Aim: To assess the efficacy of a probiotic preparation on the prevention of radiation-induced diarrhoea in cancer patients.

Methods: Group of 42 radio-oncology patients who had undergone adjuvant post-operative radiation therapy (RT) after abdominal and pelvic cancer were randomised to receive either the probiotic preparation “5” Strain Dophilus (twice per day; L-Group), or the preparation Hylak Tropfen Forte (40 drops, three times per day; H-Group). Supplementation started on the first day and lasted until the end of RT. Efficacy endpoints were the incidence and the severity of the radiation-induced diarrhoea. All patients received a paper form in which they recorded monitored parameters on a daily basis during RT.

Results: The mean daily number of bowel movements during the whole period was 4.16 in the L-Group and 2.52 in the H-Group; 62.5% of patients in L-Group and 81% in H-Group had a mean daily number of bowel movements of ≤4/day. Abdominal pain was recorded in 25% of the patients in L-Group and 22% of the patients in H-Group. Blood in the bowel movement was found in one patient from H-Group (9 days). Of patients in L-Group, 27% required diphenoxylate treatment during pelvic radiotherapy, compared with 55% in H-Group. Of patients from L-Group, 9% required antibiotics administration, compared with 25% in H-Group.

Conclusion: We concluded that the prophylactic probiotic therapy produced a highly favourable benefit/risk ratio. Supplementation with the probiotic preparation is an easy and safe approach to protect cancer patients from the risk of radiation-induced diarrhoea and carry out improvement in their quality of life.

When upgrading treatment planning software, it is important to understand and characterise any changes that may have been made to the system. This includes inverse treatment planning and dose optimisation software used for intensity-modulated radiation therapy (IMRT). A systematic and practical approach to characterising dose optimisation software following upgrades is presented based on a planning study of six IMRT prostate cases using the commercial treatment planning system Oncentra Masterplan (OMP). Upgrades included general changes in the fluence to multileaf collimator (MLC) segmentation algorithm, a change from a two-step to a one-step optimisation method and an upgrade of the dose calculation algorithm. Post upgrade changes in plan parameters such as calculation times, monitor units, segments and target doses were analysed. A 32% reduction in total calculated monitor units was observed following the general software upgrade. A smaller 12% reduction was observed when using the optional one-step optimisation method rather than a two-step process using a classic dose calculation algorithm. An increase in monitor units of approximately 12% was observed when changing to an enhanced dose calculation algorithm. The enhanced dose calculation algorithm accounted for MLC type, leakage and source size unlike the previous classic dose calculation algorithm. Differences in dose to volumes between fluence segmentation and final dose calculation varied between versions. These differences were found to be minimal for the most recent treatment planning system version. Repeatability tests revealed a more effective use of the system. The characterisation of the effects of treatment planning software upgrades allowed a better appreciation of IMRT planning and delivery attributes. Although this work is based on one commercial inverse treatment planning system, it would be easily transferable to other systems as the underlying system principles are the same.

A computer user-code (TRANSMIT), based on the use of the EGSnrc Monte Carlo system, was developed to simulate the transmission of megavoltage x-rays through three different materials used for shielding purposes in radiotherapy. These materials are Lipowitz’s metal, lead and Rad-block. The simulations were performed for 4, 6 and 10 MV x-rays using narrow beam geometry in air. The linear attenuation coefficients, in cm–1, obtained from the simulated transmission curves for Lipowitz’s metal were 0.494, 0.470 and 0.452 for 4, 6 and 10 MV, respectively. For lead, the linear attenuation coefficients were 0.532, 0.507 and 0.483 for 4, 6 and 10 MV, respectively. For Rad-block, the linear attenuation coefficients were 0.561, 0.537 and 0.518 for 4, 6 and 10 MV, respectively. Comparison of the simulation results with experimental results reported in the literature gave a percent deviation <5% which indicates the validity of the simulation results. In addition, broad beam geometry calculations were performed for a variety of field sizes (10 × 10 cm2, 20 × 20 cm2 and 40 × 40 cm2) using the three different attenuators. The results showed that broad beam attenuation coefficients decreased with increased field size and photon energy. For Lipowitz’s metal, the difference in the linear attenuation coefficient data between the broad beam attenuation coefficient and the narrow beam value lies between 3.6% and 20% depending on x-ray energy and field size. Similarly, the difference between the broad beam attenuation coefficient and the narrow beam value for lead lies between 1.5% and 10.4%. For the Rad-block material, the difference lies between 0.53% and 6.8%.

Purpose: To determine the pattern of care and survival in older patients with breast cancer.

Methods: The study population included 228 women aged ≥60 years with breast cancer treated between 1992 and 2002. Analysis was done for surgery, radiotherapy (RT), chemotherapy and hormonal therapy. Outcomes studied were locoregional recurrence (LRR) distant metastases, disease-free survival (DFS) and overall survival (OS) using univariate and multivariate analyses. Kaplan–Meier method was used to estimate DFS and OS.

Results: Mastectomy was done in 208 (91%) patients and conservative breast surgery (CBS) only in 20 (9%) patients. Majority of the patients received adjuvant RT 179 (78.5%). Chemotherapy was given to 49 (21.5%) patients and hormones to 204 (89.5%) patients. LRR with or without distant metastases was 7% and distant metastasis rate was 19.3%. DFS at 10 years was 69%. With RT, DFS was 76% in patients aged <65 years and 73% in aged ≥65 years (p = 0.13). It was 73 and 86%, respectively, with chemotherapy (p = 0.041). DFS with hormones was 96% in patients aged ≥65 years and 79% in aged <65 years (p = 0.028). The OS was 74% at 10 years. RT improved OS in all patients. OS with chemotherapy was 94% in patients ≥65 years, and 82% in patients <65 years (p = 0.044). With hormonal therapy OS was 96% in patients aged ≥65 years and 78% in patients <65 years (p = 0.020).

Conclusion: CBS rate and chemotherapy use is very low in elderly women with breast cancer in India. Adjuvant RT, chemotherapy and hormonal therapy offered a therapeutic advantage in these patients.

Objective: Extra-cranial Stereotactic Radiation Therapy (ESRT) techniques and equipment utilised in the treatment of Stage 1 or 2 inoperable non-small-cell lung cancer (NSCLC); accounting for Respiratory Induced Tumour Motion (RITM).

Methods: A narrative review of current world literature.

Results: Four main strategies are employed to address RITM: (1) tumour movement minimisation/immobilisation; (2) integration of respiratory movements into planning; (3) respiratory-gating techniques; and (iv) tumour-tracking techniques.

Discussion: Analysis of data gathered suggests that due to inherent difficulties with respiratory function, combined with co-morbidities and the level of dose escalation facilitated by ESRT: techniques that do not require patient ability to comply are more likely to be effective with a wider range of patients. Similarly, treatment planning must incorporate accurate four-dimensional (4D) data to ensure target coverage, although setup and verification should be controlled to smaller margins for error.

Conclusion: The disparate nature of reporting methods restricts statistical comparison. However, this paper suggests that the ESRT technique using abdominal compression (AC), free-breathing respiratory-gating (FBRG), 4D computed tomography (4DCT) planning, combined with daily on board kV cone beam computed tomography (CBCT) imaging for setup and target verification, is a possible candidate for further treatment regime assessments in large multi-centre trials.

Objective: Percutaneous endoscopic gastrostomy (PEG) tube insertion is used as an alternative to surgical gastrostomy in patients with head and neck cancers for nutritional support.

Methods: We report two cases of head and neck cancer with metastasis to the surgical PEG tube site. The clinical and treatment-related details are discussed.

Conclusions: Metastasis to PEG tube site is a rare occurrence.