Immobilization devices in radiotherapy are made of a soft plastic easy to mould when immersed in hot water. Same item is usually used for 6 patients (according to protocol), but at Hospital Sao Jose (HSJ) they have been showing some deformation during the re-utilization process. The latter is the reason for this research where devices were treated with 6 thermal conditions, 6 irradiation procedures and the joint effect of both treatments. DSC, TGA and WAXD indicated devices are made of polycaprolactone (PCL), but no signs of degradation, except a slight variation in crystalinity; however, mechanical properties by means of Young’s modulus steadily increase its values through number of treatments up to a 20%. Activation energy (Ea) obtained by multi-ramps of TGA-Arrhenius evaluated for the most treated samples (6th treatment) indicates that temperature facilitates degradation while irradiation and joint treatments enhance the stability of PCL, apparently by crosslinking.

Aims: Endometrial cancer is the commonest malignancy of the female genital tract. Surgery forms the cornerstone of treatment with adjuvant therapy proven to reduce local recurrence without demonstrating a clear survival benefit. The selection of adjuvant therapy is becoming increasingly more complex. The aim of this study was to investigate current adjuvant practices by reviewing outcomes of patients with endometrial cancer treated with intracavitary vaginal brachytherapy (VB).

Materials & Methods: A retrospective analysis was carried out of all women with Stage II endometrial endometroid adenocarcinoma treated at Weston Park Hospital, Sheffield with adjuvant VB from 2003–2006. The data collected and analysed included histology, stage and grade of disease, radiotherapy treatment–related parameters, morbidity, recurrence rates and survival rates. Kaplan-Meier was used to analyse recurrence-free and overall survival rates. Wilson’s score was used to determine statistical significance of outcomes. Attention was focused on the method of treatment delivery, and this was compared with available literature.

Results: In total, 33 patients were identified. All patients were treated with LDR 48 Gy prescribed to the surface of the applicator. Median follow-up was 36 months. Vaginal, pelvic and distant relapse rates were 9%, 15% and 18%, respectively. Recurrence-free and overall survival rates were 78.8% and 84.8%, respectively. Six of the seven patients (86%) who recurred developed distant metastases, not influenced by VB. No severe (Grade 3 or 4 toxicity) was recorded. When vaginal relapse rates were compared to published trials based on technique used, no statistically significant difference was demonstrated.

Conclusion: Rates of vaginal relapses were comparable to the available literature suggesting current VB practice is an effective adjuvant local treatment. The study highlights the importance of surveillance and patient education regarding toxicity and its prevention with particular attention drawn to vaginal stenosis.

The research process is a series of stages necessary to establish the integrity, value, and feasibility of a proposal. Part of the preparation is in understanding the process and factors that can contour a study. The aim of this paper is to outline the hidden factors that may be experienced when undertaking qualitative research. Although the participants are the main players of the study additional influences also require recognition to allow transparency of the project and the researcher’s stance. The guidance of university supervisors has the potential to influence the researcher’s perspective and the effectiveness of the study. Negotiation with clinical staff can add another dimension. Ethics committees are composed of individuals with varied expertise, bringing their points of view into the discussion and decision making, impacting further on the proposed research. It is important for medical radiations professionals who become involved in research to be aware of these factors and how they may influence a project and to acknowledge the impact of the perspectives of the researcher on the project. The significance of this paper is to provide novice researchers, an understanding of the influence, hidden factors play on the results of qualitative research with particular reference to ethnography.

Context: Setup error significantly affects the accuracy of treatment and outcome in high precision radiotherapy.

Aims: To determine total, systematic, random error and clinical target volume (CTV) to planning target volume (PTV) margin with alpha cradle (VL) and ray cast (RC) immobilisation in abdominopelvic region.

Methods and material: Setup error was compared by using digitally reconstructed radiograph (DRR) as reference image with electronic portal image (EPI) taken during the treatment. Statistical analysis used: The total errors in mediolateral (ML), craniocaudal (CC) and anteroposterior (AP) directions were compared by t-test. For systematic and random errors variance ratio test (F-statistics) was used. Margins were calculated using International Commission of Radiation Units (ICRU), Stroom’s and van Herk’s formula.

Results: A total number of 306 portal images were analysed with 144 images in RC group and 162 images in VL group. For VL, in ML, CC, AP directions systematic errors were, in cm, (0.45, 0.29, 0.41), random errors (0.48, 0.32, 0.58), CTV to PTV margins (1.24, 0.80, 1.25), respectively. For RC, systematic errors were (0.25, 0.37, 0.80), random error (0.46, 0.80, 0.33), CTV to PTV margins (0.82, 1.30, 1.08), respectively. The difference of random error in CC and AP directions were statistically significant.

Conclusions: Geometric errors and CTV to PTV margins are different in different directions. For abdomen and pelvis in VL immobilisation, the margin ranged from 8 mm to 12.4 mm and for RC it was 8.2 mm to 13 mm. Therefore, a margin of 10 mm with online correction would be adequate.

The objective of this study was to evaluate the delivery efficiency of intensity modulated radiation therapy (IMRT) with a non-zero collimator rotation approach compared to conventional planning IMRT in the management of prostate carcinoma. Inverse plans, created using conventional collimator angle 0° (CA0) for eight prostate patients, were compared to plans using collimator angle 70° (CA70) for all fields and also with plans utilizing an automatic collimator angle optimization tool (CAopt) for each field. Results demonstrate that IMRT plans created with rotational collimator techniques can produce comparable dose distributions to standard CA0 plans. The rotational collimator approach significantly reduced the total number of monitor units (MU) by 6% (p value = 0.027) and 9% (p value = 0.003) for CA70 and CAopt, respectively. The mean monitor units for CA0, CA70 and CAopt were 635 ± 107 MU, 597 ± 96 MU and 587 ± 104 MU, respectively. The mean peripheral dose was significantly increased with CA70 against CA0 (p value < 0.001) despite reduced monitor units. Collimator optimization resulted in reduction in monitor units and peripheral dose. The number of monitor units are reduced with the rotational collimator approach, which results in reduced delivery time. However, we conclude that peripheral dose should be analyzed when assessing monitor unit differences in IMRT plans.

The partial volume (spatial) response of four ionization chambers (Keithley) in kilovoltage X-ray beams, generated by the Philips Super 80CP X-ray unit, was assessed. The volume of the ionization chambers were of 10 cm3, 15 cm3, 150 cm3, and 600 cm3 used with Keithley electrometer Model 35040. The beam output was measured using a monitor chamber (Radcal 6.0 cm3) placed close to the collimator. The source to chamber distance was kept constant at 1 m. For the measurement of the response of ionization chambers of 15 cm3, 150 cm3, and 600 cm3, a slit of 2.0 mm width was made in a lead sheet of 3.2 mm thick and size of 30 × 30 cm2 and was placed on the ionization chamber. The measurements were made for 81 kVp, 400 mA, and 0.25 s and the slit was moved at an increment of 2.0 mm over the entire length of the chamber. For the measurements of the ionization chamber of 10 cm3 (CT chamber), the beams of 120 kVp, 200 mA and 0.2 s were generated, and a slit of 5 mm width was made in a similar lead sheet that was moved at an increment of 5.0 mm. From the result it appears that the sensitive volumes of the ionization chambers affect the response of the ionization chamber to incident radiation.

Oral mucositis is an unavoidable side effect of radiation therapy to the head and neck, which can compromise patient health and quality of life. This study investigates the effect of manuka honey on the extent of oral mucositis in head and neck patients in New Zealand. A total of 28 patients were recruited; 10 patients received standard care and 18 patients were given additional manuka honey. Honey was used three times a day; assessment included: extent of oral mucositis using a multi-site mucositis scoring system, weight and quality of life. The first six patients, randomised to the honey arm, used undiluted honey and pulled out in the first week because of extreme nausea, vomiting and stinging sensations in the mouth. The next 12 honey patients used a honey mouthwash (diluted 1:3). Six of these patients completed the trial and four more completed the first 4 weeks of the trial. Eight control patients completed the trial. In contrast to previous honey trials in Malaysia, Egypt, Iran and India, diluted manuka honey did not decrease the extent and onset of radiation-induced oral mucositis but did appear to ameliorate radiation-induced weight loss and increase quality of life in the absence of cisplatin chemotherapy.

Clinical depression is the most prevalent psychiatric disorder amongst cancer patients and is associated with significant functional impairment, although often under-diagnosed and untreated. In one study, only 6% of patients with clinical depression were identified by their oncologists. The detection of and intervention for anxiety and depression in oncology is widely debated in the literature. Diagnosing clinically significant distress amongst cancer patients requires sensitivity as many symptoms of depression are very similar to those of some cancers themselves. The two detection methods discussed in the literature are either self report questionnaires (i.e., HADS) and diagnostic clinical interviews. There are several techniques described in the literature that have shown to be effective in reducing anxiety and depression in oncology. These can be broken down into four main categories, namely, cognitive behavioural therapy (CBT), counselling, drug therapy and complementary therapies, and it is acknowledged that patients receiving any type of intervention generally cope better than those who receive none at all. The effective management of anxiety and depression is dependent on the ability of health professionals to establish a rapport with patients and pick up on cues, regardless of whether intervention is necessary. However, an obvious lack of time and resources within the NHS can be a limiting factor, thus all health care professionals must take more responsibility for the detection of anxiety and depression, followed by the appropriate referral.

Objective: To systematically review and critically appraise all evidence on skin care advice and products tailored for patients receiving radical radiotherapy for breast cancer and to determine an evidence-based conclusion regarding the most effective products.

Data Resources and Review Methods: Major healthcare databases were searched with additional efforts made to hand-search current journals. All relevant literature fulfilling the inclusion and exclusion criteria was subjected to quality assurance checks. Those that passed underwent a more rigorous appraisal and were included in the review.

Results: Ten studies were identified as fulfilling the review criteria with regards to aims and quality. All were randomised controlled trials; three were double-blinded, three were single-blinded, the remaining were not blinded. Two addressed washing regimes, two addressed deodorant use, whilst the six remaining studies investigated creams, gels or dressings.

Conclusions: The results suggest that there is a place for creams in the management and delay of radiation-induced skin toxicities; however, research fails to highlight one product which has a demonstrable benefit over others whilst still being cost effective and free from adverse effects. Patients should not be discouraged from washing with water or mild soaps and results suggest that the restriction of aluminium-free deodorant during treatment is unnecessary; however, more research in this area is needed with larger sample sizes.

Background: Endometrial cancer vaginal recurrence in a patient deemed unsuitable for EBRT. Brachytherapy proposed although standard image-guidance insufficient.

Proposed Solution: PET-CT image-guidance.

Results: PET-CT acquired with brachytherapy applicator in situ. BTV delineated by the Nuclear Medicine physician. All subsequent volumes delineated by the Clinical Oncologist. 2 phase plan delivered with minimal toxicity.

Purpose: Recent studies have shown increased prostate cancer control rates with radiation dose escalation. Herein the experience of dose escalation by high dose rate brachytherapy (HDR-BT) adjunct to the three-dimensional conformal radiation therapy (3D-CRT) for prostate cancer is presented.

Patients and methods: During the period between August 2005 and July 2007, patients with intermediate and high risk prostate cancer were treated with 3D-CRT of dose 46Gy ÷ 23 fractions to whole pelvis followed by: Arm A (102 patients): prostate boost with HDR-BT 14 Gy × 2 sessions and Arm B (103 patients): prostate boost via 3D-CRT of dose 26 Gy ÷ 13 fractions. Primary objectives were overall survival (OS), distant metastases free survival (DMFS) and PSA progression free survival (PPFS) rates. Secondary objectives were the toxicity profile and post-radiation histopathological response.

Results: At median follow up of 3.5 years, PPFS, DMFS and OS rates were; 97.8% versus 89.0% (p = 0.009), 98.1% versus 93.6% (p = 0.13) and 98.8% versus 91.6% (p = 0.24) in Arm A and Arm B. respectively. Grade 3 or 4 delayed genitourinary toxicities occurred in 2% and 4.8% of patients in Arm A and Arm B, respectively. Delayed grade 3 and 4 gastrointestinal toxicities were seen in 2% and 3.9% of patients in Arm A and Arm B, respectively. The post-radiation prostate biopsies were negative in 14/17(82.3%) and 9/15 (60%) in Arm A and Arm B, respectively.

Conclusion: 3D-CRT combined with HDR-BT resulted in better PPFS and lower morbidity than 3DCRT alone for intermediate and high risk prostate cancer.

We describe two cases of cellulitis occurring around ink sites, following tattooing for adjuvant radiotherapy in two patients who had undergone latissimus dorsi-with-implant breast reconstructions. One patient was successfully treated with intravenous antibiotics. The second patient developed a peri-implant infection requiring implant removal. Patients with implant-based breast reconstructions should be warned of the potential infection risk of radiotherapy tattooing.

Introduction: The radiotherapy profession has learned from errors made during treatment planning and delivery. Quality assurance in radiotherapy (QART) procedures are implemented to reduce the risk of an error occuring. The chief medical officer, along with others, has recommended that the QART of all departments includes in vivo dosimetry (IVD) to ensure that the delivered dose equals the planned dose.

Why we need IVD: A lot of effort goes into field verification and it is just as vital that dosimetry is verified. Overdose to normal tissue can cause devastating side effects, even death, whilst tumour underdose may compromise control. Without IVD, there is no way of knowing that a patient is receiving an overdose until it is too late. Underdoses are unlikely to manifest without IVD. IVD allows radiotherapists and physicists to correct for dose errors in a timely manner.

Why IVD is unnecessary: Radiotherapy accidents are rare. Implementing IVD is expensive, time consuming and takes resources away from developing techniques which will improve patient outcomes. Current IVD methods are not suitable for modern techniques such as intensity modulated radiotherapy (IMRT).

Discussion: IVD appears to be a useful QART tool, particularly as dose escalation techniques develop allowing a higher dose to be delivered to the tumour. Departments may be unwilling to spend time and money on an IVD system that is costly and time consuming if it cannot perform IVD on modern techniques. Electronic portal imaging devices (EPIDs) can be utilised to perform IVD on complex techniques, such as IMRT and arc therapy, which current IVD methods cannot, however there is currently no EPID IVD system available commercially.

Conclusion: Ideally, all departments would conduct IVD on all new patients. IVD has proven to be an important QART tool, however, until technology is developed to allow EPID to include IVD, the procedure is not likely to be implemented countrywide.

We described a rare case of multiple myeloma in a 60-year-old man, in whom relapse limited to the irradiated area in the left lobe of the liver developed following radiotherapy for lesions in 11th and 12th thoracic spines. Immunohistochemical analysis revealed expression of hepatocyte growth factor (HGF) and hepatocyte growth factor receptor (c-Met) in the hepatocytes in the irradiated area of the liver. We speculate that the malignant plasma cells might have proliferated in response to local increase of HGF production in the irradiated liver. The role of HGF in the extraosseous spread of multiple myeloma and also under the experimental condition of hepatic transplantation is discussed.

The quality factor for x-rays, gamma rays and electrons assigned as one need to be revised. It is observed that as the energy decreases, mean lethal radiation dose (Do)decreases as well and become more potent. It is therefore proposed that radiation quality in biological systems should be assessed in the mitotic phase of the cell cycles. Furthermore, based on the mean lethal radiation dose within specific energy range, an appropriate quality factor of x-rays, gamma rays and electrons should be assigned.

Central neurocytoma is a rare intraventricular brain tumour that affects young people and presents with increased intracranial pressure secondary to obstructive hydrocephalus. Typically, it has a favourable prognosis after complete resection. In some cases the clinical course could be more aggressive. In this report, we describe a case of recurrent central neurocytoma treated with radiosurgery after two consecutive relapses. An asymptomatic radionecrosis developed after that. At the moment the patient is in complete recovery. Finally, we discuss the role of postoperative irradiation in the treatment of this rare tumour.

The role of breast conservation in patients expressing BRCA1 and BRCA2 genetic mutations is controversial. A patient who was found to have bilateral synchronous breast cancers and expressed a BRCA genetic mutation was recently evaluated. The patient had a strong desire for breast preservation. This case and a review of the pertinent literature are presented to discuss the role of breast conservation and radiation in patients with BRCA1 or BRCA2 genetic mutations.