This study used receiver operating characteristic curve (ROC) to analyse surveillance, epidemiology and end results (SEER) adenoid cystic carcinoma data to identify predictive models and potential disparity in outcome.

For the risk modelling, each factor was fitted by a generalised linear model to predict the cause-specific survival. The area under the ROC was computed. Similar strata were combined to construct the most parsimonious models. A random sampling algorithm was used to estimate the modelling errors. Risk of adenoid cystic carcinoma death was computed for the predictors for comparison.

There were 5,947 patients diagnosed from 1973 to 2009 included in this study. The mean follow-up time (SD) was 93·8 (90·6) months. Three out of five patients were women. The mean (SD) age was 58·55 (16·01) years. SEER stage was the most predictive factor of outcome (ROC area of 0·68). Sex, radiotherapy and surgery had ROC areas of about 0·57. None of the socio-economic disparities was found for treatment outcome. Radiotherapy was underused in localised and regional stages when the intent was curative, especially in older patients.

Anatomical staging was predictive and useful in treatment selection. Understaging and underuse of radiotherapy may have contributed to poor outcomes.

The main objective of this study was to compare dosimetric characterisation of high-dose-rate brachytherapy (HDR-BT) with external beam intensity-modulated radiation therapy (EX-IMRT) as a means of delivering boost dose.

Five HDR patients were selected for IMRT planning. Patients underwent ultrasound-guided catheter placement for HDR. Computed tomography (CT) images were obtained and imported into the Nucletron PLATO Brachytherapy system. The prostate, urethra, bladder and rectum were contoured on axial slices. The dose was calculated and optimised by graphical optimisation. The CT images of these structures were exported from the PLATO to Eclipse workstation for IMRT planning. For each patient, the dose–volume histogram (DVH) of HDR and IMRT plans were generated, drawn on the same scale and compared.

The dose distribution in HDR plans was non-uniform and conformed peripherally inside the planned target volume (PTV). A small volume of the prostate received a very high dose from HDR.In IMRT plans, a uniform dose distribution was observed. The DVH curves for PTV dropped sharply and reached to a zero volume of the prostate at about 6·4 Gy. In HDR plans, the DVH curves for PTV showed a long tail up to a very high dose. About 10% of the prostate received about 13·3 Gy, which is 222% of the prescribed dose (6 Gy) in HDR plans. In contrast, the same volume in IMRT plans received <6 Gy (100%). The average dose for V90 was about 6·3 Gy for HDR and 5·8 Gy for IMRT plans. At a prostate volume of V100 level, the average dose in all plans was 5·0 Gy from HDR and 5·4 Gy from IMRT plans. In HDR plan, the V100 dose for urethra varied from 0·6 to 3·0 Gy (average 1·8 Gy). The range in IMRT plans varied from 3·6 to 6 Gy with an average of 4·7 Gy. At V90 level, the dose range in HDR and IMRT plans varied from 2·5 to 4·7 Gy (average 3·8 Gy) and 4·8 to 5·4 Gy (average 5·3 Gy), respectively. In general, the dose to the bladder and rectum was comparatively lower in HDR than in IMRT plans.

HDR brachytherapy may reduce normal tissue toxicities in prostate boost treatments, even though the dose homogeneity inside the PTV is far worse than in IMRT treatments. Another advantage of HDR over IMRT is that the organ motion is not a significant concern as in IMRT.

Palliative cancer care is by definition multi-professional in nature. An interdisciplinary approach to disease management emphasising continuity of care results in increased quality of life for patients and families. Complex disease management demands the provision of a full spectrum of high-quality care; requiring both specialist and generalist services. Appointed keyworkers are knowledgeable about patient preferences enabling effective coordination of care and promotes collaborative team-working. The need for diversity in the provision of palliative care is recommended but can challenge effective interdisciplinary collaboration by creating tension and limiting the interdisciplinary team (IDT) from reaching its full potential resulting in adverse outcomes.

The purpose of this paper is to review the literature available regarding how IDTs and keyworkers influence high-quality palliative care; evaluate how professional culture barriers can influence team collaboration; discuss the keyworker role in minimising these barriers and clinical implications.

A review of the English literature from 2003 to 2013 was performed using the databases PubMed (NML), OVID Medline and Google Scholar.

Keyworkers can help overcome professional culture barriers that result from ineffective team communication. Facilitating improved communication regarding professional roles fosters mutual understanding among team members. The dissemination of relevant and timely information minimises fragmentation, prompting team decision-making and promotes continuity of high-quality palliative care.

We studied symptomatic radiation pneumonitis (RP) and changes in pulmonary function tests (PFTs) after loco-regional radiotherapy (LRRT) with V20 lung constraints in breast cancer (BC).

Sixty-four women underwent PFTs before and 5 months after 3D planned LRRT for BC. The incidentally irradiated ipsilateral lung V20 was minimised to <30%. Patients were monitored for symptoms of RP 1, 4 and 7 months after radiotherapy (RT) and data on covariates were collected prospectively. The outcome was compared with previous treatment series.

Pneumonitis was less frequent with the applied constraint, that is, four mild and one moderate case, than in our previous report (p < 0·001). In multivariate analyses, neither dosimetric data nor covariates appeared to influence mean changes in vital capacity [−0·11L, standard error of the mean (SEM) 0·03] or diffusing capacity of the lung for carbon monoxide (DLCO) (−0·20 mmol/kPa/min, SEM 0·01), except for pre-RT chemotherapy, which diminished the change in DLCO 5 months post-RT.

The used constraint and 3D planning lowered the rate of RP and short-term changes in PFTs compared with our previous treatment series. Pre-RT chemotherapy affects DLCO baseline levels. Rates of side effects should be continuously studied when new target definitions or therapies are introduced in LRRT of BC.

Therapeutic radiographers routinely offer advice to patients regarding treatment-related side effects. Cranberry has long been used as a natural remedy for several health complaints and has more recently been suggested as having a role in the treatment and prophylaxis of urinary tract infection (UTI) and symptoms.

The aim of this review was to investigate whether there is a place for cranberry as part of the management of radiation cystitis caused by radiotherapy treatment of pelvic cancers, in order to aid therapeutic radiographers in tailoring their advice regarding pelvic side effects.

A structured search was carried out using PubMed, CINAHL, Scopus and Cochrane Library databases. A total of 25 articles were selected for review.

Themes of mechanism of action of cranberry, composition of cranberry products, cranberry and UTI, use of cranberry in radiotherapy and further issues to consider were identified and explored.

A lack of high-quality data was identified in the literature reviewed and no firm evidence was found to support the continued recommendation of cranberry as part of management of radiation induced urinary tract side effects. Well-designed randomised controlled trials are required before further recommendations regarding the use of cranberry in radiotherapy are made.

Calypso® 4D Localization System is a system based on electromagnetic transponders detection enabling precise 3D localisation and continuous tracking of tumour target. This review intended to provide information in order to (1) show how Calypso® 4D Localization System works, (2) to present advantages and disadvantages of this system, (3) to gather information from several clinical studies and, finally, (4) to refer Calypso® System as a tool in dynamic multileaf collimator studies for target motion compensation.

A structured search was carried out on B-On platform. The key words used in this research were ‘Calypso’, ‘Transponder’, ‘Electromagnetic Localization’, ‘Electromagnetic Tracking’, ‘Target Localization’, ‘Intrafraction Motion’ and ‘DMLC’.

Treatment the implanted transponders are excited by an electromagnetic field and resonate back. These frequencies are detected and Calypso® software calculates the position of the transponders. If the movement detected is larger than the limits previously defined, irradiation can be stopped. The system has been proven to be submillimetre accurate.

Calypso® System has been presented as an accurate tool in prostate radiotherapy treatments. The application of this system to other clinical sites is being developed.

The Calypso® System allows real-time localisation and monitoring of the target, without additional ionising radiation administration. It has been a very useful tool in prostate cancer treatment.

Patients require information to make informed decisions and consent to medical treatment. Shared decision making (SDM) is a methodology that promotes a patient-centred approach to informed consent and demonstrates respect for autonomy

The purpose of this paper is to critically review the legal and ethical issues relevant to Canadian and UK informed consent and SDM practices and how these processes relate to current palliative care practices, with a particular emphasis on radiation therapy.

A review of the English literature from 2003 to 2013 was performed using the databases PubMed (NML), OVID Medline and Google Scholar.

The literature identifies that palliative cancer patients desire the opportunity to be involved with decision-making discussions, which has shown to increase knowledge and result in better health-related outcomes. However, ethical and legal issues regarding the practicality of including this patient population in SDM discussions raises questions about validity of consent. For SDM to be considered a valid methodology to obtain informed consent, open and honest communication between the patient and multidisciplinary team is essential. Treatment options for palliative cancer patients are often complex and SDM allows healthcare professionals and patients to exchange information and negotiate feasible treatment options based on medical expertise and patient preferences.

Legal frameworks have defined current standards of practice for various healthcare professions, including radiation therapy. Radiation therapists, as members of the multidisciplinary team, are currently key contributors in providing information to patients regarding the radiotherapy process. Individuals working within advanced practice roles have the ability to develop skills once considered to be within medical domains and have begun to incorporate the delegated act of obtaining informed consent into practice which has shown to increase professional autonomy, accountability and improves patient-centred care.

Oral mucositis is common for patients undergoing chemoradiotherapy for squamous cell carcinoma of the head and neck (SCCHN). Despite the significant detrimental sequelae associated, there is no consensus on the optimum mouth care regimen. This prospective audit aims to record mucositis and dysphagia toxicity and the level of analgesia prescribed when recent products: MuGard™, Caphosol® and Episil® are compared with our standard departmental mouth care regimen.

Patients undergoing concurrent chemoradiotherapy for locally advanced SCCHN at University Hospital Birmingham, UK were prospectively audited weekly for 8 consecutive weeks starting from week 1 of chemoradiotherapy from June 2009 until January 2011. Patients received either standard oral care regimen of aspirin, glycerin and sucralfate, or, MuGard™, Caphosol® or Episil®. Grade of mucositis, dysphagia and analgesia score were prospectively recorded using the common toxicity criteria v3·0.

One hundred and four patients were included. There was no difference in the grade and duration of mucositis (p = 0·82), dysphagia (p = 0·99) or analgesia score (p = 0·61) for either MuGard™, Caphosol® or Episil® compared with standard oral care.

There is no evidence from this audit that Mugard™, Caphosol® or Episil® improves mucositis and dysphagia toxicity or the level of analgesia prescribed compared with our standard departmental mouth care regimen. Randomised trials comparing these approaches are required to detect any meaningful clinical benefit.

We review augmented (AR) and virtual reality (VR) applications in radiotherapy as found in the scientific literature and highlight future developments enabled by the use of small mass-produced devices and portability of techniques developed in other fields to radiotherapy.

The application of AR and VR within radiotherapy is still in its infancy, with the notable exception of training and teaching applications. The relatively high cost of equipment needed to generate a realistic 3D effect seems one factor that has slowed down its use, but also the sheer amount of image data is relatively recent, were radiotherapy professionals are only beginning to explore how to use this to its full potential. This increased availability of 3D data in radiotherapy will drive the application of AR and VR in radiotherapy to efficiently recognise and extract key features in the data to act on in clinical decision making.

The development of small mass-produced tablet devices coming on the market will allow the user to interact with computer-generated information more easily, facilitating the application of AR and VR. The increased connectivity enabling virtual presence of remote multidisciplinary team meetings heralds significant changes to how radiotherapy professionals will work, to the benefit of our patients.

A systematic literature review was conducted to critically examine patient selection for patients undergoing stereotactic body radiotherapy (SBRT) to the spine and pancreas on the CyberKnife robotic radiosurgical system (CK). Online databases were searched and data was collected and ranked using a system from the Scottish Intercollegiate Guideline Network. The quality of the evidence analysed was insufficient to generate universal recommendations. However, the conclusions reached do help to demonstrate the safety and efficacy of CK treatment to both pancreatic and spinal patients.

Excellent local control rates and minimal acute toxicity were reported within the spinal literature with uncertainties remaining with regard to the precise tolerance of the spinal cord and the reliability of current toxicity prediction methods. For pancreatic patients prognosis remains dismal due to the tendency for patients to present with advanced or inoperable disease. Combinations of CK SBRT and Gemcitabine chemotherapy are given though regimes vary and overall survival is not extended due to the rapid onset of distant metastases. New chemotherapy agents are required as well as better means of predicting response to treatment.

No randomised controlled trials or meta-analyses were identified in the review and these are required in order to generate universal guidelines

An emerging developmental tool to help radiation therapists achieve better outcomes is ‘peer review’. This review of the current literature summarises the challenges and benefits of peer review in both individual and departmental practice.

There is compelling evidence supporting peer review implementation at both individual and department level in many professions. Implementing peer review requires that radiation therapists and other radiation oncology professionals embrace a culture that supports safety. Peer review can identify trends and barriers associated with quality radiotherapy and share best practice or recommend changes accordingly. Support for peer review must come from pre-registration educational systems as well as clinical managers. Continuing professional development in the workplace is nurtured by peer review of radiotherapy practice and an aptitude for this should be viewed as important to the profession as technical and clinical skills.

It is clear that peer review has the potential to facilitate reflective practice, improve staff motivation and help foster a culture of quality and safety in radiation oncology. To drive the issues of quality and safety a step further radiation therapists need to accept the challenge of adopting peer review methods in day-to-day practice.

Key advances in cancer treatment have led to an increasing number of long-term cancer survivors. Knowledge of the long-term effects of cancer treatment on leukaemia survivors is to some degree limited. This article investigates the effects of the treatment of childhood leukaemia on the quality of life (QOL), the physical and the psychological wellbeing and general development of survivors. This article reviews current literature to examine existing gaps in knowledge and identify a potential focus of future research and clinical practice.

Online systematic searching, along with historical searching took place in order to retrieve relevant primary research papers for the review. Strict inclusion and exclusion criteria were applied to the literature, to create a manageable amount of research papers.

The extent of intellectual impairment among radiotherapy patients was significantly greater than those treated with chemotherapy only. Body composition, including endocrine function, is readily affected by cancer treatment. Early identification and interventions can greatly improve the QOL of survivors.

Further research into the effect of treatment modality on the extent of chronic effects, along with investigations into the needs of the whole family unit, is required. Future practice must take into account long-term implications while ensuring effective holistic care.

Patients with cancer undergoing radiotherapy often develop diarrhoea, causing distress and hindering treatment. As probiotics have favourable effects on the gut flora, they are potentially good candidates in the prevention of radiotherapy-induced diarrhoea (RID).

The outcome of interest of this systematic review was the efficacy of probiotics in preventing RID.

Medline and Embase databases were systematically searched. Four randomised controlled trials (RCTs) were finally selected.

Three RCTs showed beneficial results, which were statistically significant. One RCT showed non-beneficial results, which were not statistically significant. The quality of the studies was mixed, and serious limitations were found.

While the indications are towards a benefit of the use of probiotics in preventing RID, more robust evidence is required in the form of well-designed RCTs.

Papillary thyroid carcinoma combined with thyroid mucosa-associated lymphoid tissue (MALT) lymphoma is exceedingly rare and there is no standard management.

We report a rare association of MALT lymphoma of thyroid in a 60-year-old woman with Hashimoto's thyroiditis along with an incidental focus of papillary carcinoma.

Patients with Hashimoto's thyroiditis are prone to develop other thyroid pathology, including rare tumours such as MALT lymphoma. The differential diagnosis for a neoplasm in such patients should be wide.

To demonstrate the importance of fluid management in the perioperative period by presenting a case of hyponatraemic seizures following prostate brachytherapy.

A 61-year-old gentleman, who had prostate cancer but was otherwise well, developed confusion and word-finding difficulties the day after prostate brachytherapy. This was followed by tonic–clonic seizures that necessitated treatment, intubation and ventilation, and admission to the intensive care unit. Investigations revealed serum sodium of 116 mmol/L. Fluid balance was inadequately recorded, but the patient had drank more than 3 L of water before he developed hyponatraemia.

Postoperative severe hyponatraemia and hyponatraemic encephalopathy develop because of anti-diuretic hormone release and hypotonic fluid administration. These are medical emergencies and should be managed in an intensive care unit. Symptoms range from headache, nausea and confusion to seizures, respiratory arrest and death, and are related to cerebral oedema. Treatment is done using hypertonic sodium chloride to increase the serum sodium to safe levels. Care should be taken to avoid overly rapid correction of serum sodium. Complete documentation of fluid balance is essential to allow proper assessment of fluid status. Patients should be advised on appropriate oral fluids in the postoperative period.

Metastasis to the thyroid gland is a rare event.

We describe an unusual case of a 38-year-old woman with a history of small-cell lung cancer (SCLC), presenting with a new nodule in the thyroid gland, found to be metastatic SCLC, without evidence of widespread dissemination.

A new thyroid nodule should be carefully evaluated for metastasis in a patient with a history of prior malignancy.