Neuroma of the facial nerve (NFN) is an extremely rare benign tumour that can involve any segment of the facial nerve. It is revealed by facial weakness with or without hearing loss and has commonly been managed by microsurgery. Our purpose is to systematically review the literature about the role of fractionated stereotactic radiotherapy (FSRT) on the treatment of NFN.

We report the case of a 70-year-old-woman who presented progressively worsening facial paralysis associated with mild conductive hearing loss and dizziness. The multimodal magnetic resonance imaging (MRI) was very suggestive of an intrapetrous neuroma, centred on the tract of the VII nerve and the left geniculate ganglion. She was treated by FSRT at the dose of 18 Gy in three fractions on the isodose line 80 %. After 18-month follow-up, she reported a facial weakness improvement. The MRI revealed a stable disease.

The clinical presentation of the schwannoma of the facial nerve depends essentially on its location. It is therefore very variable, ranging from an isolated mild hearing loss to a vestibular syndrome with facial paralysis. Through this observation with literature review, we reported a long-term tumour control with improvement of pre-treatment symptomatology with FSRT.

This work aims to evaluate the effect of Hitachi 16-slice scanner reconstruction filters on Hounsfield unit (HU) variations. In the literature, there is a lack of information from a wide variety of scanners in this regard. In addition, not all studies have investigated the effect of reconstruction filters on HU in an exhaustive way.

The computerised imaging reference system electron density phantom (model 062M) was scanned with different substitute materials of different density from Hitachi 16-slice computed tomography. The raw images were obtained with four tube voltage settings: 80 kVp, 100 kVp, 120 kVp and 140 kVp. The raw images for each energy level were then reconstructed using different reconstruction filters.

The HU values of dense bone were significantly different when changing the reconstruction filters without beam hardening correction (BHC). Nevertheless, when selecting the BHC, this variation decreases heavily for 80 kVp and decreases slightly for 140 kVp, but it remains outside the tolerance of ±50 HU. However, for 100 kVp and 120 kVp, the differences in HU values become within the tolerances indicated for dense bone.

Changing image reconstruction filters during a dosimetric scan had a significant effect on HU in dense bone. Therefore, it is recommended to evaluate this effect during the commissioning phase. As a result, this study provides a methodology to comprehensively investigate the effect of reconstruction filters on HU.

Low-dose-rate brachytherapy (LDR brachytherapy) with Iodine-125-seeds is an established treatment modality for low- and favourable intermediate-risk prostate cancer. Our single institution experience in this field was retrospectively studied.

Two-hundred sixty consecutive patient records were reviewed for demographic, disease, therapy and side effect data. The patients were divided into subgroups by pre- and post-implant prostate-specific antigen (PSA) levels and by different LDR brachytherapy techniques used, that is, preoperative planning technique (PPT) versus intraoperative real-time planning (IOR). Data were analysed by Kaplan–Meier method and appropriate testing was conducted for PSA biochemical recurrence (BCR) and for toxicities.

After median follow-up of 65·0 months, 94·0% of all patients were free from BCR. This endpoint showed no significant differences by patient age, initial PSA, PSA decrease over time, Gleason score and implanted total activity. Patients with IOR were free of BCR in 98·9% (180/182) versus 76·9% (40/52) with PPT. All patients with a PSA nadir of <0·1 ng/mL were free from BCR. Six patients (2·5%) reported an incontinence grade 1. Transient nocturia/urge and dysuria appeared in 54·7% and 22·6% of patients.

Consistent with literature, LDR brachytherapy for low- and intermediate-risk prostate cancer appeared highly effective for freedom from BCR with mild side effects.

Haematological toxicities are seen in rectal cancer patients receiving concurrent chemoradiotherapy (CRT) with capecitabine.

To compare dose volume histogram (DVH) parameters and acute haematological toxicities using RapidArc with or without bone marrow constraints for rectal cancer patients receiving pelvic chemoradiation as part of curative treatment.

This is a prospective randomised controlled study including patients with rectal cancer initiated on chemoradiation. Patients were stratified into two arms, bone marrow sparing (BMS) arm and non-bone marrow sparing arm (NBMS).

DVH parameters and weekly toxicity data were collected. Grade 2 or more anaemia, leucopenia, neutropenia, or thrombocytopenia, any blood transfusions, colony-stimulating factor injection, platelet transfusions were considered as an event in acute haematological toxicity (HT).

Independent t-test was used to compare quantitative parameters, and Mann–Whitney U-test was used for ordinal parameters between groups.

A total of 43 patients were enrolled. Bone marrow constraints were achieved without compromising the target coverage. There was a significant reduction in the bone marrow dose with BMS technique (p < 0·05). A 16·7% reduction in the HT (33·3% versus 50%) and a 21·9% reduction in the grade 2 or more anaemia (19% versus 40·9%) were noted in the BMS arm when compared to NBMS arm, though not statistically significant. However, in the preoperative setting, a significant reduction in grade 2/more anaemia (7·1% versus 41·1%, p = 0·035) was noticed in the BMS arm.

Pelvic BMS radiotherapy may benefit patients receiving chemoradiation for locally advanced carcinoma rectum as part of curative treatment.

This study aimed to determine the suitable breast treatment technique for a small facility’s hospital with limited staff and equipment resources. The benefits and drawbacks of each technique should be considered to guide radiation oncologists choose the appropriate treatment option for postmastectomy radiation therapy (PMRT) patients.

This study included the computed tomography images of 15 patients who received left-sided PMRT. The patient’s characteristics were classified into two groups: 1. irradiation of only the chest wall (CW) and 2. CW lymph nodes plus supraclavicular lymph nodes (SPCs). All 15 PMRT patients were generated in 4 treatment techniques including 3DCRT, field-in-field (FiF), intensity-modulated radiotherapy (IMRT) and hybrid (3DCRT + IMRT). Each treatment technique’s dosimetric parameters and treatment time were compared.

All four treatment plans met the acceptable criteria. The IMRT plans achieved the highest plan quality scores for two groups of PMRT patients but require the longest treatment time, whereas the 3DCRT and FiF plans demonstrated superiority for organ at risk (OAR) sparing and required the shortest treatment time when compared with the IMRT and hybrid plans.

The IMRT plan had the highest plan quality but required the most time to treat. Treatment times are critical in facilities with limited resources. As a result, the FiF plan was found to be a suitable technique for both CW-only and CW plus SPC irradiation due to its short treatment time and high plan quality scores for OAR dose sparing.

This study investigates the dose escalation to dominant intra-prostatic lesions (DILs) that is achievable using single-source-strength (SSS) and dual-source-strength (DSS) low-dose-rate (LDR) prostate brachytherapy and a sector-based plan approach.

Twenty patients were retrospectively analysed. Image registration and planning were undertaken using VariSeed v9·0. SSS and DSS boost plans were produced and compared to clinical plans. Dosimetric robustness to seed displacement for SSS and DSS plans was compared to clinical plans using Monte Carlo simulations.

Fourteen out of 20 patients had DIL identifiable on magnetic resonance imaging. Median increase in sector D90 of 27% (p < 0·0001) and sector V150 of 31% (p < 0·0001) was achieved with SSS planning without exceeding local rectum and urethra dose constraints. DSS plans achieved dose distributions not statistically significantly different from the SSS plans with a median of eight fewer seeds and two fewer needles. SSS and DSS plan sensitivity to random seed displacement was similar to the clinical plans.

Treatment planning using VariSeed to produce SSS and DSS focal boost plans is feasible for LDR prostate brachytherapy to achieve a median escalation in sector D90 of 27% without exceeding local urethral and rectal constraints. SSS and DSS plan dosimetric robustness was similar to clinical plan dosimetric robustness.

Advanced treatment modalities involve applying small fields which might be shaped by collimators or circular cones. In these techniques, high-energy photons produce unwanted neutrons. Therefore, it is necessary to know neutron parameters in these techniques.

Different parts of Varian linac were simulated by MCNPX, and different neutron parameters were calculated. The results were then compared to photoneutron production in the same nominal fields created by circular cones.

Maximum neutron fluence for 1 × 1, 2 × 2, 3 × 3 cm2 field sizes was 165, 40.4, 19.78 (cm–2.Gy-1 × 106), respectively. The maximum values of neutron equivalent doses were 17.1, 4.65, 2.44 (mSv/Gy of photon dose) for 1 × 1, 2 × 2, 3 × 3 cm2 field size, respectively, and maximum neutron absorbed doses reached 903, 253, 131 (µGy/Gy photon dose) for 1 × 1, 2 × 2, 3 × 3 cm2 field sizes, respectively.

Comparing the results with those in the presence of circular cones showed that circular cones reduce photoneutron production for the same nominal field sizes.

Myositis ossificans (MO) is a rare disorder of ectopic ossification in soft tissue or muscle, usually associated with trauma or hereditary conditions. Surgical excision is the mainstay of treatment with anti-inflammatory medications. Radiotherapy is used as an adjuvant therapy, to treat residual lesions and to relieve symptoms.

A 36-year-old male presented with a localised tender swelling in left popliteal fossa and progressive pain in lower limb for 6 weeks and restricted mobility for 3 weeks. A local excision of calcified mass arising from fascia of left popliteal fossa was consistent with MO features. Due to persistent symptoms and a residual lesion on imaging, adjuvant external beam radiation therapy (EBRT) was planned with a low dose of 10 Gy (Gray) in 2 fractions on 2 consecutive days in a prone position after 2 weeks using 6 MV (mega voltage) photon beam on linear accelerator (LINAC).

Radiotherapy resulted in a significant clinical improvement without any related acute toxicities. Patient is disease-free and on regular follow-up without any progression after 2 years.

Post-operative EBRT can stabilise residual MO and treat intractable pain when lesion lies in the vicinity of a neurovascular bundle

Educational gamification is the introduction of game elements into other activities such as teaching and learning. VERT is a tool in therapeutic radiography that lends itself to gamification as it allows students to experiment and learn at no risk to the patient. The aim of this study was to evaluate the use of a gamified simulation using competitive task elements.

A total of 78 participants undertook the study which involved a demonstration and practice patient set-up followed by an unassisted timed patient set-up. Once complete the students score was added to a leaderboard.

Results show very good students’ feedback on the simulation elements, and that skills were transferable and would improve clinical performance. Gender differences were observed in the competitive feedback on two items, satisfaction from competing and competition encouraging performance.

Overall the competitive aspect was viewed positively by students, although females appeared to enjoy the competitive aspects less than the male students, deriving significantly less satisfaction from the competitive element of the simulation. Despite the emphasis on teamwork within the profession, competitive gamification does appear to have a role within the undergraduate curriculum if carried out correctly.

The primary intent of cancer treatment is either curative, prolongation of patient life, or to improve patient quality of life; however, treatments are associated with various side effects that may impact patient wellbeing. Thus, understanding the patients’ wellbeing from the patient’s perspective is essential as it could help enable the provision of the necessary support for patients throughout their cancer journey.

We analysed Edmonton Symptom Assessment System (ESAS) questionnaire responses completed by 19,288 patients over 201,839 visits to our Cancer Centre. As part of their routine and standard of care, patients completing the questionnaire are asked to score 6 physical and 2 psychological symptoms as well as overall wellbeing using an 11-point numerical rating scale ranging from 0 to 10, where 0 means complete absence of the symptom or best overall wellbeing and 10 means worst possible symptom or worst overall wellbeing. We used the ESAS responses to characterise the relationship between the overall wellbeing score and concurrent symptoms scored by cancer patients.

Patients reported tiredness and nausea as the physical symptom causing the most and least distress respectively. Patients that reported severe (7–10) wellbeing also scored high mean scores for tiredness (6·2 ± 2·7), drowsiness (4·7 ± 3·1) and lack of appetite (4·4 ± 3·4). Univariate and multivariable logistic regression analysis suggests higher odds for patients to report moderate-to-severe (4–10) wellbeing when they report moderate-to-severe concurrent symptoms compared to none-to-mild concurrent symptoms.

Our findings suggest that patients’ overall wellbeing as reported by the ESAS system is influenced by a number of concurrent symptoms. Tiredness was found to impact patients’ overall wellbeing to a greater extent than other concurrent symptoms. The sum of physical or psychological symptom scores was stronger indicators of a patient’s overall wellbeing compared to the scores of individual symptoms.

To analyse the dosimetric benefit of the hybrid inverse planning optimisation (HIPO) planning method over the graphical optimisation (GrO) planning method for 3D volume-based intravaginal brachytherapy (IVBT) in a mono-centre patient cohort.

Twenty-five patients surgically staged with endometrial cancer were considered for the study. All the patients had received adjuvant IVBT for three fractions with one-time computed tomography image-based planning. The data on the patient, tumour, plan, and treatment characteristics were retrieved from the database. All the plans were re-optimised with GrO and HIPO techniques for this comparison study. The different dosimetric parameters were compared between the two methods, and the collected data were tabulated and shown graphically. The statistical evaluation was performed with IBM SPSS version 26, and Origin Pro 8.5 was employed for plots.

HIPO plans show similar target coverage in terms of D 90(%), V 95(%) and conformity index with no significant statistical difference from the GrO plans with an acceptable increase in homogeneity index (0·087 ± 0·062%). It succeeds in achieving a statistically significant reduction of dose to organs at risk such as D0·1 cc, D1·0 cc and D2·0 cc for the bladder (11·59%, 4·8% and 3·99%), rectum (41·33%, 16·9% and 16·05%) and sigmoid (20·97%, 13·53% and 11·21%), respectively, in comparison with GrO optimisation.

Considering the dosimetric outcome of 3D-based IVBT, it is suggested to adopt inverse optimisation techniques like HIPO over GrO to achieve higher quality treatment plan in terms of adequate target dose and lesser dose to OARs.

A small number of studies have confirmed the advantage of generalised equivalent uniform dose (gEUD) optimisation for some standard clinical scenarios; however, its performance with complicated stereotactic treatments is yet to be explored. Therefore, this study compared two planning optimisation methods, gEUD and Physical dose, in stereotactic treatments for several complex anatomical locations.

Thirty patients were selected, ten each for sites of brain, lung and spine. Two stereotactic plans were generated for each case using the gEUD objective and Physical objective cost functions. Within each of the three sites, dosimetric indices for conformity, gradient and homogeneity, along with parameters of monitor units and dose–volume histograms (DVHs), were compared for statistical significance. Additionally, patient-specific quality assurance was conducted using portal dosimetry, and the gamma passing rate between the two plans was evaluated.

Optimisation was better with a gEUD objective as compared with Physical objective, notably sparing critical organs. Overall, the differences in mean values for six critical organs at risk favoured gEUD-based over Physical-based plans (all six 2-tailed p-values were < 0·0002). Furthermore, all differences in mean values for DVH parameters favoured gEUD-based plans: GTVmean, GTVmax, PTVD100V, homogeneity index, gradient index and monitor unit (treatment time) (each 2-tailed p < 0·05).

gEUD optimisation in stereotactic treatment plans has a clear and general statistical advantage over Physical dose optimisation.

Nodal boost is being increasingly employed to escalate the dose to involved nodes in node-positive cervical cancer. The study aimed to compare the dosimetric differences between sequential boost intensity-modulated radiation therapy (SeB-IMRT) and simultaneous integrated boost IMRT (SIB-IMRT) in terms of target coverage and organs-at-risk (OARs) with special emphasis on the effect of nodal shrinkage and anatomical change of normal tissues during radiotherapy.

Two computed tomography (CT) datasets (of phase I and phase II) of 40 patients of node-positive cervical cancer treated with SeB-IMRT [planning target volume (PTV) 45/25] followed by SeB to residual nodes (PTV 12·6/7) were utilised. SIB-IMRT1 plan consisted of PTV pelvis and para-aortic nodal region (PTV 45/25) and SIB to gross nodes (PTV 55/25). In order to account for the change in nodal and normal tissue topography during treatment, a third plan (SIB-IMRT2) was generated by utilising the SIB-IMRT1 plan for 44 Gy in 20 fractions and reproducing the plan on the second CT dataset for 11 Gy in 5 fractions. Dosimetric parameters of the three plans were compared using the Friedman test with Bonferroni correction.

We observed that the doses to OARs (bowel, rectum and bladder) were significantly higher in SeB-IMRT plan as compared to the SIB-IMRT plans. V40 Gy of bowel for SeB-IMRT, SIB-IMRT1 and SIB-IMRT2 plans were 354·8 cc, 271 cc and 321·8 cc, respectively (p = 0·001), whereas V30 Gy were 687·8 cc, 635·5 cc and 680 cc, respectively (p = 0·001). The target coverage was marginally better in SeB-IMRT plan as compared to SIB-IMRT1 and SIB-IMRT2 plans (V95% = 99·2 versus 97·7 versus 97·9, respectively, p = 0·000)

SIB-IMRT led to better sparing of OARs, especially bowel. However, the magnitude of benefit decreases if the change in nodal and normal tissue topography during radiotherapy is not considered implying the need for frequent image guidance when SIB-IMRT is planned for node-positive cervical cancer.

It is already well-understood that patients requiring multiple hospital visits deal with several barriers. This paper considers a new methodology for determining the barrier that travel can cause, applying it to the mixed rural-city population of South-West Wales, calculating the travel burden for patients accessing radiotherapy. Travel burden could factor into conversations around optimisation of appointments and the impact of changes to treatment pathways.

Patient-specific travel data were calculated using Google Maps, for 1516 patients attending South-West Wales Cancer Centre for radiotherapy, modelled for 5-fraction and 15-fraction regimes.

28% of patients travelled for longer than 60 minutes. Moving to a 5-fraction treatment regime saves 20 one-way trips to the hospital, resulting in an average time saving of 15.9 hours for those travelling by car and 39.3 hours for those travelling by public transport. On average, this reduces carbon dioxide emissions by 91 kg per patient.

Implementation of a 5-fraction treatment regime has significantly reduced the travel burden for some patients receiving radiotherapy, as well as emissions related to travel. However, access to radiotherapy services in South-West Wales varies, with certain regions facing substantial travel burdens. Further research exploring other potential options to reduce travel burden is needed.

This study aimed to investigate the patient’s perception of the usefulness and limitations of a mobile application as part of the supportive care provided to patients undergoing radiotherapy.

Patients undergoing radiotherapy between February 2023 and March 2023 at a local oncology hospital (n = 150) were invited to complete a questionnaire that assessed the patient’s smartphone knowledge, willingness to use an app during radiotherapy, perceptions of the usefulness of specific app features, and barriers to using such applications. For quantitative analysis, frequencies were obtained for all areas of interest, and the results were correlated with the patient’s demographics.

Of the 39 participants who completed the questionnaire, 82·1% had a smartphone device, 59% could use their smartphones with minimal to no help and 41% had not used their smartphones for medical purposes before. However, 79·5% of patients showed a strong interest in using a mobile app during radiotherapy. Age, gender and level of education had no significant impact on the acceptability of using the mobile application for radiotherapy purposes.

Overall, the findings indicate that most patients have access to mobile technology and are willing to use the mobile app as an additional supportive care tool.