Recently published evidence has shown an improvement in locoregional control and a survival advantage in the treatment of squamous cell carcinomas of the head and neck (SCCHN) using cetuximab, a monoclonal antibody that inhibits the tumour-promoting mechanism of the epidermal growth factor receptor (EGFR). In a large randomised trial, cetuximab was delivered concurrently with radiotherapy and compared to radiotherapy alone in locally advanced SCCHN. The trial showed that the addition of cetuximab offers improved locoregional control and survival without enhancing acute toxicity compared to radiotherapy alone. These exciting results have the potential to change standard head and neck cancer practice, impacting on head and neck cancer services provided by oncology departments and multidisciplinary working.

This article aims to define the mechanism of action of cetuximab, critically appraise the evidence for the use of cetuximab within Oncology departments for SCCHN, and critically evaluate how cetuximab may impact on current practice. Future possibilities and trials to assess the use of cetuximab within clinical practice will also be discussed.

The reduction in dose received by normal tissue is essential in radiotherapy to reduce the chance of late side-effects. This is especially true in paediatric radiotherapy as any late-effects can seriously impair the future quality of life experienced by the treated child.

Particle therapy uses high-energy particles to deliver a surgically precise beam of energy to a pre-determined position in the body. Common side-effects associated with conventional radiotherapy (CRT) are considerably reduced, often virtually eliminated, owing to the reduction in dose received by neighbouring healthy tissues, improving future quality of life. The superior accuracy of particles also means the dose can be escalated improving control rates.

Clinical trials, reviews and planning studies have been reviewed to assess the benefits and limitations offered by particle therapy in paediatric treatments. The reduced integral dose and improved conformity is clearly highlighted throughout these studies, demonstrating the potential advantages available with particles when treating paediatric patients.

The data suggest that the advantages experienced with particle therapy result in a significant reduction in the side-effects experienced and therefore an improvement in quality of life when compared with conventional therapy. Owing to the reduction of subsequent sequelae, paediatric patients need to be considered when designing and constructing a particle centre in the UK.

Aims: Monitoring and reviewing patients during adjuvant radiotherapy for breast cancer is an integral component of care and was until recently a predominantly medical domain. Patients were often reviewed in busy routine breast clinics, for short consultations with a variety of medical staff and with little time to address questions or concerns. Non-medical treatment review clinics, staffed by senior nursing and senior therapy radiographers have been introduced to provide a dedicated, consistent treatment review. This survey was conducted to assess the effectiveness of the non-medical review of these patients.

Materials and methods: This was a prospective survey of all patients attending for breast or chest wall radiotherapy, between 1st July 2003 and 30th June 2004. Patients were invited to complete and return a postal questionnaire related to their treatment and treatment review. Review staff collected data on demographic information, clinical history and treatment intent for these patients at first visit. At subsequent weekly review visits, data were recorded relating to patient assessment, interventions and referrals initiated. Skin reactions were graded using Radiation Therapy Oncology Group scoring tool.

Results: One thousand and ninety-five patient questionnaires were distributed and 865 (79%) were returned. There were high satisfaction scores with the time spent with review staff (99.7%) and the ability to discuss all aspects of treatment and concerns (99.1%). One hundred and ninety-three patients were referred to non-medical staff for additional support. Five hundred and forty-four were referred to medical staff. The majority (437) were planned referrals to their clinical oncologist to prescribe a ‘boost’ or review endocrine treatment and 107 to their general practitioner for routine visits and employment certificates. Review staff data of 1,067 patients showed 342 referrals for treatment and non-treatment related physical problems, 80 referrals for additional information and emotional support. Majority of skin reactions were grade 1 or 2a.

Conclusion: The successful identification of patients’ supportive needs and high patient satisfaction with this service supports the use of this approach.

Introduction: In squamous-cell carcinoma (SCC) of the head and neck, unplanned gaps risk prolongation of the overall treatment time (OTT) and reduction in tumour control. This audit determines whether further acceleration can safely be employed to compensate for missed treatments during accelerated hypofractionated radiotherapy.

Methods: Patients receiving accelerated hypofractionated radiotherapy for SCC of the head and neck were prospectively audited. Outcome measures were OTT, degree of compensation and acute toxicity determined by incidence of grade 3 mucositis, prolonged grade 3 mucositis, grade 3 dysphagia and pain.

Results: In the 87 patients identified, the dose administered was 55 Gy in 20 fractions (81 patients), 50 Gy in 20 fractions (1 patient) and 50 Gy in 16 fractions (5 patients). Of those patients receiving 20 fractions, 94% completed within 28 days. Grade 3 mucositis was seen in 56 patients (64%). Compensating for unplanned gaps did not result in any significant increase in toxicity. Administering 6 fractions/week, as compensation, was associated with a lower pain score (p = 0.003) as was receiving 2 fractions on the same day (p = 0.0004).

Conclusions: Accelerated hypofractionation is tolerable with most patients completing treatment within the planned OTT. When unplanned gaps occur, then compensation by further acceleration is possible.

Purpose: The purpose of this review was to explore the literature on the use of hyperthermia (HT) in advanced breast cancer.

Methods: A literature search was conducted to obtain information from recent trials of HT and/or chemotherapy (CH) and radiotherapy (RT) for patients with locally recurrent breast carcinoma. Issues concerned with patient compliance and side effects have also been reviewed and future recommendations for research made.

Results: Results of recent trials have demonstrated promising outcomes for HT and RT in combination, particularly for recurrent disease to improve local control (LC). There is no evidence, however, to support a positive effect on overall survival.

Conclusions: Despite positive results HT has not been widely embraced, due to financial and logistical limitations. Future recommendations include larger, randomised, controlled studies and the development of temperature mapping to avoid potentially limiting HT blisters.

Purpose: The purpose of this case study is to discuss factors that have an influence on the process of role development in radiotherapy breast planning.

Key themes: This article describes the process of development as experienced by the author and discusses factors that hindered the process of role development. These factors include development of a career plan, professional issues, resources, organisational structures, support from consultants, managers, multi-disciplinary, and professional colleagues and peer resistance.

Conclusion: The author makes recommendations that may contribute to improving the role development strategy in the profession and aid successful implementation of advanced practitioner and consultant roles for those radiographers who aspire to the consultant radiographer role in future. The article concludes that there is a need to identify, standardise and coordinate role development for therapy radiographers nationally to increase the appointment of more consultant radiographers.