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: Total body irradiation (TBI) involves delivery of marrow-ablative or suppressive dose to the entirety of the marrow habitus. In its current practice, TBI often involves positioning the patient in an uncomfortable upright body position for extended periods of time while delivering radiation dose via anteroposterior/posterioanterior (AP/PA) fields. In an effort to maximize reproducibility and patient comfort, especially for paediatric patients, a supine lateral total body irradiation (LTBI) protocol was implemented as preparatory regimen for bone marrow transplant.

Methods and Materials: One hundred and forty-five patient charts were reviewed. Patients were treated in supine position with hands clasped over the upper abdomen in a comfortable position. They were placed in a methylcrylate body box and irradiated with opposed lateral fields at extended distance of 350 cm to the midplane of the patient. Each field delivered 100 cGy with a midplane dose of 200 cGy per fraction. Dose regimes varied from 200 to 1,200 cGy total doses. Custom lead compensating filters were utilized. A 6 MV photon beam produced by a Varian Clinac 600c linear accelerator was applied. In vivo thermoluminescent dosimeter (TLD) readings were taken for anatomical regions of interest (ROI). TLDs were placed in each ROI under a 1.5-cm-thick bolus for maximum dose build-up.

Results and Conclusion: The resulting data demonstrate a dosimetric variability of anatomical ROI from reference prescription dose of less than 3%. LTBI has been used for more than ten years in our institution and produced favourable results for more than 100 patients. We suggest this LTBI approach to facilitate successful treatment of children who require TBI while maintaining dose uniformity as recommended by the American Association of Physicists in Medicine Report 17.

Purpose: This study aimed to explore the patient’s experience of the radiotherapy pathway with a view to improving patient-centred services.

Methods: Women’s views about the radiotherapy pathway were gathered through a focus group. Focus groups have been used extensively in qualitative research to gather rich meaningful data. A thematic analysis of the transcript identified areas of importance for the women, which could be used to direct service improvement.

Results: Five main themes emerged: information, communication and support, dignity and individualised care, service accessibility and staff relationships. Generally, staff were viewed as professionals and the radiotherapy service well run although women did identify several unmet needs during radiotherapy. Lack of information and perceived time constraints of busy staff was revealed. However women did feel treated with dignity, respect and as individuals. ‘End-of-treatment’ was a particular focus; women felt dedicated time with staff would enable discussion, information giving and support around this vulnerable time. In addition, women felt that communication barriers and time constraints influenced the information and support they experienced during radiotherapy.

Conclusion: The use of a focus group enabled service users to identify clear areas for improvement at a local level. Priorities include information, communication and support and the ‘end-of-treatment’.

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.

We study how mucosal dose in the oral or nasal cavity depends on the irradiated small segmental photon fields varying with beam energy, beam angle and mucosa thickness. Dose ratio (mucosal dose with bone underneath to dose at the same point without bone) reflecting the dose enhancement due to the bone backscatter was determined by Monte Carlo simulation (EGSnrc-based code), validated by measurements. Phase space files based on the 6 and 18 MV photon beams with small field size of 1 × 1 cm2, produced by a Varian 21 EX linear accelerator, were generated using the BEAMnrc Monte Carlo code. Mucosa phantoms (mucosa thickness = 1, 2 and 3 mm) with and without a bone under the mucosa were irradiated by photon beams with gantry angles varying from 0 to 30°. Doses along the central beam axis in the mucosa and the dose ratio were calculated with different mucosa thicknesses. For the 6 MV photon beams, the dose at the mucosa-bone interface increased by 44.9–41.7%, when the mucosa thickness increased from 1 to 3 mm for the beam angle ranging from 0 to 30°. These values were lower than those (58.8–53.6%) for the 18 MV photon beams with the same beam angle range. For both the 6 and 18 MV photon beams, depth doses in the mucosa were found to increase with an increase of the beam angle. Moreover, the dose gradient in the mucosa was greater for the 18 MV photon beams compared to the 6 MV. For the dose ratio, it was found that the dose enhancement due to the bone backscatter increased with a decrease of mucosa thickness, and was more significant at both the air-mucosa and mucosa-bone interface. Mucosal dose with bone was investigated by Monte Carlo simulations with different experimental configurations, and was found vary with the beam energy, beam angle and mucosa thickness for a small segmental photon field. The dosimetric information in this study should be considered when searching for an optimized treatment strategy to minimize the mucosal complications in the head-and-neck intensity-modulated radiation therapy.

The assessment of mean lethal radiation dose (D0) in human organs, using multi-target and linear quadratic models, with water proton nuclear magnetic resonance spin lattice relaxation time yields a correlation coefficient of 0.90 and 0.82, respectively. Results of this study reveal that as the spin lattice relaxation time increases, the D0 decreases.

A cancer diagnosis is likely to have a devastating effect when it occurs, but it is possibly especially problematic during adolescence. The many challenges faced by adolescents have led to a concern for their psychosocial well-being. There is evidence to support the notion that the provision of effective psychosocial care improves the outcomes of patients with cancer. The review of the literature has identified that amongst the psychological challenges; there is uncertainty and fear around the status and progression of the cancer. Issues such as body image and sexuality and fertility have been highlighted as a major cause of concern for adolescents. The literature suggests health professionals need to be trained in such areas to give the appropriate care and support. It has also been identified that hopefulness and a positive attitude by patients, families and the multi disciplinary team contribute to positive outcomes. Nurses play a key role in providing psychosocial care as they are primarily the ones who deliver the daily care and can be used as a mediator between the multi disciplinary team. Other disciplines such as Clinical Nurse Specialists, Activities Coordinators, Social workers and Psychotherapists all contribute to the overall direction and experience of care.

Dental assessments are important before the commencement of radiotherapy to the head and neck area to assess the teeth and associated structures lying in the treatment field and to inform the patient of the effects of radiotherapy on the oral cavity. This case report documents an incidental radiographic finding of a mandibular cystic lesion and its impact on the radiotherapy planning and decision making to proceed with radiotherapy.

The effectiveness of PET-CT (positron emission tomography–computed tomography) was investigated for staging target delineation compared with CT-MR (computed tomography–magnetic resonance) and early response of intensity-modulated radiotherapy (IMRT). Gross tumour volume–clinical target volume (GTV-CTV) differences between PET-CT and CT-MR for 14 nasopharyngeal carcinoma (NPC) patients were compared. Evaluation of doses of organs at risk (OARs) was done by IMRT plans. Responses of IMRT were evaluated with both sets. PET-CT changed MR-based TNM (Tumour Lymph Nodes Metastasis) in 11 of 14 patients. The median GTVNP (nasopharyx gross tumour volume) was 49.25 and 18.8 cm3 for CT-MR and PET-CT, respectively. In eight cases, GTVNP in the PET-CT was smaller than the CT-MR. The PET-CT presented a larger GTVNP than the CT-MR for six cases. Mean doses for the parotid glands were found to be higher than in CT-MR-based plan in one patient although he had smaller GTVNP at the PET-CT. The median follow-up was 16 months. Only one patient experienced recurrence in the CTVNP (nasopharyx clinical target volume). MR showed a decrease in the size-number of lymph nodes in four patients whereas PET-CT showed no uptake. All patients had positive responses to IMRT in their second control MR and PET-CT. PET-CT could improve tumour delineation. This enables an increase in dose inside the CTV. PET-CT provided significant information on the control scans for most of our patients whose MR imaging showed residual or recurrence.

The sharp dose gradients in intensity-modulated radiation therapy increase the treatment sensitivity to various inter- and intra-fractional uncertainties, in which a slight anatomical change may greatly alter the actual dose delivered. Image-guided radiotherapy refers to the use of advanced imaging techniques to precisely track and correct these patient-specific variations in routine treatment. It can also monitor organ changes during a radiotherapy course. Currently, image-guided radiotherapy using computed tomography has gained much popularity in radiotherapy verification as it provides volumetric images with soft-tissue contrast for on-line tracking of tumour. This article reviews four types of computed tomography-based image guidance systems and their working principles. The system characteristics and clinical applications of the helical, megavoltage, computed tomography, and kilovoltage, cone-beam, computed tomography systems are discussed, given that they are currently the most commonly used systems for radiotherapy verification. This article also focuses on the recent techniques of soft-tissue contrast enhancement, digital tomosynthesis, four-dimensional fluoroscopic image guidance, and kilovoltage/megavoltage, in-line cone-beam imaging. These evolving systems are expected to take over the conventional two-dimensional verification system in the near future and provide the basis for implementing adaptive radiotherapy.

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.

This patient case study represents the introduction of adaptive radiotherapy (ART) at the Andrew Love Cancer Centre (ALCC) with non-uniform margins for invasive bladder cancer treatment. Invasive bladder cancer has historically had poor local control with radiotherapy treatment; however, with the introduction of cone-beam computer tomography (CBCT) and adaptive treatment, there is potential for improvements in disease control and reduced toxicities.