Lung stereotactic body radiotherapy (SBRT) is a novel and effective technique for the treatment of early stage non small cell lung cancer which is rapidly becoming the radiotherapy regime of choice for those patients unable or unwilling to undergo surgical resection.

Although introduced almost 20 years ago, it was not until the wider establishment of image guided radiotherapy (IGRT) techniques that many UK departments first considered and then succeeded in implementing lung SBRT. Many have been assisted in this through membership of the national UK SBRT consortium which aims to facilitate local introduction and to provide guidelines and practical support for the wider radiotherapy community.

This article will seek to place the introduction of SBRT within a broad historical context, outline basic principles for safe and effective practice and describe how such principles are currently being pursued in an era of IGRT. Additionally, the role of the UK SBRT consortium in implementation will be reported alongside the results of its first national survey on the subject.

Background: In low-risk prostate cancer, the target volume for radiotherapy is the prostate gland only and prostate brachytherapy with an I-125 implant provides the most conformal radiotherapy.

Methods: Patients underwent a pre-implant prostate volume study from which a treatment plan was developed 2 weeks prior to implant. A dosimetric study was performed 1 month following the implant. The prescription dose was 145 Gy with the 95% isodose line covering the entire target volume. The maximal dose to the urethra was less than 210 Gy. Follow-up included serum PSA and IPSS evaluation every 3 months during the first year and then every 6 months beginning in the second year.

Results: During December 2000–March 2009, 181 patients with early prostate cancer underwent I-125 implant. The median post-implant PSA value of the entire cohort was 0.7 ng/ml. No patient developed clinical failure. In the follow-up, nine patients had biochemical failure according to the RTOG-ASTRO Phoenix definition (Nadir + 2.0 ng/ml). Of these, one patient refused hormonal therapy desiring to preserve sexual potency, and eight patients received hormonal therapy with a decreased serum PSA to 0.0 ng/ml. The treatment side effects were primarily urinary disturbances.

Conclusion: An I-125 implant is an effective and well-tolerated treatment and should be recommended for patients with low-risk prostate cancer.

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.

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.

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.

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.