Purpose: The purpose of this study is to identify the incidence of anxiety and distress among patients requiring immobilization during radiation therapy to the head and neck region; then to compare this with radiation therapists’ ability to identify anxiety in the same group of patients.

Materials and methods: Data from a sample of 70 patients requiring an immobilization mask participated in this study. Patient self-report assessments and radiation therapists’ ratings were recorded at two time points, CT-Simulation and fraction 1 of treatment. Self-reported patient anxiety was assessed with the Brief Symptom Inventory-18. To determine radiation therapists’ ratings of patient anxiety, two rating scales were developed.

Results: Patient self-report identified anxiety in 16% and 14% of patients at CT Simulation and fraction 1 of treatment, respectively. Radiation therapists identified anxiety in 24% patients at time point one and in 44% of patients at time point two.

Conclusion: There was slight agreement between patient self-reported levels of anxiety and radiation therapists’ ratings of patient anxiety. This study suggests that there is scope for further investigation into the identification and management of anxiety and distress in head and neck cancer patients requiring immobilization.

Purpose: The service was piloted in response to requests for assistance with patients experiencing severe anxiety undergoing head and neck radiotherapy. This paper describes the aims of the service, interventions provided and the recorded responses of patients to the support given.

Data: Information about who referred, patient demographics, the interventions provided and patient feedback (n = 112) was extracted from treatment records over a 15-month period.

Findings: All referred patients successfully completed procedures and treatment. About 43 patients voluntarily disclosed past trauma, for example, sexual abuse, assault, childhood trauma, which they judged to have been linked to their claustrophobic responses. Advice and support was given to 40 patients also referred for smoking cessation; an additional three patients requested support when cravings returned.

Conclusion: There is a paucity of information about the extent of the distress triggered by radiotherapy procedures and what interventions could be offered in practice. Further work is required to include an economic assessment and longer term effects on patient compliance with treatment and smoking cessation. Training needs for complementary therapists and radiotherapy staff at this centre were also identified; these are being addressed.

Purpose: The purpose of this study was to identify predictors and treatment outcome of late bowel toxicity after three dimensional pelvic radiotherapy for genitourinary malignancies and also to describe our experience with Argon Plasma Coagulation (APC) in this toxicity.

Patients and methods: Between March 2004 and March 2010, all patients who had completed a course of pelvic radiotherapy for genitourinary malignancies at our Institute were enrolled in this study. Every patient with lower GI symptoms underwent sigmoidoscopy and accordingly, some patients were subjected to intervention by APC.

Results: One hundred and thirty-six patients met all inclusion criteria. Median FU period was 37 months. Chronic diarrhoea was scored as Grade 1 or 2 in 35 patients (25.7%). Chronic proctitis was scored as Grade 1 or 2 in 17 patients (12.5%) and Grade 3 in 6 patients (4.4%), 25 patients developed chronic bleeding per rectum, 16 (11.8%) were Grade 1 or 2, while 9 patients (6.6%) were Grade 3. Both maximum rectal dose and comorbidity ≥1 significantly correlated with the development of chronic proctitis (p = 0.040 for both).

Endoscopic findings showed mucosal injury in 59 cases (84.29%) and vascular injury in 42 patients (60%). APC was successful in controlling bleeding and other symptoms in 14 cases (82.4%) and 16 cases (70%) respectively.

Conclusion: Three dimensional pelvic radiotherapy using two-phase technique is associated with a low level of Grade 3 late lower gastrointestinal toxicities. The most common presenting symptom is chronic diarrhoea. Both maximum rectal dose and comorbidity ≥1 significantly predict the development of chronic proctitis. APC is an effective, safe and well-tolerated treatment for chronic radiation proctitis.

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.

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.

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.

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.