Malignant spinal cord compression (MSCC) is a serious condition requiring urgent palliative radiotherapy to alleviate symptoms and avoid permanent paralysis. The aim of this project was to analyse the 30-day mortality rate post-palliative radiotherapy for MSCC patients to identify if radiotherapy can be safely omitted or the fractionation reduced in the poor prognosis group (patients likely to die within 30 days) by biomarkers and performance status (PS).

A retrospective audit was performed (July–December 2019) and data on treatment duration, date of death, biomarkers (C-reactive protein (CRP), albumin) and PS were collected using hospital patient management systems.

Hundred and one patients received palliative radiotherapy for MSCC in the 6-month period. The number of patients who died within 30 days was 17, representing 16·8% mortality rate. Rising CRP levels and poor PS indicated a poorer prognosis in this patient group.

Monitoring biomarkers and PS as standard throughout patients’ treatment is recommended to assess disease progression. Worsening PS and high CRP is an indicator of poor prognosis and early death, and therefore omission of treatment or a single fraction of radiotherapy is recommended.

A middle-aged gentleman presenting with dyspnoea was presumptively assumed to be a novel coronavirus suspect.

Nasopharyngeal and oropharyngeal swabs were reported negative, and clinico-radiological workup revealed a case of adenoid cystic carcinoma (ACC) of the lung with metastases to the contralateral lung and the lumbar vertebrae.

ACC is a rare malignancy of exocrine glands. Most commonly found in the minor salivary glands, they may rarely occur in other sites. Primary ACC of the lung is a rare histologic subtype that is encountered infrequently in clinical practice for which standard guidelines do not exist.

Malignant spinal cord compression (MSCC) is a serious condition requiring urgent palliative radiotherapy to alleviate symptoms and avoid permanent paralysis. This audit compares the number of patients treated for MSCC before and during Covid-19, their treatment regimes and 30-day mortality rates to assess if the pandemic affected the treatment and the number of patients referred for palliative radiotherapy.

A retrospective audit was performed (July–December 2019) and 101 patients were treated for MSCC, an average of 17 patients per month. A further audit was undertaken during Covid-19 (March–May 2020) and 36 patients were treated for MSCC, an average of 12 patients per month in this shorter cohort.

The results have demonstrated fewer patients presenting during the pandemic and this may be due to patients not wishing to utilise the National Health Service (NHS) during this time. It also highlighted the need to reduce the treatment duration to minimise hospital attendance and lessen the potential for exposure to Covid-19.

Educating patients at risk of MSCC is essential and all cancer patients should be counselled on symptoms and what to do if they occur. Ensuring clinicians know the warning signs and the referral pathway for MSCC is also key to ensure early presentation and early referral for treatment.

To investigate whether a radiographer-led radiotherapy pathway can provide an efficient service for patients requiring treatment for symptomatic skeletal metastases.

A retrospective review of 425 courses of palliative radiotherapy was conducted. Data was analysed assessing diagnosis, dose/fractionation, time from referral to treatment, gender, age, inpatient/outpatient status and referring clinic location for radiographer- and clinical oncologist-led cohorts.

Patients aged ≥70 years were more likely to be planned by radiographers (n = 162/57, p < 0·001). Patients were more likely to be treated with 8 Gy in single fraction than with 20 Gy in five fractions (n = 279/136, p = 0·012). The median referral to treatment time in 8-Gy single-fraction prescriptions was 3 days for radiographer-led versus 7 days for clinical oncologist-led cohorts. In all patients and in 20 Gy in five-fraction prescriptions, it was 4 versus 8 days. A comparison of all prescriptions (p < 0·001), 8 Gy in single-fraction (p < 0·001) and 20 Gy in five-fraction prescriptions (p = 0·001) showed radiographer-led procedures as enabling faster access to treatment in each category.

A radiographer-led service can facilitate faster access to treatment than a clinical oncologist-led pathway for an appropriately selected patient caseload.

There is abundant evidence of the comparative efficacy of single-fraction (SF) radiotherapy and multi-fraction (MF) radiotherapy when treating patients with bone metastases. Despite this, previous surveys have shown SF schedules to be underutilised.

To determine current patterns of practice in patients with bone metastasis and to investigate the factors that influence practice.

An electronic audit was performed amongst 46 physicians, within 7 hospital trusts in the UK. The audit comprised of four hypothetical cases in which consultants and registrars chose which dose and fractionation they would recommend and their reasons for this recommendation.

SF radiotherapy was the most common radiotherapy schedule in hypothetical cases 1, 3 and 4. SF radiotherapy was recommended by 65% of respondents in case 1, 47% in case 2, 89% in case 3 and 46% in case 4. For case 2, 50% proposed MF radiotherapy. For case 4, 22% of respondents recommended Stereotactic Body Radiotherapy (SABR). The following deciding factors were cited as influencing choice of an SF schedule: prognosis, published evidence, performance status and spinal cord compression.

The most common radiotherapy schedule selected was SF. However, there were inter-institution differences regarding the use of SF radiotherapy. Furthermore, the survey had shown that a third of respondents recommended an MF regime, despite evidence supporting the efficacy of an SF schedule.

Merkel cell carcinoma is a rare and aggressive primary cutaneous neuroendocrine carcinoma with a high risk of loco-regional and distant metastasis. It is predominantly seen in the elderly, on the head and neck or extremities. Although treated primarily with surgery, some patients are too frail. A World Health Organization performance status of two or more with co-existing medical co-morbidities, or the site of the disease adjacent to a critical structure, can prevent surgical management. In this cohort of patients, primary palliative radiotherapy has been found to achieve excellent tumour regression and improve quality of life. A new palliative split-course hypofractionated regime has been used in North Middlesex University Hospital in this cohort of patients. The purpose of this case series was to provide supporting evidence on the efficacy of this dose and fractionation regime and review the literature for the palliative management of Merkel cell carcinoma.

In total, four patients were treated with the palliative split-course hypofractionated regime. The regime consisted of an initial 20 Gray in 5 fractions over 1 week, a 2-week gap and then a further 20 Gray in 5 fractions over 1 week. Tolerability and response to treatment were evaluated by history and clinical examination.

The split-course hypofractionated regime was well tolerated, achieved excellent tumour regression and improved quality of life in all four patients. Since then, a further three patients have been successfully treated with the above regime. This case series demonstrates the efficacy of this dose and fractionation in a select group of patients too frail for radical management and adds to the evidence base for the optimal palliative management of Merkel cell carcinoma.

To record the characteristics, management and functional outcome of a group of patients with IMSCC, who were treated with radiotherapy in our institution, and compare these parameters with similar data on MSCC patients.

Data (gender, age, primary oncological diagnosis, pain, performance status and neurological status) were prospectively collected for 28 patients. Patients were then followed up post treatment to document their response to treatment and treatment-related toxicity.

The median survival of our group of IMSCC patients is similar to that of an MSCC patient. In addition, the IMSCC group exhibits significant clinical symptoms including neurological deficit.

Although further studies are necessary, we have found that IMSCC patients in this study share similar prognosis and clinical symptoms with MSCC patients. Clinicians should be aware of this when communicating with IMSCC patients and their families, and short-course radiotherapy should be considered.