Purpose: To investigate the dosimetric consequences of rectal distension at the time of the planning computed tomography (CT) scan and any resultant prostate movement on the planned dose delivery for patients receiving three-dimensional conformal radiotherapy (3DCRT) to the prostate.

Methods and materials: 25 prostate cancer patients whose planning CT scan demonstrated a full rectum were rescanned after following a laxative protocol. Rectal dimensions on the two scans and 3DCRT treatment plans produced on each plan were compared. The dosimetric implications of changes in rectal size on the treatment plans and the delivered dose were determined. Statistical significance was evaluated with the Wilcoxon signed ranks test.

Results: Significant differences in rectal size were found between the initial CT scan and the rescan. The corresponding median change in prostate position was 4.7 mm. The use of planning scans with a full rectum, that is unrepresentative of the rectum, during treatment causes significant reductions in planning target volume (PTV) minimum dose (median reduction 33.7%) and coverage by the 95% isodose (median reduction 3.7% of the PTV).

Conclusion: Rectal distension on the initial planning scan can lead to significant PTV underdosage. Patients presenting with large initial rectal fillings must be rescanned in order to avoid a systematic underdosing of the PTV.

Timely administration of palliative radiation therapy (PRT) to manage symptoms derived from advanced prostate cancer is necessary to help alleviate discomfort and improve quality of life. Despite PRT being an effective treatment, analyzing utilization rates in British Columbia (BC), Canada for palliative purposes implies it is an under-utilized medical resource. Access to and utilization of radiation therapy (RT) is lower in remote geographical regions and higher in urban regions where a cancer care facility is close in proximity suggesting the presence of geographical barrier affecting access to health care and services. Equitable access to PRT can be achieved by reducing barriers such as geographical distance. This retrospective cohort study describes accessibility of PRT in the management of prostate cancer and the impact of an additional facility on improving access to PRT.

Purpose: High-dose-rate brachytherapy (HDR) boost is an effective method for dose escalation when treating prostate cancer. Optimal number and location of catheters play key role in radiation dose delivery. We studied the impact of catheters and associated trauma on the dose uncertainties and urethral toxicity.

Methods and Materials: Between July 2008 to August 2009, 50 patients with prostate cancer were treated with 46 Gy of external irradiation of whole pelvis (2 Gy per fraction) and two HDR brachytherapy fractions (each 14 Gy) at the end of 10 fractions of external beam. All brachytherapy implants were planned using real-time, ultrasound-based planning system. Variables were prostate and urethral volumes, number of catheters and their mean distance from base of bladder and dose volume histogram parameters. All data were collected during first implant only. The toxicities were graded according to Radiation Therapy Oncology Group Toxicity Criteria. Statistical analysis was done on SPSS version 17.0.

Results: The mean number of catheters implanted was 12.38 (8–19), and number of attempts per needle to achieve desired position was 1.6 (range = 0–5). Mean distance between the catheters tips to contrast filled bladder was 3.2 mm (1–8 mm) after the adjustment. Distances >5 mm showed lower doses to prostate and lower predicted tumour control probability (TCP) (p < 0.01). No correlation was found between numbers of catheters implanted, attempts per catheter and severity of acute genitourinary (GU) toxicity. Significant correlation was found between severity of acute GU toxicity and urethral V130, V150 (p < 0.001).

Conclusion: Dose decline and subsequently lower TCP were seen for the greater distances between the needles and bladder. Acute GU toxicity increased with higher urethral, but severity of acute GU toxicity does not increase with increase in prostate/urethral volumes, number of catheters needles and attempts.

Purpose: The aim of this study was to determine radiation therapists’ knowledge on the nutritional management of side effects for patients receiving treatment to the gastrointestinal tract and genitourinary system and to determine the willingness of radiation therapists’ to participate in nutritional training.

Method: A cross-sectional survey at a Radiation Oncology Treatment Centre was performed coupled with a semi-structured interview to explore radiation therapists’ knowledge and experiences related to patient nutritional care.

Results: Eighty-one percent of participants agreed that they were often asked by patients for advice on eating. The majority of participants recognised that providing adequate nutrition support would be beneficial in terms of patient outcomes (91%) and ongoing patient compliance with nutrition advice (81%). However, participants demonstrated low confidence in providing nutrition support. Eighty-six percent of radiation therapists had not received any training on nutritional interventions and 100% of radiation therapists were interested in receiving more training.

Conclusion: This research indicates that radiations therapists are often asked for nutritional advice by patients and recognise the associated benefits but are not confident in providing advice. Our findings reveal an opportunity for radiation therapists to provide scripted nutrition advice to patients to reinforce recommendations made by dietitian.

Purpose: To correlate six-minute walk test (6MWT) and pulmonary function test (PFT) with incidence of radiation pneumonitis (RP) while treating patients with oesophageal cancer with conformal radiotherapy.

Methods: Forty-five patients were selected to the study protocol. Pulmonary evaluation was done objectively by chest x-ray (CXR), 6MWT and PFT and subjectively by symptoms of cough, dyspnoea and fatigue. These tests were performed before radiation and then repeated at 1, 3, 6 and 9 months after treatment. The dose-volume histogram (DVH) was used to derive doses received by lung and organs at risk. χ2-test was used for calculating the p value.

Results: The walk distance change (WDC) correlated with the changes in PFT values (p = 0.001) were done at 3 and 9 months after radiation, respectively. V30 values of ≥20% correlated with the incidence of acute pneumonitis (p = 0.007). 6MVT/vital capacity (VC) values of ≤4 ft/l had a correlation with the incidence of clinically symptomatic RP at 9 months.

Conclusion: 6MWT and PFT are supplementary to each other for assessing the lung function status; but their individual role in predicting RP is weak. However, they are complementary to each other in assessing the risk of radiation-induced lung dysfunction.

Radiation therapy is an integral part of management in breast carcinoma treatment. Standard curative schedules of radiotherapy to the breast deliver 25 fractions of 2.0 Gy per day over 5–6 weeks. Considerable recent literature suggests that hypo-fractionation may be advisory in breast cancer. The use of fewer fractions of more than 2 Gy per day (hypo-fractionation) is based on data suggesting that breast carcinoma is more sensitive to fraction size than squamous carcinomas and therefore could have similar fractionation sensitivity to the dose-limiting healthy tissues, including skin, subcutaneous tissues, muscle and ribs. In this article, a review of published studies and currently ongoing trials, which may provide evidence for the use of hypo-fractionated radiotherapy in breast cancer patients, is presented. Also, for all these different hypo-fractionation regimens found in literature, biologically effective dose (BED) values are calculated and compared. Data from studies and randomised trials seem to support the concept that modest hypo-fractionation can be used to treat the whole breast after breast-conserving surgery with similar rates of local control and radiation morbidity as seen with conventional fractionation.

Guidelines concerning early stage breast cancer do not clearly recommend tumour bed boost dose after breast conserving surgery and irradiation when the resection margins are negative. Because the number of these patients is expected to increase, we evaluated the results of our treatment scheme in which the additional tumour bed dose was omitted. One hundred consecutive individuals with ductal carcinomain-situ or stage I or II cancer of the breast were identified for this retrospective analysis. The observed ipsilateral breast tumour recurrence and 10-year disease-free survival rates were 4% and 91% respectively. Univariate analysis indicated that triple receptor negative tumour is the most independent prognostic risk factor. In conclusion, the observed low rate of local recurrence and many long-term survivors in this study seem to legitimize the omission of the tumour bed boost dose after whole breast irradiation in women with early carcinoma of the breast and free breast conserving surgical margins.