Wilms tumor (WT) is the most common renal malignancy in children, with a peak incidence between the ages of 3 and 4 years. This study aimed to evaluate the clinicopathological features, treatment characteristics and survival outcomes of patients managed for WT at the study site.

This was a quantitative cross-sectional study involving 137 pediatric patients diagnosed with and managed for WT between 2012 and 2021. Total population sampling was used for participant selection. Data were analyzed using SPSS software, with Kaplan-Meier and Cox regression analysis used to estimate survival rates and examine prognostic factors. P-values < 0·05 were considered statistically significant.

The 2- and 5-year overall survival (OS) rates were 75% and 70%, respectively, while the disease-free survival (DFS) rates at 2- and 5-years were both 79%. Pathological staging significantly impacted OS and DFS (p = 0·000), while age, gender, weight and risk stratification did not show statistically significant differences. The left kidney was the most common primary site (51%), with an even male to female gender ratio of 1:1. Metastases were most common in the chest (n = 19, 13·8%) and lungs (n = 13, 9·5%).

Pathological stage was the most significant prognostic factor for both OS and DFS, emphasizing the importance of early detection and timely intervention. While the 2- and 5-year OS and DFS rates represent an improvement over previous studies in Ghana, they remain suboptimal compared to outcomes in high-income countries. A holistic, coordinated institutional treatment regimen has enhanced patient compliance, survival outcomes and follow-up care.

Radiotherapy is a critical component of head and neck cancer (HNC) management that requires reliable patient immobilization. Using thermoplastic masks helps to ensure reproducible patient positioning during radiotherapy, thus reducing the risk of a geographical miss. However, the use of these masks can also induce anxiety and distress, which can negatively impact treatment adherence and quality of life outcomes.

The research was a quantitative cross-sectional study that determined the prevalence and severity of thermoplastic mask-induced anxiety and assessed the scope of coping mechanisms used by HNC patients. Data were collected using a structured questionnaire from recruited participants and analysed with the Statistical Package for Social Sciences software, version 26·0. Relevant clinical and treatment-related data were retrieved from patients’ hospital-based medical records. Descriptive and inferential statistical analyses such as chi-square tests and likelihood ratios were conducted, with p-values < 0·05 considered statistically significant.

In all, there were 145 HNC patients with a male to female ratio of 1·9:1 and a median age of 52·8 years (IQR 20·7), ranging from 18 to 82 years. There was a high prevalence of thermoplastic mask-induced anxiety both during mask moulding (93·8%) and radiation therapy sessions (94·5%). Most participants (95·2%) adopted coping mechanisms including distraction (58%) and visualization techniques (46%).

Even though there was a high level of awareness and utilization of coping mechanisms, the high prevalence of thermoplastic mask-induced anxiety highlights a critical aspect of HNC patient care that may be overlooked in resource-limited settings.

The technological development of radiotherapy equipment enabled the changing of the dose rate over time during irradiation. Further, techniques, such as volumetric modulated arc therapy (VMAT), are becoming more widespread. This study aimed to assess the changes in radiation isocenter and beam alignment with different dose rates and investigate the dose error during VMAT plan delivery.

The Winston–Lutz (WL) test and three-dimensional water phantom profiles were measured at different dose rates using 4, 6 and 10 MV and flattening filter-free (FFF) at 6 and 10 MV of X-rays. Furthermore, the change in alignment with the dose rate was reproduced through beam parameter adjustments, and the change in dose difference (DD) in the VMAT plan was assessed.

The WL test revealed a 0·1–0·3 mm radiation isocenter displacement with dose rate. Further, the beam profile measurement results demonstrated a 0·3 mm beam centre position displacement in both the lateral and gun-target directions caused by the change in dose rate. VMAT plan delivery with a beam whose centre position changed by 0·3 mm caused a 0·2–3% decrease in the previous DD rate.

The radiation isocenter and beam alignment changed based on the dose rate. Evaluating the change in beam alignment at multiple dose rates is recommended when performing irradiation with different dose rates.

Given the increased risk of cardiac toxicity with higher doses, cardiac sparing is crucial for left-sided breast cancer patients. Deep inspiration breath hold (DIBH) is one approach, but its reproducibility is questioned. This study evaluates the reproducibility of DIBH with an active breathing coordinator (ABC) device, focusing on its dosimetric impact in maintaining consistent cardiac sparing for patients undergoing partial breast irradiation (PBI).

Thirty-three patients undergoing PBI with a prescription dose of 30 Gy in five fractions were randomly selected. Each patient was treated with 6 MV photons using volumetric modulated arc therapy (VMAT) with DIBH using an ABC device. Prior to each fraction, kilo-voltage cone beam computed tomography (kV-CBCT) images were acquired to assess inter-fractional heart motion. Contours of the whole heart and left anterior descending artery (LAD) were transferred from the planning CT to CBCTs and back, using rigid alignment and isocentre shifts to represent treatment positions. Agreement between delivered and planned doses assessed DIBH reproducibility.

Throughout the entire treatment course, changes in mean and maximum cardiac doses were less than 16·4 cGy and 264·8 cGy, respectively. Changes in mean and maximum LAD doses were less than 54·0 cGy and 160·2 cGy, respectively. Overall, the mean cardiac dose increased by 2·4 ± 6·6 cGy, and the maximum by 23·3 ± 58·0 cGy. The mean LAD dose increased by 4·8 ± 18·5 cGy, and the maximum by 17·0 ± 51·0 cGy.

DIBH can be effectively reproduced with the ABC device, limiting inter-fractional cardiac dose changes.

Radiotherapy aims to provide either curative treatment or palliation, with radiation transmission through shielding blocks ideally not exceeding 5% of the incident dose.

This study assessed the attenuation efficacy of Cerrobend shielding blocks, determining the thickness required for achieving 95% attenuation and evaluating the adequacy of currently used blocks.

An experimental study was conducted using a 1·25 MeV cobalt-60 teletherapy machine. Radiation intensities transmitted through Cerrobend blocks of varying thicknesses (1–5 cm) were measured with a calibrated ionization chamber and electrometer. Measurements were performed with a fixed field size of 10 cm × 10 cm at a 100-cm source-to-chamber distance, minimizing scatter. Baseline and transmitted intensities were recorded, with each measurement repeated five times for precision.

The percentage transmission, linear attenuation coefficients and thickness required for 5% transmission were calculated using regression analysis. Radiation intensity decreased exponentially with increasing Cerrobend block thickness, from 15·01 nC (0 cm) to 0·939 nC (5 cm thickness). Regression analysis showed a strong negative linear relationship (y = −0·5386x + 2·6705; R2 = 0·992). The thickness required for maximum transmission of 5% was determined to be 6 cm, while the routinely used 5 cm blocks at the study site allowed 8% transmission, exceeding the recommended threshold. Minimal environmental variations ensured measurement consistency.

The study demonstrated that 6 cm Cerrobend blocks were necessary to achieve the recommended 95% attenuation, whereas the 5 cm blocks in use resulted in suboptimal shielding. This highlights the need to revise shielding practices to improve radiation protection and patient safety in resource-constrained radiotherapy settings.

Optimal radiotherapy technique selection for left-sided breast cancer remains challenging. This study compared volumetric-modulated arc therapy (VMAT), VMAT+IMRT (VMAT+IMRT) and IMRT+VMAT (IMRT+VMAT) using an innovative integrated scoring system and risk factor (RF) assessment.

Retrospectively analysed 41 patients with left-sided breast cancer. Treatment plans were evaluated using an integrated scoring system considering tumour coverage and organs at risk (OARs) sparing. RF analysis assessed potential adverse effects on the heart and lungs. Correlation analysis explored relationships between integrated scores and risk factors.

VMAT showed the best overall integrated score (1·0931 ± 0·1707), followed by IMRT+VMAT (1·2011 ± 0·2440) and VMAT+IMRT (1·2264 ± 0·2499). VMAT had the highest percentage of Excellent OAR plans (14·6%), while VMAT+IMRT and IMRT+VMAT showed better PTV coverage (53·7% and 51·2% Excellent, respectively). RF analysis revealed: VMAT (heart RF: 0·341, lung RF: 0·671), VMAT+IMRT (heart RF: 0·294, lung RF: 0·750) and IMRT+VMAT (heart RF: 0·533, lung RF: 0·546). Correlation analysis showed strong positive correlations between integrated scores and lung RF for VMAT (r = 0·671) and VMAT+IMRT (r = 0·750), with IMRT+VMAT showing moderate correlations for lung (r = 0·546) and heart (r = 0·533) RFs.

VMAT demonstrated the best balance between PTV coverage and OAR sparing, hybrid techniques improved target coverage but increased risk to OAR. The RF analysis highlighted varying impacts on heart and lung across techniques. This analysis provides valuable insights for technique selection, potentially improving treatment outcomes and reducing complications in left-sided breast cancer radiotherapy.

Predicting radiotherapy (RT) tooth dose guides pre-RT dental management, reducing osteoradionecrosis (ORN) risk through informed extraction or treatment adjustments. This study evaluated the mean radiation dose to individual teeth for head and neck cancer (HNC) patients receiving external beam RT at the South West Wales Cancer Centre (SWWCC), to guide pre-emptive tooth extraction.

A retrospective analysis was conducted on 158 HNC RT patients treated over a 2-year period. Patients with subsites containing ≤10 patients were excluded, and larynx cases were analysed separately before exclusion due to low ORN risk, leaving 107 patients in the final analysis. Teeth were outlined using MedCom ProSoma v4.2, and treatment plans were generated with Philips Pinnacle v16.2 using volumetric arc therapy (VMAT), without dental dose optimisation. Mean doses were reported per tooth and categorised by site, staging and tooth position, with mean and standard deviations calculated. ORN risk was defined as medium (≥40Gy) and high (≥50Gy).

Larynx patients received low mean doses (<25Gy), supporting their exclusion. Base of tongue (BoT) cases showed a dose ≥40Gy for lower ipsilateral molars in T4. Oral cavity diagnosis had the highest ORN risk, with most teeth ≥40Gy in T2+ cases and ≥50Gy in later cancer staging. The oropharynx showed some higher risk doses for T4-staging. T-tests confirmed significant dose differences between upper and lower teeth.

This study provides a site-specific indicative guide for pre-RT tooth extraction based on likely dose exposure, to guide pre-radiation dental management strategies and plan optimisation decisions to reduce ORN risk.

Oropharyngeal squamous cell carcinoma (SCC) is a common type of head and neck cancer often linked to tobacco, alcohol use, and, in youngers, HPV infection. Standard care for locally advanced SCC involves radiotherapy (RT) and cisplatin, (total doses of 66–70Gy in 30–35fractions). However, some patients with significant comorbidities cannot tolerate chemotherapy, requiring alternative approaches. We present a case of a 66-year-old male with p16-negative oropharyngeal SCC and bulky cervical nodal metastasis, ineligible for chemotherapy.

The patient was treated using adaptive volumetric modulated arc therapy (VMAT) with simultaneous integrated boost (SIB) and central gross tumor volume (GTV) dose escalation. This approach delivered up to 72Gy to the central GTV in 30 fractions; 66 Gy in 30 fractions to the high-risk area; 60Gy in 30 fractions to the intermediate-risk area; 54 Gy in 30 fractions to the low-risk area.

An epithelolysis (grade 3) led to a four-day treatment pause. A mid-treatment CT showed tumor shrinkage, reducing the nodal GTV volume from 107to 33cc, prompting adaptive planning to optimize dose distribution and reduce toxicity. The patient completed RT without further interruptions. At six months post-treatment, no recurrence or severe toxicities were detected and four years post-treatment, the patient remains in complete remission without significant late toxicity.

This case demonstrates the effectiveness of VMAT with SIB in delivering accelerated radiotherapy to a bulky nodal lesion in a patient with p16-negative oropharyngeal SCC unfit for chemotherapy; This allowed for tumor control while minimizing exposure to critical structure.

Teaching volumetric modulated arc therapy (VMAT) treatment planning to therapeutic radiography students faces challenges, including time constraints and resource limitations. Gamification, an active learning strategy incorporating game-based elements, may enhance engagement and understanding of VMAT treatment planning.

A VMAT treatment planning session was implemented for 15 second-year undergraduate and postgraduate therapeutic radiography students using gamification. Participants were tasked with optimising a VMAT plan for a palliative prostate cancer patient using Eclipse treatment planning software. Students completed pre- and post-session questionnaires assessing perceived understanding and enjoyment. Plans were evaluated against clinical goals, and a leaderboard was used to rank top performers. Thematic analysis was applied to qualitative feedback.

About 86·7% of participants initially reported a limited understanding of VMAT planning structures. Post-session, all participants reported improved perceived understanding, with 93·3% finding the session beneficial and recommending its inclusion in the programme. While 66·6% enjoyed the gamified approach, technical issues limited individual optimisation time. Qualitative feedback highlighted increased confidence and engagement despite challenges.

Gamification enhanced student-reported understanding, enjoyment and engagement in VMAT planning. While technical issues affected session efficiency, feedback supports the integration of gamification in treatment planning sessions but should not be overused as its usefulness can wear off.

This is a radiobiological modelling study aimed at comparing stereotactic ablative body radiotherapy (SABR) with conventional palliative radiotherapy (CPRT) and curative-dose volumetric-modulated arc therapy (CD-VMAT) in the palliation of patients with previously untreated head and neck cancer.

Three radiotherapy plans were generated for 8 patients with head and neck cancer: SABR, prescribed to 45 Gy in 5 fractions; CPRT, prescribed to 30 Gy in 5 fractions and CD-VMAT, prescribed to 70 Gy in 35 fractions. The tumour control probability (TCP) and normal tissue complication probability for salivary and swallowing function (NTCPsaliva and NTCPswallow, respectively) were determined. From those values, the therapeutic ratio, as measured by the uncomplicated tumour control probability (UTCP), was determined.

Dosimetric objectives were achieved in all treatment plans. SABR had a higher mean TCP compared to CPRT and CD-VMAT (100% vs 81% vs 93%, p = 0·003). There were no statistically significant differences in the mean NTCPs for salivary or swallowing function (mean NTCPsaliva 27% vs 41% vs 36%, p = 0·093 and mean NTCPswallow 9% vs 12% vs 23%, p = 0·093). This resulted in the mean UTCP being statistically significantly higher for SABR plans compared to CPRT and CD-VMAT (66% vs 42% vs 49%, p = 0·004).

It is feasible to create SABR plans that satisfy the dosimetric objectives in this study. Based on radiobiological modelling, SABR has superior TCP and similar NTCP, leading to a better therapeutic ratio than CPRT and CD-VMAT.