Cone beam computed tomography (CBCT) images contain more scatter than a conventional computed tomography (CT) image and therefore provide inaccurate Hounsfield units (HUs). Consequently, CBCT images cannot be used directly for dose calculation. The aim of this study is to enable dose calculations to be performed with the use of CBCT images taken during radiotherapy and potentially avoid the necessity of re-planning.

A phantom and prostate cancer patient with a metallic prosthetic hip replacement were imaged using both CT and CBCT. The multilevel threshold algorithm was used to categorise pixel values in the CBCT images into segments of homogeneous HU. The variation in HU with position in the CBCT images was taken into consideration and the benefit of using a larger number of materials than typically used in previous work has been explored. This segmentation method relies upon the operator dividing the CBCT data into a set of volumes where the variation in the relationship between pixel values and HUs is small. A field-in-field treatment plan was generated from the CT of the phantom. An intensity-modulated radiation therapy plan was generated from CT images of the patient. These plans were then copied to the segmented CBCT datasets with identical settings and the doses were recalculated and compared.

In the phantom study, γ evaluation showed that the percentage of points falling in planning target volume, rectum and bladder with γ<1 (3%/3 mm) was 100%. In the patient study, increasing the number of bins to define the material type from seven materials to eight materials required 50% more operator time to improve the accuracy by 0·01% using pencil beam and collapsed cone and 0·05% when using Monte Carlo algorithms.

The segmentation of CBCT images using the method in this study can be used for dose calculation. For a simple phantom, 2 values of HU were needed to improve dose calculation accuracy. In challenging circumstances such as that of a prostate patient with hip prosthesis, 5 values of HU were found to be needed, giving a reasonable balance between dose accuracy and operator time.

This study aimed to examine the dosimetric properties of Gafchromic® EBT3 film and intensity-modulated radiation therapy quality assurance (IMRT QA).

Beams characteristics dosimetric properties and 20 IMRT plans were created and irradiated on Varian dual-energy DHX-S Linac for 6 and 15 MV energies. EBT3 films were analysed using ‘film Pro QA 2014’ software.

The dosimetric comparison of EBT3 film (for red channel dosimetry) and ionisation ion chamber measurement showed that average deviations of symmetry, flatness, central axis, penumbra (left) and penumbra (right) of dose profile were 0·18, 1·34, 0·49%, 3·68 and 3·61 mm for 6 MV and 0·10, 1·3, 0·45, 2·65 and 2·71 mm for 15 MV, respectively. The blue and green channels dosimetry showed greater dose deviation as compared with red channel. IMRT QA verification plan complied about 95% at all different criteria. Reproducibility, stability and face orientation of film were within 1·4% for red channel.

The results advocate that the film can be used not only for dosimetric assessment but also as a reliable IMRT QA tool.

Whole breast irradiation is an essential treatment after breast-conserving surgery (BCS). However, there are some adverse effects from inhomogeneity and dose to adjacent normal tissues.

Aim of this study was to compare dosimetry among standard technique, three-dimensional conformal radiotherapy (3D-CRT), and advanced techniques, electronic compensator (ECOMP), inverse intensity-modulated radiation therapy (IMRT) and volumetric-modulated arc therapy (VMAT).

Whole breast irradiation treatment plans of patients who had underwent BCS and whole breast irradiation were re-planned with all four techniques. Clinical target volume was contoured according to the Radiation Therapy Oncology Group atlas for breast only in patients who had negative node or ductal carcinoma in situ and breast with chest wall for patients with positive node. Planning target volume was non-uniformly expanded. Dose prescription was 50 Gy in 25 fractions with 6 MV photon energy.

In total, 25 patients underwent whole breast irradiation with computed tomography simulation from November 2013 to November 2014 were included. Six patients with positive nodes were re-planned for breast with chest wall irradiation and 19 patients with negative nodes were re-planned for breast only irradiation. Primary outcome, radical dose homogeneity index (HI) of 3D-CRT, ECOMP, IMRT and VMAT were 0·865, 0·889, 0·890 and 0·866, respectively. ECOMP and IMRT showed significant higher HI than 3D-CRT (p-value<0·001). Secondary outcome, conformity index (CI) of advanced technique were significantly better than 3D-CRT. Lung V20, mean ipsilateral lung dose (MILD), mean heart dose (MHD), heart V25, heart V30 of advanced techniques were also lower than 3D-CRT. ECOMP had better mean lung dose (MLD), mean contralateral lung dose (MCLD) and mean contralateral breast dose (MCBD) when compared with 3D-CRT. Monitor units of advanced techniques were significantly higher than 3D-CRT.

HI of ECOMP and IMRT were significantly higher than 3D-CRT technique. All advanced techniques showed statistically better in CI. Lung V20, MILD, heart V25 and heart V30 of advanced techniques were lower than 3D-CRT. However, only ECOMP showed decreased MLD, MHD, MCLD and MCBD when compared with 3D-CRT.

To compare the contours and dose volume histograms (DVH) parameters of the high-risk clinical target volume (HRCTV) contoured on computed tomography (CT) using clinical findings at brachytherapy, clinical findings at brachytherapy with magnetic resonance imaging (MRI) at diagnosis and HRCTV defined on MRI at brachytherapy in cervical cancer patients.

Fifteen patients undergoing MRI-guided image-based brachytherapy underwent both CT and MRI after applicator insertion. Two sets of contours were defined on CT. In the first set, the HRCTV was defined with the help of clinical findings at brachytherapy (CT-HRCTV). In the second set, HRCTV was defined with MRI at diagnosis and clinical findings at brachytherapy (CT-HRCTVdmri). This was compared with the HRCTV defined on MRI at brachytherapy (MR-HRCTV). The doses to the organs at risk (OARs) were compared for CT and MRI.

A significant overestimation of the maximum width and width at point A was observed for CT-HRCTV (p −0·00; 0·00) and CT-HRCTVdmri (p −0·03; 0·01), respectively. The height was underestimated with CT-HRCTV in patients with intrauterine disease extension. For a single fraction, the mean difference in the D90 for the CT contours was <1 Gy. The doses to the OARs were comparable.

CT may be an alternative when facilities for MRI image-based brachytherapy are lacking, provided at least one MRI is available before brachytherapy.

The dosimetric and clinical advantages offered by implementation of pencil beam scanning (PBS) proton therapy for moving thoracic tumours is hindered by interplay effect. The purpose of this study is to evaluate the impact of large proton beam spot size along with adaptive aperture (AA) and various motion mitigation techniques on the interplay effect for a range of motion amplitudes in a three-dimensional (3D) respiratory motion phantom.

Point doses using ionisation chamber (IC) and planner dose distributions with radiochromic film were compared against the corresponding treatment planning system (TPS) information. A 3D respiratory motion phantom was scanned either for static or 4D computed tomographic (CT) technique for 6-, 10- and 14-mm motion amplitudes in SI direction. For free breathing (FB) treatment, a tumour was contoured on maximum intensity projection scan and an average scan was used for treatment planning. Each FB treatment was delivered with one, three and five volumetric repaintings (VRs). Three phases (CT40–60%) were extracted from the 4D-CT scans of each motion amplitude for the respiratory-gated treatment and were used for the treatment planning and delivery. All treatment plans were made using AA and robustly optimised with 5-mm set-up and 3·5% density uncertainty. A total of 26 treatment plans were delivered to IC and film using static, dynamic and respiratory-gated treatments combinations. A percent dose difference between IC and TPS for the point dose and gamma indices for film–TPS planner dose comparison was used.

The dose profile of film and TPS for the static phantom matched well, and percent dose difference between IC and TPS was 0·4%. The percent dose difference for all the gated treatments were below 3·0% except 14-mm motion amplitude-gated treatment. The gamma passing rate was more than 95% for film–TPS comparison for all gated treatment for the investigated gamma acceptance criteria. For FB treatments, the percent dose difference for 6-, 10- and 14-mm motion amplitude was 1·4%, −2·7% and −4·1%, respectively. As the number of VR increased, the percent difference between measured and calculated values decreased. The gamma passing rate met the required tolerance for different acceptance criteria except for the 14-mm motion amplitude FB treatment.

The PBS technique for the FB thoracic treatments up to 10-mm motion amplitude can be implemented with an acceptable accuracy using large proton beam spot size, AA and robust optimisation. The impact of the interplay effect can be reduced with VR and respiratory-gated treatment and extend the treatable tumour motion amplitude.

To evaluate the information needs of radiotherapy patients and their families. To explore influential factors regarding information-seeking behaviours. To identify the preferred formats of information and the optimum time for radiotherapy patients to receive information. To assess the implications for clinical practice in satisfying patient information needs.

A Cumulative Index to Nursing and Allied Health Literature database search of literature was undertaken and publications screened for retrieval with 36 qualifying for inclusion in the evaluation.

There was inconclusive evidence exploring the impact that patient age, diagnosis, family background, and educational status had on the information-seeking behaviours and preferences of cancer patients. There is an agreement that there are positive and negative benefits of using different formats of information: verbal, written, virtual, and so on, and ultimately healthcare providers must utilise a combination of information formats to satisfy the information needs and preferences of individual patients. Inconsistent data were found on the optimum time to deliver cancer information to patients and professionals, and therapeutic radiographers should not assume that their information priorities are the same as those of their patients—every patient has unique and individually specific information needs.

The information needs of patients and families are dependent on individual circumstances, and priorities have a tendency to change during the cancer management journey, presenting huge challenges for therapeutic radiographers who are required to regularly reassess and satisfy the varying needs and preferences. More research is needed within the area of information needs and preferences for cancer patients receiving radiotherapy.

Research in the applications of the principles of quantum physics in oncology has progressed significantly over the past decades; and several research groups with professionals from diverse scientific background, including electrical engineers, mathematicians, biologists, atomic physicists, computer programmers, and biochemists, are working collaboratively in an unprecedented and pioneering economic, organisational and human effort searching for a wider and more effective, potentially definitive, understanding of the cancers. It is hypothesised that the principles of quantum physics could open new and broader understanding of the cancers and the development of new effective, targeted, accurate, personalised and possibly definitive cancer treatment.

This paper reports on a review of recent studies in the field of the applications of the principles of quantum physics in biology, chemistry, biochemistry and quantum physics in cancer research, including quantum physics principles and cancer, quantum modelling techniques, quantum dots and its applications in oncology, quantum cascade laser histopathology and quantum computing applications.

The applications of the principles of quantum physics in oncology, chemistry and biology are providing new perspectives and greater insights into a long-studied disease, which could result in a greater understanding of the cancers and the potential for personalised and definitive treatment methods.

Recent investigations demonstrate a strong potential for cobalt-60 (Co-60)-based teletherapy. The influence of the lower energy and penetration of a cobalt-60 beam compared with linear accelerator beams is negligible for intensity-modulated radiotherapy.

The aim of this research is to investigate source head fluence modulation in cobalt-60 teletherapy by using a three-dimensional (3D) physical compensator and secondary collimator jaw motion.

The Oncentra treatment planning system was used to develop three hypothetical plans by secondary collimator jaw motion. A clinical MDS Nordion Equinox 80 cobalt-60 teletherapy unit was used to acquire conventional water phantom beam characteristics. Fluence modulation experiments were executed at 5·0 cm depth in a PTW universal intensity-modulated radiation therapy (IMRT) verification phantom using calibrated Gafchromic external beam therapy 2 (EBT2) and RTQA2-1010 film batches. Gafchromic EBT2 film was used to sample intensity maps generated by secondary collimator jaw motion, yet Gafchromic RTQA2-1010 film sampled maps from the 3D physical compensator. The solid-state drives used were 75·0 and 74·3 cm for the Gafchromic EBT2 and Gafchromic RTQA2-1010 film measurements.

A 2D gamma index analysis was coded to compare EBT2 film measurements with Digital Imaging and Communications in Medicine data. This analysis was also used to verify film measurements versus Monte-Carlo simulations.

Lateral beam profiles generated from water phantom measurements were used to establish source head fluence modulation on the film measurements. The source head fluence of a cobalt-60 teletherapy beam could be modulated by secondary collimator jaw motion and using a 3D physical compensator.

The objective of this study has been to identify monitor unit (MU) and treatment time variations, volume coverage dissimilarity among 3D conformal radiation therapy (3D-CRT), intensity-modulated radiation therapy (IMRT) and volumetric-modulated arc therapy (VMAT) treatment plans for head and neck cancer (HNC) based on literature review.

A number of HNC cases were studied with the investigation of conformity and homogeneity index.

When high-dose modulation was required around small organs at risk (OARs), a clinically acceptable IMRT plan was achieved as VMAT usually required longer dose optimisation time. The greatest benefit of VMAT has been rapid treatment delivery allowing improved patient comfort, reduced intra-fraction motion and increased patient throughput. In some papers, 3D-CRT was shown not to meet well the requirements on parotid glands. One paper showed that cerebellum dose was lower for 3D-CRT than IMRT. However, it was found in other papers that OAR sparing with 3D-CRT was reasonable but in complex cases not enough.

IMRT usually consists of several treatment fields with different directions, hundreds of beam lets with modulated intensity, an advantage over 3D-CRT, whereas VMAT has advantage over IMRT due to rotating beam utilisation. VMAT has lower total MU and treatment times than IMRT and 3D-CRT, while maintaining similar dosimetric endpoints.

In this study, the radiation contamination dose (RCD) for different combinations of electron energy/distance, applicator and radius around the light intraoperative accelerator (LIAC), a high dose per pulse dedicated intraoperative electron radiotherapy machine, has been estimated. Being aware about the amount of RCDs is highly recommended for linear medical electron accelerators.

Monte Carlo Nuclear Particles (MCNP) code was used to simulate the LIAC® head and calculate RCDs. Experimental RCDs measurements were also done by Advanced Markus chamber inside a MP3-XS water phantom. Relative differences of simulations and measurements were calculated.

RCD reduction by distance from the machine follows the inverse-square law, as expected. The RCD was decreased by increasing angle from applicator walls opposed to the electron beam direction. The maximum differences between the simulation and measurement results were lower than 3%.

The RCD is strongly dependent on electron beam energy, applicator size and distance from the accelerator head. Agreement between the MCNP results and ionometric dosimetry confirms the applicability of this simulation code in modelling the intraoperative electron beam and obtaining the dosimetric parameters. The RCD is a parameter that would restrict working with LIAC in an unshielded operative room.

To evaluate the Klarity® Mask with respect to skin doses and toxicity secondary to head and neck cancer radiation treatment.

This prospective study included five nasopharyngeal cancer patients who underwent intensity-modulated radiation therapy and monitored for skin toxicity. An anatomical Perspex head and neck phantom was designed and used. All patients’ treatment plans were separately transferred to the phantom. Dosimetric measurements were performed using chip-shaped thermoluminescent dosimeters (LiF:Mg,Ti TLDs) which were distributed at certain target points on the phantom. Phantom was irradiated twicely with and without a Klarity® Mask. Three fractions for each patient plan were obtained and compared with treatment planning system (TPS) doses as guided by computed tomography.

The Klarity mask used for patient immobilisation increased the surface dose by 10·83% more than that without the mask. The average variations between skin dose measurements with and without the Klarity mask for all patients’ plans ranged from 10·26 to 11·83%. TPS overestimated the surface dose by 19·13% when compared with thermoluminescent dosimeters that measured the direct skin dose.

Klarity immobilisation mask increases skin doses, as a consequence, surface dose measurements should be monitored and must be taken into account.

To evaluate the inter-fraction variation in interstitial high-dose-rate (HDR) brachytherapy. To assess the positional displacement of catheters during the fractions and the resultant impact on dosimetry.

Although brachytherapy continues to be a key cornerstone of cancer care, it is clear that treatment innovations are needed to build on this success and ensure that brachytherapy continues to provide quality care for patients. The dosimetric advantages offered by HDR brachytherapy to the tumour volume rely on catheter positions being accurately reproduced for all fractions of treatment.

A total of 66 patients treated over a period of 22 months were considered for this study. All the patients underwent computer tomography (CT) scan and three-dimensional treatment planning was carried out. Brachytherapy treatment was delivered by the HDR afterloading system. On completing the last fraction, CT scan was repeated and treatment re-planning was done. The variation in position of the implanted applicators and their impact on dosimetric parameters were analysed using both the plans.

For all breast-implant patients, the catheter displacement and D90 dose to clinical target volume were <3 mm and 3%, respectively. The displacement for carcinoma of the tongue, carcinoma of the buccal mucosa, carcinoma of the floor of mouth, carcinoma of the cervix, soft-tissue sarcoma and carcinoma of the lip were comparatively high.

Inter-fraction errors occur frequently in interstitial HDR brachytherapy. If no action is taken, it will result in a significant risk of geometrical miss and overdose to the organs at risk. It is not recommended to use a single plan to deliver all the fractions. Imaging is recommended before each fraction and decision on re-planning must be taken.

Patients require information to make informed decisions and consent to medical treatment. Shared decision making (SDM) is a methodology that promotes a patient-centred approach to informed consent and demonstrates respect for autonomy

The purpose of this paper is to critically review the legal and ethical issues relevant to Canadian and UK informed consent and SDM practices and how these processes relate to current palliative care practices, with a particular emphasis on radiation therapy.

A review of the English literature from 2003 to 2013 was performed using the databases PubMed (NML), OVID Medline and Google Scholar.

The literature identifies that palliative cancer patients desire the opportunity to be involved with decision-making discussions, which has shown to increase knowledge and result in better health-related outcomes. However, ethical and legal issues regarding the practicality of including this patient population in SDM discussions raises questions about validity of consent. For SDM to be considered a valid methodology to obtain informed consent, open and honest communication between the patient and multidisciplinary team is essential. Treatment options for palliative cancer patients are often complex and SDM allows healthcare professionals and patients to exchange information and negotiate feasible treatment options based on medical expertise and patient preferences.

Legal frameworks have defined current standards of practice for various healthcare professions, including radiation therapy. Radiation therapists, as members of the multidisciplinary team, are currently key contributors in providing information to patients regarding the radiotherapy process. Individuals working within advanced practice roles have the ability to develop skills once considered to be within medical domains and have begun to incorporate the delegated act of obtaining informed consent into practice which has shown to increase professional autonomy, accountability and improves patient-centred care.

This study was conducted for comparison of techniques between volumetric modulated arc therapy (VMAT), forward-planning intensity-modulated radiotherapy (FIMRT) and conventional technique for left-sided breast radiotherapy after conservative surgery.

In all, 20 postoperative left breast carcinoma patients were included in this study. In all plans the planning target volume (PTV) was the breast tissue with appropriate margin as per our institutional protocol. The contouring was done on a Monaco Sim (V5.00.02) contouring workstation. All patient were planned using partial arc VMAT in Monaco treatment planning system (TPS) (V5.00.02) and treated on Elekta Synergy linear accelerator. The 3D conformal radiotherapy (3DCRT) and FIMRT planning were done in CMS XIO (V5.00.01.1) TPS. The 3DCRT planning consisted of conventional medial and tangential wedge portals with multileaf collimator field shaping conforming to the target volume. For all the plans generated the following metrics were scored: V105%, V100%, V95%, mean dose (for PTV), V5%, V20%, D2cc and mean dose (for organs at risk).

The mean PTV volume for 20 patients was 1,074·6±405·1 cc. The highest PTV dose coverage was observed in the 3DCRT technique with 94·1±1·8% of the breast PTV receiving 95% of the prescription dose (V95%). However, it was also observed that this technique resulted in 21·3±10% of the PTV receiving more than 105% of the prescription dose (V105%), which was highest among the three techniques. In contrast, VMAT yielded lowest V95% of 93·0±1·8 and 3·3±5·5% of V105%.

This study concluded equivalent result between FIMRT and VMAT. However, VMAT was found to be the choice of radiotherapy technique as it produces lesser dose distribution to heart compared with any other technique.

During radiotherapy of the prostate it is important to minimise interfraction prostate motion to allow dose escalation and reduce normal tissue damage. Rectal volume has been identified as playing a significant role in prostate motion with various methods used to reduce it. The aim was to systematically review published literature to allow evidence based recommendations to be made to current practice to reduce interfraction prostate motion.

A systematic search of CINAHL, Medline, PubMed, Science Direct, NHS Evidence and The Cochrane Library was performed. Limited searches of The Society of Radiographers website, OpenGrey and COPAC were undertaken, alongside manual searches of cross references of eligible articles. The quality of included papers was measured using a pre-existing tool. The causes, consequences and solutions to manage rectal volume and its effect on prostate position were extracted, compared and evaluated to extract solutions to be implemented into clinical practice.

Of the 2,339 unique articles systematically retrieved, 23 met the inclusion criteria, 15 of which discuss radiotherapy, five constipation and three flatulence.

A combined medicinal and dietary approach adaptable to departmental workflow is required to manage rectal volume, with special consideration to patients with pre-existing extrinsic factors.

The aim of this study is to investigate the accuracy of dose distributions calculated by the BrachyDose Monte Carlo (MC) code in heterogeneous media for high-dose-rate (HDR) brachytherapy and to evaluate its usability in the clinical brachytherapy treatment planning systems.

For dose comparisons, three different dose calculation algorithms were used in this study. Namely, BrachyDose MC code, Eclipse TG-43 dose calculation tool and Acuros®BV model-based dose calculation algorithm (MBDCA). Dose distributions were obtained using any of the above codes in various scenarios including ‘homogenous water medium scenario’, an ‘extreme case heterogeneous media scenario’ and clinically important ‘a patient with a cervical cancer scenario’. In the ‘extreme case, heterogeneous media scenario’, geometry is a rare combination of unusual high-density and low-density materials and it is chosen to provide a test environment for the propagation of photons in the interface of two materials with different absorption and scattering properties. GammaMed 192Ir Model 12i Source is used as the HDR brachytherapy source in this study. Dose calculations were performed for the cases where there is either a single source or five sources planted into the phantom geometry in all homogenous water phantom and extreme case heterogeneous media scenarios. For the scenario a patient with a cervical cancer, dose calculations were performed in a voxelized rectilinear phantom, which is constructed from a series of computed tomography (CT) slices of a patient, which are obtained from a CT device.

In homogeneous water phantom scenario, we observed no statistically significant dose differences among the dose distributions calculated by any of the three algorithms at almost every point in the geometry. In the extreme case heterogeneous media scenario, the dose calculation engines Acuros®BV and BrachyDose are agreed well within statistics in every region of the geometry and even in the points close to the interfaces of low-density and high-density materials. On the other hand, the dose values calculated by these two codes are significantly different from those calculated by the TG-43 algorithm. In the ‘a patient with a cervical cancer scenario’, the calculated D2cc dose difference between Acuros®BV and BrachyDose codes is within 2% in the rectum and 11% for the bladder and sigmoid. There was no meaningful difference in the mean dose values between MBDCAs in the bone structures.

In this study, the accurate dose calculation capabilities of the BrachyDose program in HDR brachytherapy were investigated on various scenarios and, as a MC dose calculation tool, its effectiveness in HDR brachytherapy was demonstrated by comparative dose analysis.

This study was designed to evaluate whether radiographer-led on-treatment review clinics are meeting the wider needs of prostate patients receiving radiotherapy.

Semi-structured interviews were used to elicit patient and staff perspectives. Interviews are used extensively in qualitative research to produce a breadth and depth of insight into participants’ experiences and opinions. Seven patients and two radiographers participated in individual audio-taped interviews. Thematic analysis of the data identified some key themes and their perceived importance within the review service for both patients and staff.

Semi-structured interviews were used to elicit patient and staff views. Several themes emerged from patient and radiographer perspectives. Radiographers and patients both expressed overall satisfaction with the service. Strengths included staff communication, relaxed environment, individualised support, regular information spread throughout the review pathway and consistency in managing acute side effects. Weaknesses included information and communication gaps at the beginning and end of treatment, information inconsistency between staff groups, gaps in specialist knowledge and a possible gap in skills where staff could train as supplementary prescribers.

Interviews produced an in-depth view of patient and staff experiences. Staff and patients identified both strengths and areas for improvement within the local service. Study findings support review radiographers in sourcing additional specialist training and a closer collaboration with other staff groups, which will further develop the service. As a next step, triangulation of research methods with questionnaires could be used to evaluate whether this small sample of patients is characteristic of prostate patients in general.

Recurrence is frequent in surgically treated non-functioning pituitary adenomas (NFPA). The use of radiation therapy (RT) to prevent recurrence has to be weighted against the potential side effects, particularly, hypopituitarism. Our objective was to evaluate the efficacy and safety of RT in postoperative patients with NFPA with adenoma remnant.

The 3- and 5-year outcome of 51 patients with NFPA with a remnant after surgery that received RT (cases) was compared with that of 61 subjects who did not receive RT (controls). Cases and controls were matched for postoperative remnant size, cavernous sinus invasion, age and gender.

Tumour volume decreased in the radiated group from a median of 1,601 mm3 to 816 mm3 after 5 years of follow-up (p = 0·01, 50% tumour volume reduction). In the non-radiated controls median tumour volume decreased at 3 years but increased again after 5 years (baseline 1,415 mm3, 5 years 1,204 mm3, p = 0·93). Recurrence rate was 4% for the radiated group and 29% for the controls (OR 0·10, 95% CI 0·01–0·04, p = 0·02). Although pituitary hormone deficiencies at baseline were more prevalent in the radiated group, after 5 years, both groups showed a significant worsening of pituitary function. No RT-related side effects were recorded.

Postoperative RT is effective in preventing tumour regrowth in NFPA patients with postoperative remnants. The fact that hypopituitarism is highly prevalent even in non-radiated patients should allow a more generalised use of this treatment modality.