The aims of conservative treatment in patients with ocular melanoma are globe retention, good visual acuity (VA) and local control. Two well-established radiation conservative treatment options are proton beam radiotherapy and episcleral plaque brachytherapy (EPB). Patients who receive treatment with either of these options will experience some degree of radiation-related ocular complications and poor VA. The purpose of this review of the literature is to establish whether there is a significant clinical difference in normal tissue morbidity and local tumour control between proton therapy and EPB, and whether this difference can justify the purchase and implementation of additional proton therapy facilities. Based on this review, evidence suggested that both treatment options are comparable, and that neither proton therapy nor EPB is clinically superior than the other regarding normal tissue morbidity and local tumour control. This review highlighted the need for further research on a larger scale in order to bridge the gap that is apparent within the literature.

Objective: Extra-cranial Stereotactic Radiation Therapy (ESRT) techniques and equipment utilised in the treatment of Stage 1 or 2 inoperable non-small-cell lung cancer (NSCLC); accounting for Respiratory Induced Tumour Motion (RITM).

Methods: A narrative review of current world literature.

Results: Four main strategies are employed to address RITM: (1) tumour movement minimisation/immobilisation; (2) integration of respiratory movements into planning; (3) respiratory-gating techniques; and (iv) tumour-tracking techniques.

Discussion: Analysis of data gathered suggests that due to inherent difficulties with respiratory function, combined with co-morbidities and the level of dose escalation facilitated by ESRT: techniques that do not require patient ability to comply are more likely to be effective with a wider range of patients. Similarly, treatment planning must incorporate accurate four-dimensional (4D) data to ensure target coverage, although setup and verification should be controlled to smaller margins for error.

Conclusion: The disparate nature of reporting methods restricts statistical comparison. However, this paper suggests that the ESRT technique using abdominal compression (AC), free-breathing respiratory-gating (FBRG), 4D computed tomography (4DCT) planning, combined with daily on board kV cone beam computed tomography (CBCT) imaging for setup and target verification, is a possible candidate for further treatment regime assessments in large multi-centre trials.

Dementia, which affects about 5% of those aged over 65 years, is the progressive decline in cognitive function due to damage or disease in the body beyond that expected from normal aging. It causes the loss of mental abilities such as thinking, remembering and reasoning and memory impairment, which is important when considering informed consent in radiotherapy. Radiotherapy treatment often involves many visits for a patient and each time it is the legal responsibility of staff to ensure that patient is aware of what is happening and why. Informed consent is challenging in patients with dementia because of the memory impairments and the nature of the information. There is enormous variation in how this illness affects people, depending on the type of dementia and the individuals themselves. Full information about the treatment itself, the benefits and risks of the treatment and the availability of any other reasonable alternatives to the proposed treatment or procedure must be made available. Dementia patients respond well to set approaches and these are detailed. It is important for staff to be familiar with the most effective approaches and consider these in obtaining informed consent.

Background and purpose: Following a recent major upgrade in cone-beam computed tomography (CBCT) software and functionality, we have reassessed aspects of our Varian Acuity simulator performance for use in treatment planning. The feasibility of using CBCT for treatment planning has been assessed and here we report specifically on Hounsfield number (HN) accuracy and related dose errors, and digitally reconstructed radiograph (DRR) image quality.

Methods: Using a Catphan® 600 CT phantom, HN accuracy and uniformity were investigated for a range of CBCT imaging modes. This included the variation in HNs with scan length and phantom position. Results were compared with those acquired from conventional CT. Treatment plans for three sites were generated using the Rando phantom, and results from CBCT-based data were compared to that from CT-based data using a gamma analysis. Image quality of DRRs based on CBCT data were compared with those from CT data both quantitatively, by calculating the modulation transfer function (MTF) and qualitatively, by counting the number of line pairs visible on a phantom.

Results and conclusions: Catphan data showed that for certain cases, the HN calibration of the Acuity CBCT was out of tolerance and could lead to errors in dose calculation of >2%. HNs were only acceptable for scan lengths >10 cm. In multi-scan mode, geometric shifts and differences in HNs were seen on CT slices on either side of the interface between the two acquisitions. However, comparisons between treatment plans calculated using CBCT data and conventional CT data from Rando phantoms showed that head, pelvis and thorax plans were acceptable. CBCT DRR image quality compared favourably with a conventional CT scanner in some respects; however, image uniformity and low contrast resolution were poorer due to the ‘cupping’ artefact obtained with CBCT scans.

Introduction: Health professionals have a duty of care to radiotherapy patients in providing them with adequate information before treatment. There is a lack of research that describes the roles of radiation therapists and radiation oncology nurses in providing information to patients. This study aimed to: (1) explore how radiation therapists communicate with breast cancer patients during a radiotherapy planning appointment; (2) determine what information is provided during this appointment and (3) explore radiation therapists’ perspectives on their role in providing patient information and support.

Methods: The following methodologies were used: self-report questionnaires; simulated radiotherapy planning sessions and joint interpretive forums. Statistical analysis was used to analyse the questionnaires and the simulated planning sessions and forums were analysed qualitatively.

Results: A total of 110 radiation therapists participated in the survey. We simulated two radiotherapy planning appointments and held two forums. Four themes emerged: role definitions, reducing patient anxiety and distress, barriers and strategies for effective communication and confidence in patient communication.

Conclusion: Radiation therapists play an important role in communicating with patients and providing information, particularly if patients exhibit anxiety and distress. Further research is required to determine whether patients’ information needs can be met with additional information provided by radiation therapists.

Background: Addenbrooke’s was awarded Department of Health funding for Tomotherapy in 2006, to evaluate the functionality and application of the image guidance element of Tomotherapy. No Tomotherapy unit had been implemented into a National Health Service (NHS) working environment before, so there was no model to follow. An education and training program needed to be created to ensure accurate and efficient delivery of radiotherapy using Tomotherapy.

Method: The educational needs of radiographers had to be derived from first principles. An assessment of Tomotherapy treatment delivery process was made, identifying the tasks within the process and then the skills and knowledge required to achieve each task. The process was derived from site visits to non-NHS centres using Tomotherapy, nationally and internationally. This was supplemented by educational courses for specific aspects of Tomotherapy Intensity Modulated Radiotherapy (IMRT) and Image Guided Radiotherapy (IGRT).

Results: The core skills and knowledge required were identified and an in-house educational programme created. Competencies for Tomotherapy delivery were assessed against image matching accuracy and speed. All radiographers were able to meet these standards so that Tomotherapy IGRT on the treatment unit required no input from clinical oncologists, making effective and efficient use of staff resources.

Conclusion: The educational and training needs of radiographer staff were identified and a Tomotherapy training program was devised to enable image registration to be radiographer driven.

Objective: Percutaneous endoscopic gastrostomy (PEG) tube insertion is used as an alternative to surgical gastrostomy in patients with head and neck cancers for nutritional support.

Methods: We report two cases of head and neck cancer with metastasis to the surgical PEG tube site. The clinical and treatment-related details are discussed.

Conclusions: Metastasis to PEG tube site is a rare occurrence.

According to the World Health Organization (WHO 2006), cancer is one of the leading causes of death worldwide. Deaths from cancer are projected to continue rising, with an estimated 9 million people dying from cancer in 2015 and 11.4 million dying in 2030 (WHO 2006). Delayed presentation or late diagnosis of cancer is associated with low survival. The aim of this review is to identify factors associated with delayed presentation of cancer that were reported by previous studies. Published studies which identified the most common factors attributed to the late presentation of cancer were reviewed. Publications were identified using MEDLINE (Medical Literature Analysis and Retrieval System Online), the Cochrane Library, CINAHL (Cumulative Index to Nursing and Allied Health Literature) and EMBASE (Excerpta Medica Database) databases. A Critical Appraisal Skills Programme (CASP) was used to assess the methodological quality of the studies. A total of 24 studies met the inclusion criteria. A data extraction sheet was used to systematically record relevant factors. Twenty-four studies met the inclusion criteria which identified factors associated with patients’ delay including patients’ knowledge, stress and fear, and nature of the disease. Other factors were attributed to health providers such as general practitioner (GP) experience, referral delay, and a younger age group being considered as low risk, so symptoms were missed.

Dermatitis is a common side effect of radiation therapy (RT) whereas squamous cell carcinoma (SCC) is not. Management must include treatment options outside of RT, especially when cases are limited by extreme fibrosis. Here, we present a case in which a patient developed multiple SCC, severe radiation fibrosis, and limited neck mobility. This situation of increased risk for intubation required interdisciplinary coordination for proper therapeutic intervention, namely Mohs micrographic surgery to manage cutaneous lesions.