Here, we report the feasibility and long-term efficacy of a granulomatous slack skin disease (GSSD) treatment with combined high-energy photon and proton beams.

A GSSD patient with abdominal disease volume 25×15×2–4 cm deep was recommended for treatment at this institution. In addition to photons and electrons, high-energy protons delivered with advanced planning techniques and patient positioning were used. The patient was irradiated to a total dose of 40 Gy by using 20 Gy matched photon and electrons followed by 20 Gy equivalent protons delivered by using innovative range compensation and patient positioning.

The test patient tolerated the treatment well and is now a 10-year survivor of the disease.

Treatment of GSSD with protons is feasible. The range and narrow penumbra properties of the proton beam provided an ideal capability to match fields accurately to cover large volumes while also sparing underlying normal tissues.

The aim of this study was to assess the feasibility of radiographer led verification of cone-beam computed tomography (CBCT) images for patients with solitary lung tumours treated with stereotactic body radiotherapy treatment (SBRT).

CBCT setup images of 20 patients from the first fraction of each patient were retrospectively registered by therapeutic radiographers. The displacements recorded were compared with the clinical oncologist’s original online match. The time taken by radiographers to verify the CBCT images was also recorded.

Overall agreement for all radiographers when compared with the clinical oncologist match was 91%. Interobserver variations between radiographers were X plane 0·87 (0·76–0·94); Y plane 0·74 (0·51–0·88); and Z plane 0·88 (0·78–0·95) intraclass correlation coefficient and 95% confidence interval. The average time taken for verification was 128 seconds.

Therapeutic radiographers are able to verify CBCT images for thorax SBRT with results comparable to the ‘gold standard’ clinical oncologists’ match, however additional training will be provided for online verification. The time taken was within acceptable limits.

Bladder complications may be seen in up to 12% of patients treated with pelvic irradiation. To report the long-term efficacy of hyperbaric oxygen therapy (HBOT) on radiation-induced cystitis.

We followed 70 patients diagnosed with radiation cystitis submitted to HBOT in our institution from 2007 to 2013. All patients answered a questionnaire documenting symptom severity pre-HBOT and at the end of the follow-up period using the Late Effects of Normal Tissues – Subjective, Objective, Management, Analytical (LENT-SOMA) scale. Our treatment protocol consisted of multiple sessions (median of 40) of 100% oxygen delivery in a multiplace hyperbaric chamber at 2·4 atm for 80 minutes.

With a median follow-up of 55·5 (4–85) months, the success rate after the follow-up period in terms of haematuria resolution or improvement was 91·4%. The mean score of each subjective variable of LENT-SOMA scale (dysuria, frequency, haematuria, incontinence) were significantly lower after the follow-up period (p<0·05) with the exception of decreased stream (p=0·14). The sum of all subjective scores of LENT-SOMA scale was also significantly lower after the follow-up period (p<0·05). No serious complications were observed.

Our results highlight the safety and long-term benefits of HBOT on haemorrhagic radiation cystitis and other distressful bladder symptoms.

The comparative study of the plan quality between volumetric modulated arc therapy (VMAT) and 3D conformal therapy (3DCRT) for the treatment of selected representative childhood neoplasms was performed.

During the year 2013, 44 children with neoplasms were irradiated using VMAT. The 3DCRT plans were created retrospectively and compared with the VMAT plans for four tumour locations. The conformity parameters, dose volume histograms for target volume and organs at risk, number of monitor units and time used to deliver the single fraction were evaluated and compared for each plan. Additionally, for patients with brain tumour the comparison of different arcs configuration was made.

VMAT modality presented the superiority over older conformal methods with regard to the improvement in the dose conformity and normal tissue sparing. The noncoplanar arcs arrangement was beneficial in the decrease of high-dose volume and the protection of the organs at risk located oppositely to the target volume.

VMAT could be preferred technique for treating childhood neoplasms, especially when the complex-shaped target volume is localised close to the critical structures. The noncoplanar arcs arrangement could be the method of choice in the reirradiated patients and in these with laterally located brain tumours.

Superficial X-ray therapy units are used for the treatment of certain types of skin cancer and some severe dermatological conditions. The performance assessment and beam characteristics of the superficial unit are very important to ensure accurate dose delivery during patient treatment. Both experimental measurements and Monte Carlo calculations can be used for this purpose.

This study aims to investigate whether it is possible to reproduce experimentally measured data for the XSTRAHL 150 superficial X-ray unit with simulations using the BEAMnrc Monte Carlo code.

The experimental procedure applied in this study included the following: experimental measurements of different X-ray spectra, half-value layers, percentage depth dose and beam profiles. Monte Carlo modelling of the XSTRAHL 150 unit was performed with the BEAMnrc code. The validity of the model was checked by comparing the theoretical calculations with experimental measurements.

There was good agreement (∼1%) between experimentally measured and simulated X-ray spectra. Results of half-value layers obtained from simulated and measured spectra showed that there was a maximum of 3·6% difference between BEAMnrc and measurements and a minimum of 2·3%. In addition, simulated percentage depth dose and profile curves have been compared against experimental measurements and show good agreement (within 2% for the depth dose curves and 3–5% for beam profile curves, depending on the applicator size).

The results of this study provide information about particles’ interaction in different kilovoltage and filter combinations. This information is useful for X-ray tube design and development of new target/filter combinations to improve beam quality in superficial X-ray radiotherapy. The data presented here may provide a base for comparison and a reference for other or potential new users of the XSTRAHL 150 X-ray unit.

To determine and summarise the literature on prostatic seed stability by investigating seed marker migration and loss in prostate cancer patients. In addition, documenting the implications of significant seed migration and loss in clinical practise.

PubMed and Sciencedirect databases were used to locate papers on the stability of gold seed markers in prostate patients treated with external beam radiation therapy. The search found 3,238 articles and ten articles were selected and reviewed based on inclusion and exclusion criteria for the scope of this literature review.

Minimal migration and loss of seeds was observed in the literature reviewed, with the majority of authors reporting <2·0 mm migration within the prostate; however, there were individual cases reported outside of the 2·0 mm threshold. It was also found that significant migration had an impact on image matching, as well as, planning treatment volume margins.

Seed stability within the prostate has been proven, with most authors reporting minimal migration within a 2·0 mm threshold and minimal loss of seeds. Although individual cases can have significant migration and loss, if marker migration exceeds the 2·0 mm threshold, a protocol is required to deal with both non-significant and significant migration.

The combination of radiation therapy and chemotherapy is rooted in its ability to help achieve locoregional and systemic control, therefore increasing the overall disease-free survival of patients. Understanding the mechanistic actions of cytotoxic agents and their targets on the cell cycle, as well as the governing pharmacokinetic principles can improve treatment delivery. The adjuvant treatment setting can overcome barriers such as hypoxia and genetically driven treatment resistance.

The purpose of this review is to present theoretical frameworks behind the chemoradiation paradigm and to describe current chemoradiation practices in radiation oncology.

A review was conducted using the US National Library of Medicine, National Institutes of Health database (PubMed) using the following search keywords: chemoradiation, spatial cooperation, chemotherapeutic agents, pharmacokinetics, anti-vascular agents, tumour vasculature and tumour hypoxia.

Current research has reported several rationales for the beneficial combination of radiation and chemotherapy to eradicate oncological diseases. Mechanisms of action and biological approaches are showing that concurrent treatments, as well as novel agents such as anti-vascular and anti-angiogenic agents may benefit improved treatment outcomes by reducing micro hypoxic environments in tumours. In addition, chemotherapy administered in tandem with radiation enhances cell-killing effects by targeting the cell cycle.

To establish whether the use of a passive or active technique of planning target volume (PTV) definition and treatment methods for non-small cell lung cancer (NSCLC) deliver the most effective results. This literature review assesses the advantages and disadvantages in recent studies of each, while assessing the validity of the two approaches for planning and treatment.

A systematic review of literature focusing on the planning and treatment of radiation therapy to NSCLC tumours. Different approaches which have been published in recent articles are subjected to critical appraisal in order to determine their relative efficacy.

Free-breathing (FB) is the optimal method to perform planning scans for patients and departments, as it involves no significant increase in cost, workload or education. Maximum intensity projection (MIP) is the fastest form of delineation, however it is noted to be less accurate than the ten-phase overlap approach for computed tomography (CT). Although gating has proven to reduce margins and facilitate sparing of organs at risk, treatment times can be longer and planning time can be as much as 15 times higher for intensity modulated radiation therapy (IMRT). This raises issues with patient comfort and stabilisation, impacting on the chance of geometric miss. Stereotactic treatments can take up to 3 hours to treat, along with increases in planning and treatment, as well as the additional hardware, software and training required.

Four-dimensional computed tomography (4DCT) is superior to 3DCT, with the passive FB approach for PTV delineation and treatment optimal. Departments should use a combination of MIP with visual confirmation ensuring coverage for stage 1 disease. Stages 2–3 should be delineated using ten-phases overlaid. Stereotactic and gated treatments for early stage disease should be used accordingly; FB-IMRT is optimal for latter stage disease.

Immobilisation for patients undergoing brain or head and neck radiotherapy is achieved using perspex or thermoplastic devices that require direct moulding to patient anatomy. The mould room visit can be distressing for patients and the shells do not always fit perfectly. In addition the mould room process can be time consuming. With recent developments in three-dimensional (3D) printing technologies comes the potential to generate a treatment shell directly from a computer model of a patient. Typically, a patient requiring radiotherapy treatment will have had a computed tomography (CT) scan and if a computer model of a shell could be obtained directly from the CT data it would reduce patient distress, reduce visits, obtain a close fitting shell and possibly enable the patient to start their radiotherapy treatment more quickly.

This paper focuses on the first stage of generating the front part of the shell and investigates the dosimetric properties of the materials to show the feasibility of 3D printer materials for the production of a radiotherapy treatment shell.

Computer algorithms are used to segment the surface of the patient’s head from CT and MRI datasets. After segmentation approaches are used to construct a 3D model suitable for printing on a 3D printer. To ensure that 3D printing is feasible the properties of a set of 3D printing materials are tested.

The majority of the possible candidate 3D printing materials tested result in very similar attenuation of a therapeutic radiotherapy beam as the Orfit soft-drape masks currently in use in many UK radiotherapy centres. The costs involved in 3D printing are reducing and the applications to medicine are becoming more widely adopted. In this paper we show that 3D printing of bespoke radiotherapy masks is feasible and warrants further investigation.