Purpose: Having previously reviewed the implementation of systematic in vivo dosimetry at the Norfolk and Norwich Hospital this paper examines the results of entrance dose measurements for specific sites/techniques and determines whether different action/alert protocols are required for these different categories.

Methods and materials: Entrance dose measurements using p-type diodes were analysed for the following treatment categories: Breast, head and neck in beam direction shell, abdomino-pelvic and intrathoracic. A 4% tolerance was applied.

Results: Mean deviations from expected dose and proportion of measurements exceeding tolerance were: Breast: +1.15%±3.04% (1SD), 238/1073≥4%; Head and neck: +0.35%±2.20% (1SD), 21/326≥4%; Abdomino-pelvic: +0.52%±2.75% (1SD), 93/712≥4%; Intrathoracic: −0.01%±2.75% (1SD), 22/119≥4%. Significant improvements in results for breast patients were noted following the introduction of a commercial breast board. The results for abdomino-pelvic patients confirmed a substantial variation in diode response under short FSD, wedged fields at 16MV (that had not been corrected for). The statistical uncertainty in dose measurement for each treatment category was calculated in order to assist determination of appropriate tolerance levels.

Conclusions: A blanket tolerance of 4% was generally too low given the extent of measurement uncertainty. The relatively high number of readings outside tolerance where identification of errors was difficult/impossible resulted in inconsistent application of the action protocol. Some widening of tolerances is likely to improve quality of procedure and treatment. Appropriate action levels are recommended for each treatment category.

Spinal cord ependymomas are relatively rare tumours and their management is not well established. This retrospective analysis was performed to examine the outcome of patients treated for this malignancy at our institution between 1982 and 2004.

Hospital charts of 14 consecutive patients (10 men and four women) aged 8 to 58 years (median 32 years) were retrospectively analysed. This series included nine extramedullary and five intramedullary well differentiated (eight – G1, six – G2) ependymomas. All patients were treated with primary surgery. Postoperative radiotherapy was administered in 12 patients after subtotal excision. Total dose ranged from 35Gy in 17 fractions to 50.4Gy in 28 fractions. One patient experienced spinal axis failure despite complete resection of the primary tumour and was managed with salvage radiotherapy and chemotherapy following surgical excision of the relapse. There have been no radiotherapy-related serious side effects.

One patient was lost to follow-up. Of the remaining 13 patients, at a median follow-up of 5.5 years (3 months to 20 years), 12 were alive including 11 without progression.

Conclusion: In our group of patients radiotherapy following subtotal resection or used as a single modality was well tolerated and resulted in 92% long-term survival.

Melanoma patients can be split into two main categories that have different aims for treatment; localised disease with either intermediate or high-risk of recurrence after surgery, and metastatic disease. Over the past decade, there have been many clinical trials looking at improving the success rates for localised and metastatic melanoma with alternative systemic treatments, namely immunotherapy, biochemotherapy and vaccines. This literature review summarises the clinical trials for each form of systemic treatment in localised and metastatic melanoma and assesses the effectiveness of each by an evaluation and comparison of relevant clinical trials for each systemic modality. The main objective was to assess whether alternative forms of systemic therapy have improved the disease free and overall survival rates achieved with chemotherapy.