In the recent years, some publications (mainly from one group of authors) have dealt with the effectiveness of proton–boron fusion therapy (PBFT). This theory is based on the Q-value of three produced α particles in the reaction of protons with boron (11B). They claim that this reaction significantly increases the absorbed dose in the target volume. However, the current study would re-evaluate their method to show if PBFT is really effective.

A parallel 80-MeV proton beam was irradiated on a water medium in a cubic boron uptake region (BUR). The two-dimensional dose distribution and percentage depth dose of protons, alphas and all particles were calculated using tally F6 and mesh-tallies by Monte Carlo N Particle Transport code.

The results not only showed that the dose enhancement in BUR is neglectable but also the higher density of BUR in comparison with water led to decrement of dose in this region. Because of low cross section of boron for proton beam (<100 mb), the α particles’ dose is 1,000 times lower than the proton dose.

The physical aspects and the simulation results did not show any effectiveness of the PBFT for proton therapy dose enhancement.

To evaluate the patterns of recurrence following postoperative conformal radiotherapy (RT) for intracranial meningioma.

Eighty-six patients who received conformal RT for intracranial meningiomas from 2014 to 2017 were retrospectively analysed. For documented recurrences, recurrence imaging was deformably co-registered to planning CT scan. In-field recurrence was defined as recurrence within the 90% isodose line, and out-of-field recurrences were those that occurred outside the 90% isodose line. We present the demographic details, surgical and RT details, outcomes and patterns of recurrence.

The median age was 46 years (range 17–72); 82·6% underwent surgery [46·5% had subtotal resection (STR), 43·7% gross tumour resection (GTR), 5·6% biopsy] and 17·4% had no surgery. Among these, 53·5% were WHO grade 2; 27·9% grade 1; and 1·2% grade 3 meningioma. Fifty per cent received stereotactic RT (SRT), 46·5% 3D conformal RT (3DCRT) and 3·5% intensity-modulated RT (IMRT). The mean clinical target volume (CTV) and planning target volume (PTV) margins were 4·5 mm (range 0–15) and 3·9 mm (range 1–5), respectively. The doses ranged from 54 to 59·4 Gy. The median follow-up after RT was 1·7 years (range 0·2–4·7). 17·4% were lost to follow-up, 5·4% had recurrence, and the median time to recurrence after completion of RT was 2 years (range 0·7–2·9). The 3-year recurrence-free rate was 81·5%. Three patients had in-field and two had in-field and out-of-field recurrence. Among the cases with recurrence, three received SRT, one 3DCRT and one IMRT. Four were grade 2 and one was grade 3 tumour, and the CTV margin ranged from 0 to 5 mm, and the PTV margin ranged from 3 to 5 mm.

Local recurrence was seen in grade 2 and 3 meningiomas. SRT probably had more recurrence as they had lesser CTV margin. Increased CTV margin, escalated dose up to 59·4 Gy and 3DCRT/IMRT may be helpful in preventing local recurrences in grade 2 and grade 3 meningiomas.

As the number of proton therapy facilities has steadily increased, the need for the tool to provide precise dose simulation for complicated clinical and research scenarios also increase. In this study, the treatment head of Mevion HYPERSCAN pencil beam scanning (PBS) proton therapy system including energy modulation system (EMS) and Adaptive Aperture™ (AA) was modelled using TOPAS (TOolkit for PArticle Simulation) Monte Carlo (MC) code and was validated during commissioning process.

The proton beam characteristics including integral depth doses (IDDs) of pristine Bragg peak and in-air beam spot sizes were simulated and compared with measured beam data. The lateral profiles, with and without AA, were also verified against calculation from treatment planning system (TPS).

All beam characteristics for IDDs and in-air spot size agreed well within 1 mm and 10% separately. The full width at half maximum and penumbra of lateral dose profile also agree well within 2 mm.

The TOPAS MC simulation of the MEVION HYPERSCAN PBS proton therapy system has been modelled and validated; it could be a viable tool for research and verification of the proton treatment in the future.

Although hypofractionated radiotherapy has been standardised in early breast cancer, even in post-mastectomy no such consensus has been developed for locally advanced breast cancer (LABC), probably due to complex planning and field matching. This study is directed towards dosimetric evaluation and comparison of toxicity, response and disease-free survival (DFS) comparison between hypofractionation and conventional radiotherapy in post-mastectomy LABC.

In total, 222 female breast cancer patients were randomly assigned to be treated with either hypofractionated radiotherapy (n = 120) delivering 40 Gy in 15 fractions over 3 weeks or conventional radiotherapy (n = 102) with 50 Gy in 25 fractions over 5 weeks after modified radical mastectomy (MRM) along with neoadjuvant and/or adjuvant chemotherapy. All patients were planned with treatment planning software and assessed regularly during and after treatment.

Median follow-up period was 178 weeks in conventional arm (CRA) and 182 weeks in hypofractionation arm (HFA). There exists a dosimetric difference between the two arms of treatment, in spite of similar dose coverage [planning treatment volume (PTV) D90 92·04% in CRA versus 92·5% in HFA; p = 0·49], average dose in HFA is less than that of CRA (p < 0·001); so is the maximum clinical target volume (CTV) dose (p < 0·001). Similarly, average lung dose in HFA arm is significantly lower than CRA (9·9 versus 10·84; p = 0·06), but the V20Gy of lung and V30Gy of heart had no difference. The toxicity of radiation was comparable with similar mean time to produce toxicity [CRA: 7 W, HFA: 10 W; hazard ratio 0·64, 95% confidence interval (CI) = 0·28–1·45]. Three-year recurrence event was alike in two arms (CRA: 4·9%, HFA: 5·8%; p = 0·76). Mean DFS in CRA is 230 weeks and that of HFA is 235 weeks with hazard ratio 1·01 (95% CI = 0·32–3·19; p = 0·987).

Though biologically effective dose (BED) in hypofractionation is lesser than that of conventional fractionation, there are indistinguishable toxicity, locoregional recurrence, distant failure rate and DFS between the two modalities.

Sexual dysfunction is a common side effect of external beam radiotherapy (EBRT) and androgen deprivation therapy (ADT) to treat prostate cancer. Men are likely to experience erectile dysfunction, low libido, ejaculatory problems and penile shortening. This qualitative study explored men’s perceptions of sexual dysfunction, including factors such as self-perception, relationships and information and support needs.

Semi-structured interviews were carried out with n = 8 men living 18–30 months after EBRT ± ADT. The interviews were transcribed and thematic analysis was carried out.

All men experienced sexual dysfunction following treatment. The main themes arising were: (i) priorities—sexual issues were not a priority when making treatment decisions, (ii) information and support—men described a lack of information and support about sexual dysfunction and (iii) impact—sexual dysfunction impacted on their self-perception and relationships.

Men undergoing EBRT/ADT for prostate cancer may be affected by post-treatment changes in sexual function in a range of ways. This study suggests that they would benefit from early and wide-ranging information and support on sexual dysfunction, even if they do not consider it as a priority. Candid discussions about self-perception and relationships, as well as physical changes, may equip them to cope with post-treatment changes.

The aim of the study was to find the dosimetric impact of positron emission tomography (PET)-based gross tumour volume (GTV) delineation over computed tomography (CT)-based GTV delineation for carcinoma oesophagus.

Fifteen patients with carcinoma oesophagus were retrospectively selected. Two sets of GTVs in CT plain images were generated, one with the help of intravenous and oral contrast (GTV CT) and the other with only using PET uptake with the standardised uptake value (simple way of determining the activity in PET) (SUV) > 2.5 (GTV PET). Corresponding PTVs were generated. For all patients, rapid arc plans were generated. Changes in target volumes and critical structure doses were evaluated. The Wilcoxon signed-rank test was used for statistical analysis, and p value < 0.05 was assumed as statistically significant.

Mean reduction in GTV was 5.76 ± 19.35 cc. Mean reduction in PTV 45 Gy was 42.40 ± 76.39 cc. Mean reduction in heart mean dose was 1.53 ± 2.16 Gy. Mean reductions in left lung V20% and V10% were 2.43 ± 4.28 and 3.25 ± 5.09 Gy, respectively. Mean reductions in right lung V20% and V10% were 3.11 ± 4.91 and 2.80 ± 4.51 Gy, respectively. Mean reduction in total lung mean dose was 1.00 ± 1.19 Gy.

PET-based GTV contouring reduces the treatment volume and critical structure doses significantly over CT-based GTV contouring for carcinoma oesophagus.

Evaluating the improvements of placing the treatment isocentre at the boost centre of mass (CoM) in a hybrid treatment for breast cancer radiotherapy.

Twenty-two patients were planned in two isocentre locations with two forward intensity-modulated radiation therapy (fIMRT) tangentials to the breast and a volumetric-modulated arc therapy (VMAT) to the boost. A simultaneous integrated boost technique was used. Breast Boost (BB) Vector was investigated as a criterion for selecting an appropriate isocentre placement. Various metrics for boost, breast and hybrid plans were analysed using analysis of variance statistics.

Comparing hybrid plans at the boost CoM vs. hybrid plans at the breast CoM, no significant differences were found. Analysis of relative variations of planning target volume (PTV) boost coverage vs. BB Vector indicated an upgrade in boost CoM isocentre strategy. Dose to organs at risk was comparable: V5Gy (26·24 vs. 25·69%, p = 0·8), V20Gy (14·66 vs. 14·58%, p = 0·959) and the mean dose (7·37 Gy vs. 7·26 Gy, p = 0·879) to ipsilateral lung; V5Gy (15·60 vs. 15·22%, p = 0·903), and the mean dose (4·91 Gy vs. 4·86 Gy, p = 0·950) to heart and dose to free breast of boost (46·71 Gy vs. 46·62 Gy, p = 0·408).

The hybrid fIMRT–VMAT technique centred at the boost CoM resulted equivalent to plans centred at the breast CoM, while benefiting from an enhancement in PTV boost coverage for patients with BB Vector superior to 5.

To report 5- and 10-year overall survival (OS) outcomes of squamous cell carcinoma of the head and neck and identify prognostic factors.

Data on 2,095 patients at Maharaj Nakorn Chiang Mai Hospital, Thailand between 2007 and 2014 were analysed using the Kaplan–Meyer method to estimate 5- and 10-year OS rates. Cox proportional hazard regression models were applied to assess the independent prognostic factors of survival.

8·7% had hypopharyngeal cancer, 19·7% laryngeal, 53·3% oral cavity and 18·3% oropharyngeal. Two-thirds of the patients had locally advanced stage (III–IVB). Five- and ten-year OS rates were 30·1 and 22·8%, respectively.

Cancer site, stage and age at diagnosis were associated with mortality, highlighting the importance of prevention and early detection.

The aim of this work was to study the acceptability of plans prepared for prostate patients treated by volumetric modulated arc therapy (VMAT) with the vision to evaluate the quality of plans and test pre-treatment quality assurance (QA).

VMAT plans of 35 patients, planned on the Eclipse Treatment Planning System (Aria 15), were included in the study. Plan acceptability was checked using statistical analysis, which includes homogeneity index, radical and median homogeneity index, coverage and uniformity index. Dose–volume histograms (DVH) of the plans were also studied to check prescribed dose (PD), Dmax, Dmin, D5 and D95. Portal dosimetry was also done by gamma analysis using 3%/3 mm criterion. SD and mean SD error were also calculated and analysed.

Statistical analysis showed a mean HI of 1·054, coverage 0·959, UI 1·055, mDHI 0·962 and rDHI 0·866. SD of HI, coverage, UI, mDHI and rDHI was 0·019, 0·019, 0·014, 0·013 and 0·030, respectively. From the DVHs, mean of D5, D95, Dmin and Dmax was calculated at 6,252·9, 5,757·4, 6,413·3 and 5,657·7 cGy, respectively, with a prescribed dose of 6,000 cGy. According to gamma analysis, area gamma < 1 was 99·12% with a tolerance limit of 95%, maximum gamma was 1·466 with a tolerance limit of 3·5, average gamma was 0·388 with a tolerance limit of 0·5, area gamma > 1·2 was 0·242% with a tolerance limit of 0·5%, maximum dose difference was 0·6 with a tolerance limit of 1·0 and average dose difference was 0·029 with a tolerance limit of 0·2.

All three computations showed the results to be within acceptable limits. VMAT possesses a unique feature of delivering the whole treatment with only two rotations of the gantry. VMAT has an improved efficiency of delivery for equivalent dosimetric quality.

To modify the final dose delivered to superficial tissues and to modulate dose distribution near irradiated surface, different boluses are used. Air gaps often form under the bolus affecting dose distribution. This study aimed to evaluate the effect of an air gap under the bolus radiation on dose delivery.

To evaluate the impact of the air gap, both helical tomotherapy (HT) and direct tomotherapy (DT) were performed in a simulation study.

The maximum dose to bolus in DT plans was bigger than that used in HT plans. The maximum dose delivered to the bolus depended on the air gap size. However, the maximum dose to bolus in all HT plans was within the acceptable value range. Acceptable value was set to up to 107% of the prescription dose. In the simulation performed in this study, the acceptable air gap under bolus was up to 15 mm and below 5 mm in HT and DT plans, respectively.

HT technique is a good choice, but DT technique can be also used if the bolus position can be reproduced accurately. Thus, the reproducibility of the bolus position between planning and treatment is very important.

To analyse the presentation, treatment strategies and outcomes of neuroendocrine carcinoma of cervix treated with multi-modality approach at our institute.

The data of patients diagnosed to have cervical cancer between October 2004 and November 2018 were retrieved, and 14 patients of neuroendocrine carcinoma cervix who received treatment in our institution were identified. The patients were analysed based on demographic characteristics, disease stage, pathological characteristics, treatment and follow-up. The median overall survival and disease-free survival were calculated.

Median follow-up period was 8 months (range 1–52 months). Six patients died within 4 months of completion of treatment due to disease progression. Median overall survival was 12 months and median disease-free interval was 5·5 months. Four of the patients who underwent combined modality treatment consisting of neoadjuvant chemotherapy, concurrent chemoradiation therapy and brachytherapy are still on regular follow-up and are disease-free.

Neuroendocrine carcinoma of the cervix is a rare but aggressive histological subtype. Combined modality approach with judicious use of systemic chemotherapy along with surgery and radiation therapy is essential for optimal outcomes.

The aim of this study was to investigate the extent to which lung stereotactic body radiotherapy (SBRT) treatment plans can be improved by replacing conventional flattening filter (FF) beams with flattening filter-free (FFF) beams.

We selected 15 patients who had received SBRT with conventional 6-MV photon beams for early-stage lung cancer. We imported the patients’ treatment plans into the Eclipse 13·6 treatment planning system, in which we configured the AAA dose calculation model using representative beam data for a TrueBeam accelerator operated in 6-MV FFF mode. We then created new treatment plans by replacing the conventional FF beams in the original plans with FFF beams.

The FFF plans had better target coverage than the original FF plans did. For the planning target volume, FFF plans significantly improved the D98, D95, D90, homogeneity index and uncomplicated tumour control probability. In most cases, the doses to organs at risk were lower in FFF plans. FFF plans significantly reduced the mean lung dose, V10, V20, V30, and normal tissue complication probability for the total lung and improved the dosimetric indices for the ipsilateral lung. For most patients, FFF beams achieved lower maximum doses to the oesophagus, heart and the spinal cord, and a lower chest wall V30.

Compared with FF beams, FFF beams achieved lower doses to organs at risk, especially the lung, without compromising tumour coverage; in fact, FFF beams improved coverage in most cases. Thus, replacing FF beams with FFF beams can achieve a better therapeutic ratio.

Vestibular schwannomas (VS) are benign slow-growing tumours treated either with microsurgery or stereotactic radiosurgery (SRS) or both. The aim of this study was to correlate the outcome factors—tumour control and adverse factors—facial nerve function and hearing loss with patient and treatment factors.

A retrospective review of the records of 98 patients with 99 VS treated from June 2007 to June 2014, all patients receiving Linear Accelerator (LINAC)-based SRS.

Median follow-up period was 5·6 years (range: 1–12 years). The response to treatment was stable disease in 37 (37·4%), regression in 46 (46·5%), asymptomatic minimal progression in 9 (9·1%) and symptomatic progression in 5 (5%) and unknown in 2 (2%) patients. There was no evidence of SRS induced tissue damage on magnetic resonance scans for any. Hearing preservation rate after SRS was 92%. The patients who developed worsening of facial function were predominantly in the cohort that had prior surgery.

SRS is an effective modality to treat VS lesser than 3 cm in size. Tumour control rate was 95% with a median follow-up period of 5·6 years. The complication rates were 8% each for facial function worsening and worsening of hearing. Prior surgery was a statistically significant factor that affected facial nerve function deterioration.

The aim of this study was to evaluate clinical efficacy and radiobiological outcome of intensity-modulated radiation therapy (IMRT) modalities using various collimator angles and non-coplanar fields for nasopharyngeal cancer (NPC).

A 70-Gy planning target volume dose was administered for 30 NPC patients referred for IMRT. Standard IMRT plans were constructed based on the target and organs at risk (OARs) volume; and dose constraints recommended by Radiation Therapy Oncology Group (RTOG). Using various collimator angles and non-coplanar fields, 11 different additional IMRT protocols were investigated. Homogeneity indexes (HIs) and conformation numbers (CNs) were calculated. Poisson and relative seriality models were utilised for estimating tumour control probability (TCP) and normal tissue complication probabilities (NTCPs), respectively.

Various collimator angles and non-coplanar fields had no significant effect on HI, CN and TCP, while significant effects were noted for some OARs, with a maximum mean dose (Dmax). No significant differences were observed among the calculated NTCPs of all the IMRT protocols. However, the protocol with 10° collimator angle (for five fields out of seven) and 8° couch angle had the lowest NTCP. Furthermore, the standard and some of non-coplanar IMRT protocols led to the reduction in OARs Dmax.

Using appropriate standard/non-coplanar IMRT protocols for NPC treatment could potentially reduce the dose to the OARs and the probability of inducing secondary cancer in patients.

This study aims to evaluate the application of the exit skin dose (ESD) in verifying the accuracy of intra-cavitary brachytherapy treatments performed by the BEBIG 60Co machine using thermoluminescent dosimeters (TLDs).

Eleven patients who were treated for gynaecological (GYN) malignancy by high-dose-rate (HDR) brachytherapy machine have been considered in this study. A combination of tandem, cylinder and interstitial needles was applied for eight patients while tandem ovoid (TO) applicators were used for the rest (three patients). In order to measure ESD, thermoluminescent dosimetry was performed for each patient. TLDs were placed precisely on the patient’s skin along her symphysis pubis bone (anterior) and left (L)/right (R) sides of her pelvic. Positioning of the dosimeter was accurately determined using fiducial markers in computed tomography (CT) scan imaging, prior to the treatment. Finally, a comparison was made between the calculated dose from the treatment planning system (TPS) and the dose measured by TLDs.

About 90% of all cases showed a good agreement (while considering TLD uncertainty ∼5·5%) between TPS dose calculations and TLD measurements. The measured mean values of ESD received to anterior, left and right positions were 56·72, 12·18 and 12·82 cGy, respectively. For three patients, differences up to 11·9% were detected.

To conclude, ESD measurement method can be a suitable practical approach for verifying the accuracy of GYN HDR treatment delivery.

The purpose of the present study is to compare hybrid [three-dimensional conformal radiation therapy-volumetric-modulated arc therapy (3DCRT-VMAT)] and helical tomotherapy (HT) techniques in terms of both planning target volume (PTV) and organs at risk (OARs) in the plans we made in locally advanced non-small cell lung cancer (NSCLC) patients

Radiotherapy was planned for 15 locally advanced NSCLC patients with 2 different techniques. Large tumours with positive mediastinal lymph nodes were preferred. The prescription dose was determined as 60 Gy at 30 fractions.

Mean PTV volume was 602·5 cc (range: 265–1461). Mean total lung volume was 4264 cc (range: 1885–6803). Homogeneity index, Dmean, Dmax, D2 and V105 were found to be lower in HT, V100, total monitor units (MU) and total beam on time were found to be lower in the hybrid plan. Total lung Dmean was found to be 17 Gy in both techniques. V10 value was 42·85 in the hybrid plan and 48·67 in HT (p = 0·037). Heart Dmean was 14·5 Gy in the hybrid plan and 18·7 in HT (p < 0·001), and V30 values were 18·1 and 22·9, respectively (p = 0·009).

Suitable dose coverage and OAR doses can be provided with both techniques. Especially the opposite lung, heart and oesophagus doses can be kept lower with the hybrid plan, and lower MU and shorter beam on time can be provided.

Mastectomy is a treatment option for patients diagnosed with breast cancer. There is very limited research into the psychosocial impact of mastectomy on female breast cancer patients, especially in the sub-Saharan African setting which has unique cultural norms. The study aimed at assessing the psychosocial impact of mastectomy on female breast cancer patients attending a radiotherapy/oncology centre in Ghana.

A cross-sectional design was used to undertake this study. A total of 80 female mastectomy breast cancer patients participated in this study. A semi-structured questionnaire was used for data collection over a 5-month period, January to May 2018. The data collected were analysed with Statistical Package for Social Science (SPSS) version 22.

Most of the participants were adversely affected psychologically and emotionally by mastectomy. In particular, many (56·7%) agreed that they felt less feminine, and 71% reported they experienced psychological distress as a result of their mastectomy, while 63% of them reported loss of self-confidence. A large proportion of them (51, 63·8%) agreed that their lifestyles had changed following mastectomy, while 58% of them admitted that they felt treated as outcasts by society, and 75% resorted to the use of breast prostheses to reduce attention.

The study revealed that mastectomy for breast cancer patients had a negative impact on their psychological, emotional and social well-being. The availability of affordable breast prostheses, involvement of clinical psychologists in the care of post-mastectomy women, provision of emotional, psychological and even financial support could alleviate the psychosocial impact of affected women.

To measure and compare the skin doses received by treated left breast and contralateral breast (CB) during whole breast radiotherapy using five treatment techniques in an indigenously prepared wax breast phantom.

Computed tomography (CT) images of the breast phantom were used for treatment planning and comparison of skin dose calculated from treatment planning system (TPS) with measured dose. Planning target volume (PTV) and the CB were drawn arbitrarily on the CT images acquired for the breast phantom with 10 numbers of calibrated optically stimulated luminescent dosimeters (OSLDs) fixed on the surface of both breasts. The TPS calculated surface doses of PTV breast and CB for five treatment planning techniques, viz., conventional wedge (CW), irregular surface compensator-based (ISC), field-in-field (FiF), intensity-modulated radiotherapy (IMRT) and rapid arc (RA) techniques were obtained for comparison. The plans were executed in Clinac iX Linear Accelerator with the OSLDs fixed at the same locations on the phantom as in simulation. The TPS calculated mean dose at the surface of the treated left breast and CB was noted for the 10 OSLDs from dose-volume histogram (DVH) and compared with the measured dose. Also, the mean chamber dose at the centre of the left breast was noted from the DVH for comparing with ion chamber measured dose.

With reference to the results, it is seen that the dose to the CB is lowest in ISC technique and FiF technique and greatest in IMRT technique. The CW technique also delivered a dose comparable to IMRT to the CB of the phantom. The dose to the surface of PTV breast was highest and comparable in CW plans and FiF plans (68% and 67%) and lowest in IMRT and RA plans (50% each).

Analysis of the results shows that the FiF and ISC techniques are preferred while planning breast radiotherapy due to the reduced dose to the CB.

The updated World Health Organization 2016 classification of central nervous system tumours recommends the addition of molecular parameters to histological diagnosis. In a resource-constrained setting, molecular testing such as gene sequencing and fluorescence in situ hybridisation is not feasible for all the patients. We assessed the utility of immunohistochemistry (IHC) for isocitrate dehydrogenase (IDH1/R132H) gene and alpha thalassemia/mental retardation syndrome X linked gene (ATRX) to stratify adult diffuse gliomas into subgroups and analysed the outcomes.

Fifty-eight patients with grades III/IV astrocytic gliomas were tested by IHC for IDH1/R132H and ATRX mutation as per the standard protocol and were later stratified into three subgroups based on IHC. IDH1/R132H positive/ATRX retained gliomas were stratified as group 1 (G1), IDH1/R132H positive/ATRX lost were grouped as G2 and IDH1/R132H negative (with or without ATRX loss) as G3. All patients underwent adjuvant therapy as per the Stupp regimen. Outcomes and survival were analysed by Kaplan–Meier analysis using SPSS 21.v.

Median age of the cohort of 58 patients (male: 39, female: 19) was 40 years. Histologically, glioblastoma multiforme (GBM), anaplastic astrocytoma (AA) and anaplastic oligodendroglioma (AOD) were seen in 23:17:18 patients. Forty-eight percent were tested positive for IDH1/R132H, 62% had retained ATRX protein stratifying patients into three subgroups (G1:14, G2:14, G3:30). The G3 group contained both AA and GBM cases. At median follow-up of 18 months, overall survival (OS) of the entire cohort was 76%, higher in G1, compared to G2 and G3 (log-rank p = 0·01). In comparison to various factors such as age, gender, location of the lesion and presenting symptom on survival among various groups, we found that gender of the patient in group I (men vs. women, p = 0·02), laterality of the tumour in group II (right vs. left, p = 0·07) and age of the patient in group III (<45 vs. >45, p = 0·01) demonstrated significant impact on OS.

Subgroup stratification of adult diffuse gliomas based on IHC for IDH/R132H and ATRX demonstrates that group 1 was the most favourable prognostic factor. In a resource-constrained environment, IHC alone may guide appropriate management decision for the majority of adult diffuse gliomas, gene sequencing reserved for IDH1/R132H negative GBM in patients less than 45 years of age.

The standard treatment modalities for prostate cancer include surgery, chemotherapy, hormonal therapy and radiation therapy or any combination depending on the stage of the tumour. Radiation therapy is a common and effective treatment modality for low-intermediate-risk patients with localised prostate cancer, to treat the intact prostate and seminal vesicles or prostate bed post prostatectomy. However, for high-risk patients with lymph node involvement, treatment with radiation will usually include treatment of the whole pelvis to cover the prostate and seminal vesicles or prostate bed and the pelvic lymph nodes followed by a boost delivery dose to the prostate and seminal vesicles or prostate bed.

We retrospectively analysed the treatment plans for 179 prostate cancer patients treated at the cancer centre with the volumetric-modulated arc therapy (VMAT) technique via RapidArc using 6 MV photon beam. Patients were either treated with a total prescription dose of 78 Gy in 39 fractions for patients with intact prostate or 66 Gy in 33 fractions for post prostatectomy patients.

There were 114 (64%) patients treated with 78 Gy/39 and 65 (36%) treated with 66 Gy/34. The mean homogeneity index (HI), conformity index (CI) and uniformity index (UI) for the PTV-primary of patients treated with 78 Gy are 0.06 ± 0.01, 1.04 ± 0.01 and 0.99 ± 0.01, respectively, and the corresponding mean values for patients treated with 66 Gy are 0.06 ± 0.02, 1.05 ± 0.01 and 0.99 ± 0.01, respectively. The mean PTV-primary V95%, V100% and V105% are 99.5 ± 0.5%, 78.8 ± 12.2% and 0.1 ± 0.5%, respectively, for patients treated with 78 Gy and 99.3 ± 0.9%, 78.1 ± 10.6% and 0.1 ± 0.4%, respectively, for patients treated with 66 Gy. The rectal V50Gy, V65Gy, V66.6Gy, V70Gy, V75Gy and V80Gy are 26.8 ± 9.1%, 14.2 ± 5.3%, 13.1 ± 5.0%, 10.8 ± 4.3%, 6.9 ± 3.1% and 0.1 ± 0.1%, respectively, for patients treated with 78 Gy and 33.7 ± 8.4%, 14.1 ± 4.5%, 6.7 ± 4.5%, 0.0 ± 0.2%, 0.0% and 0.0%, respectively, for patients treated with 66 Gy.

The use of VMAT technique for radiation therapy of high-risk prostate cancer patients is an efficient and reliable method for achieving superior dose conformity, uniformity and homogeneity to the PTV and minimal doses to the organs at risk. Results from this study provide the basis for the development and implementation of consistent treatment criteria in radiotherapy programs, have the potential to establish an evaluation process to define a consistent, standardised and transparent treatment path for all patients that reduces significant variations in the acceptability of treatment plans and potentially improve patient standard of care.