corresponding decrease in the TCP. The dose reductions in 131Cs implants varied from 1.1% (for EHL = 4 days and M0 = 5%) to 32.3% (for EHL = 34 days and M0 = 60%). These are higher than the dose reduction in 125I implants, which vary from 0.3% (for EHL = 4 days and M0 = 5%) to 17.5% (for EHL = 34 days and M0 = 60%). As edema half life increased from 4 days to 34 days and edema magnitude increased from 5 to 60% the SF increased by 4.57 log, and the TCP decreased by 0.80. Compensation of edema induced increase in the SF and decrease in the TCP in 131Cs seed implants should be carefully done by redefining seed positions with the guidance of post-needle plans. The presented model in this study can be used to estimate the SF or the TCP for pre plan or real time permanent prostate implants using day 0 post-implant CT images.

Purpose: Medical device performance checks are essential following changes to control system software. This work investigates the effects of new software on the performance of a high dose rate (HDR) brachytherapy treatment unit.

Methods and Materials: A performance assessment was undertaken of the Eckert & Ziegler BEBIG GmbH MultiSource® HDR treatment unit following software upgrade. Video recordings of source transits were used to calculate transit doses, and autoradiography used to measure source dwell positions. Results were compared to a previous study.1

Results: All results showed improved performance with the new compared to old control software. Optimal source movement profiles were observed with maximum transit speeds of 63 (+/−4) mm s−1 between dwells of 5.0 mm separation. The maximum error in transit dose correction with the new software was 2.5 % at 10.0 mm perpendicular from the source axis, compared to 5.6 % previously. The new software eliminated a causal relationship between curvature of the source transfer tubes and dwell position uncertainty.

Conclusions: This work demonstrates the need for comprehensive medical device system checks following software changes. Technical improvements in HDR device performance have been achieved with the new software; reducing transit doses, improving transit dose correction, and improving source positioning accuracy.