The accuracy of a range of immobilisation systems for head and neck radiotherapy has been measured. Two types of vacuum-formed shells, and eight thermoplastic systems have been evaluated. For each system, a mask was made for the same volunteer. A non-invasive optical system, using a scanning laser digitiser, was used to measure the displacement of a fiducial marker. The volunteer was asked to move a maximum comfortable distance in each of the superior, inferior, left and right directions, and a scan was taken at each location. Standard deviations, calculated from the maximum range of movements, were in the range of 1.7–2.9mm in the right–left direction, and 0.9–3.0mm in the superior–inferior direction. The smallest movements were measured for the Medtec S-frame, with nine-point fixation. A laser-scanning camera can assess the movement potential for a subject inside an immobilisation device with good accuracy and precision. Because ionising radiation is not used as part of the imaging process, the same subject can be used for several mask systems to assess which is the best one.

Introduction: Computed radiography (CR) is an imaging facility that does not require the use of hard copy film, digital images are obtained with a photostimulable phosphor plate, which replaces film, in a cassette. As the first UK radiotherapy site to trial CR, we are collecting data to assess the feasibility of using CR in radiotherapy treatment verification.

Method: From 30 patients undergoing radical radiotherapy, 10 were consecutively accrued to three sites: pelvis, thorax and head and neck. Treatment verification images were taken using current protocols, but substituting standard imaging for CR images on one fraction. Four independent observers were used: two clinical oncologists and two therapy radiographers. Observers rated CR, electronic portal imaging (EPI) and enhanced contrast (EC) films of the three sites for both landmark visibility and ease of verification decision, using a numerical scoring system.

Results: Ratings for visibility of landmarks and for verification decision were similar for CR and film/EPI images for most landmarks. However, CR images rated poorly compared to EC film in the head and neck region with landmarks such as thyroid cartilage and cricoid cartilage rating as ‘not clear’. CR images rated better than EPI images for both visibility and verification decision on the majority of landmarks in the pelvis region.

Conclusion: Results gathered from a relatively small sample size have provided the following conclusion. The visibility of landmarks in CR images is comparable to that in film and EPI. Verification of treatment images based on CR is comparable to that of the current imaging media in the department.

Intraoperative radiotherapy (IORT) using a miniature X-ray source has the potential to impart the same clinical benefit as external beam radiotherapy (EBRT), in a single fraction. The patient benefits are significant, since IORT could replace several weeks of fractionated EBRT. We present our initial experiences of IORT using the Zeiss Intrabeam™ system for treating early stage breast cancer and intracranial malignancies. Implementing this treatment modality requires a multidisciplinary approach drawing on the expertise of surgeons, oncologists, medical physicists, anaesthesiologists, nursing staff and pathologists. Team coherence is facilitated by a nurse co-ordinator. We have treated 66 patients in 24 months. For breast tumours, the mean treatment time was 28.54 min and the applicator sizes ranged from 3.0 to 5.0cm (mode = 4.5cm). A dose of 5Gy is prescribed to spherical volume of 1cm from the applicator surface. For brain tumours, the mean treatment time was 19.70 min and the applicator sizes ranged from 1.5 to 3.5cm (mode = 2.5cm). Mean dose was 11.1Gy prescribed to a spherical volume of 0.5cm from the applicator surface.

A multidisciplinary team is essential for the successful implementation of IORT. This paper describes how, through reliance on an oncology nurse specialist to co-ordinate the programme, we have successfully set-up an IORT service.

Background: The literature on the evaluation of the management of radiation-induced dermatitis demonstrates the methodological difficulties of studying this subject. Therefore, the feasibility of a methodology whereby the patient acted as their own control was used to study acute cutaneous side effects for head and neck radiotherapy patients using 1% hydrocortisone cream (HC).

Methods: Twenty patients were asked to apply Hyderm (1% hydrocortisone) cream twice daily to one side of the treatment area (either right or left) beginning on day one of radiation therapy and ending 2 weeks post-radiation therapy. The centres standard skin care protocol using mild soap and water and no creams was used on the other side of the neck. Once weekly the patients were assessed and scored using the Radiation-Induced Skin Reaction Scale and Radiotherapy and Oncology Group assessment scales and the patient completed a symptom scoring scale each week was a baseline assessment undertaken before they started treatment. To document compliance with study instructions, patients were asked to keep a calendar indicating when they applied the cream and to which side, and this was collected by clinical staff.

Results: At the conclusion of the study, 12 patients were enrolled. During the course of the study it became increasingly obvious that the side to which patients were applying the Hyderm scored higher on the assessment scale, indicating an increased skin reaction than the control side. This was confirmed with the photographs and patient symptom scale. As a result of these increased reactions, the study ceased accrual earlier than anticipated and all patients were advised to discontinue Hyderm use.

Conclusion: The increase in skin toxicity was unexpected, particularly as the institutional standard of care recommended the use of HC as treatment for radiation dermatitis. The number of patients in the study was too small to make conclusive statements about the efficacy of HC. We were able to confirm the feasibility of using an internal control methodology in these patients. Compliance results indicate the skin care instructions were clearly written and patients were able to follow them.

Prostate cancer is a common male cancer, and arguably the form of cancer with least certainties about most appropriate form of treatment, leading to a greater freedom of choice among patients as to which treatment they wish to undertake.

Department of Health guidelines state that to be valid, consent to treatment must be fully informed, and professional bodies demand that consent should be ongoing throughout a course of treatment. It is recognised that in spite of the wealth of information available, prostate cancer patients generally feel less well informed about their disease and treatment than those with any other form of cancer.

Information about treatment efficacy and outcome is available from a wide variety of sources, of varying reliability, and patients can as easily receive too much information as they can too little. Bias from those imparting information cannot be excluded, and patient choices could be made on the basis of inaccurate or misleading information.

Practitioners have a duty of care to ensure that patients receive a level of information appropriate to their level of understanding and ability to absorb knowledge, and longstanding legal precedents are established to ensure that risks as well as benefits of treatment are discussed with patients.

Prostate cancer has been treated with low-dose rate (LDR) brachytherapy for early localised disease in the form of permanent seed implants, with all its inherent problems in terms of dosimetry and seed migration. High-dose rate (HDR) brachytherapy has mainly been utilised as a boost to external beam radiotherapy (EBRT) in patients with locally advanced disease. However, limited studies investigating HDR as a monotherapy for early local disease are yielding promising results in terms of biochemical control and reduced toxicity. With the ability to optimise the plan and conform the dose, dose escalation can be achieved whilst sparing normal tissue. Recent studies to assess the α/β ratio of prostate cancer have shown this to be low, making this tumour sensitive to large fractions or hypofractionation. The HDR delivery and large fraction sizes may be advantageous in tumours sensitive to radiation fraction size making HDR brachytherapy the treatment of choice over LDR brachytherapy and EBRT.

There is evidence that a conservative approach with chemoradiotherapy can achieve long-term local control in patients with anal adenocarcinoma. Identification of suitable patients for this approach remains a problem. We describe a patient with a clinically staged T2N0 tumour, who achieved a complete clinical response on magnetic resonance imaging and positron emission tomography after chemoradiotherapy, but was noted to have residual disease with evidence of lymph node metastasis on pathological examination in the abdominoperineal resection specimen. A complete clinical response does not necessarily equate to pathological response.