Cancer during pregnancy has an incidence of 1/1,000, and when diagnosed, the most common ones are breast cancer (1/10,000), Hodgkin’s lymphoma (1/6,000), and head and neck cancer (1/10,000). If a diagnosis is made during pregnancy, the treatment cannot wait until delivery, and there is concern about the effects that radiotherapy may have on the foetus. The multidisciplinary group has to assess and ethically make decisions with regard to the mother and foetus.

A 35-year-old female, a carrier of Behcet’s disease, underwent 5 years of treatment with hydroxychloroquine, prednisone and low-molecular-weight heparin (the patient being a carrier of Behcet’s disease, there is a high risk for cancer of the oral cavity and oropharynx with an HR of 2·11, so the cancer could be related to the tonsil). The patient’s oncological situation started on December 2017 with a volume increase in preauricular, parotid and right mandibular angle, with a progressive growth. At this time, the foetus was of 17·5 weeks of gestation. An oral cavity tumour that invaded the right retromolar triangle was observed, and upon biopsy, a basaloid squamous cell carcinoma was diagnosed.

Radiotherapy treatment was started at 22 weeks of gestation; intensity-modulated radiation therapy (IMRT) was planned with a dose of 69·96 Gy to the primary tumour and 59·4 Gy to ganglion levels II, III and IV, bilaterally in 33 fractions. At fraction 27 a significant decrease in tumour volume was noted, so adaptive radiotherapy was performed to complete the treatment. Currently the patient has no clinical evidence of tumour pathology.

The risk of radiation exposure in pregnant women (after 20 weeks of gestation), being treated for cancers of the tonsil, reaching the foetus is minimal, with a reduced risk of a few or no effects.

Radiotherapy in tonsil cancer has been shown to be effective in combination with chemotherapy for local control of the disease. In the case of this pregnant patient, radiotherapy, as the only modality, provided local control and little exposure of radiation to the foetus.

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.

Radiation oncology information systems (OIS) play a crucial role in radiation therapy by ensuring accurate and safe delivery of treatment. A MOSAIQ OIS system is currently used to support undergraduate radiation therapist training at Queensland University of Technology. This review addresses the rationale for implementation and integration in teaching environments and explores the pedagogical benefits supported by educational theory.

A review of MOSAIQ functionality shows potential to transform learning through the development of authentic and engaging learning tasks. It provides students with an opportunity to learn two-dimensional image matching through the use of digitally reconstructed radiographs and electronic portal images as well as three-dimensional image matching using computed tomography (CBCT) data in a safe learning environment without clinical time pressures. In addition, this provides the students with knowledge of quality assurance (QA) checks through the verification of treatment parameters and the transfer of information from the planning system to the treatment units. However, there are several potential challenges and practical considerations that need to be overcome.

The application of MOSAIQ OIS could potentially transform teaching and learning strategies for student radiation therapists. Increased knowledge and hands-on skills at undergraduate levels in areas such as image matching and QA can be powerful tools to drive the standards of practice a step further.

Tumour vasculature plays an important role in the development, maintenance and sustainability of a tumour. Endothelial cells which are recruited into the tumour stroma facilitate the formation of essential blood vessels that deliver nutrients and oxygen to tumour cells. A growing body of research is showing that there are synergistic anti-tumour effects when anti-vascular agents are combined with radiation. More recent reports have described favourable radiation response as a function of vascular targeting and blood vessel breakdown, primarily through interactions of radiation with vascular endothelial cells. Vascular disrupting agents are being utilised in several forms that include molecular targeting, biophysical assault and biological interference.

In the present review, we examine current advances in anti-vascular agents to enhance tumour response when combined with radiation therapy.

A comprehensive literature search was conducted on the US National Library of Medicine, National Institutes of Health (PubMed) using the following search keywords: vascular disrupting agents, radiation sensitisation, anti-angiogenic therapy, anti-vascular therapy, radiation therapy.

Current research suggests the applicability of vascular disrupting agents as an effective radiation sensitisation agent. Pre-clinical and clinical trials have been well developed to form the theoretical framework to apply this powerful modality to the treatment of cancer.

There are only limited studies available in literature that discuss methods to reduce the oesophageal dose and acute oesophagitis during breast cancer radiotherapy. The aim of this study is to compare dose volumetric parameters of oesophagus in radiation treatment of breast with and without oesophagus delineation.

Treatment plans of 44 patients, who underwent chest wall and supraclavicular fossa irradiation, were selected for the study. Oesophagus was later delineated and treatment replanned using three-dimensional conformal radiotherapy (3DCRT) considering oesophagus as an organ at risk (OAR). The dose prescribed was 40 Gy/15 fractions to the planning target volume (PTV). Dose volumetric parameters of oesophagus such as maximum dose (Dmax), mean dose (Dmean), the percentage of oesophagus volume receiving ≥15Gy (V15), ≥25Gy(V25), ≥33Gy(V33) and ipsilateral lung volume parameters V4, V8 and V16 were compared with already executed plans in which oesophagus was not delineated.

Contouring the oesophagus as an OAR as a part of the radiotherapy treatment for Carcinoma Breast resulted in statistically significant reduction in dose to the oesophagus. No statistically significant change was found in the ipsilateral lung volume parameters. No compromise in plan quality was required as evident from the statistically non-significant differences in Homogeneity index and Conformity index.

3DCRT planning with oesophagus delineation can be considered as a method to reduce oesophageal dose and the acute oesophageal toxicity during radiotherapy for carcinoma breast.

Radiotherapy is a mainstay of cancer therapy for a wide variety of anatomical areas. An unfortunate side effect of treatment can be radiation damage to the skin which can be a painful and debilitating problem. Previous experience from the experimental use of Flamigel® in two large-scale clinical studies on affected skin has proven sufficiently positive for the addition of a new product in the Flamigel® family (now commercially available in the UK as Flamigel RT®, Flen Health UK). The aim of this investigation is to evaluate the use of this new product to study how effective it is in the prevention and/or treatment of radiation-induced skin damage.

A survey was conducted among radiotherapy specialist teams in dedicated UK radiotherapy centres between 1 January 2017 and 31 October 2017. This report is of a preliminary evaluation conducted by UK-based specialists on 108 patients undergoing radiotherapy. The scoring system for skin reactions of the ‘Radiation Therapy Oncology Group’ was used.

Results show that the use of Flamigel® has the potential to soothe (p = 0·0001), reduce pain (p = 0·0001) and reduce pruritus (p = 0·004). The product met the expectations of the clinicians involved (p < 0·0001) of whom most were happy to continue use or to recommend its use to colleagues (p < 0·0001).

Flamigel® is an effective treatment in the management of radiation-induced skin reactions. Erythema was unchanged through the study period (p = 0·42). No adverse reactions were reported after the use of Flamigel from twice to six times a day.

To evaluate the patterns of recurrence following postoperative conformal radiotherapy (RT) for intracranial meningioma.

Eighty-six patients who received conformal RT for intracranial meningiomas from 2014 to 2017 were retrospectively analysed. For documented recurrences, recurrence imaging was deformably co-registered to planning CT scan. In-field recurrence was defined as recurrence within the 90% isodose line, and out-of-field recurrences were those that occurred outside the 90% isodose line. We present the demographic details, surgical and RT details, outcomes and patterns of recurrence.

The median age was 46 years (range 17–72); 82·6% underwent surgery [46·5% had subtotal resection (STR), 43·7% gross tumour resection (GTR), 5·6% biopsy] and 17·4% had no surgery. Among these, 53·5% were WHO grade 2; 27·9% grade 1; and 1·2% grade 3 meningioma. Fifty per cent received stereotactic RT (SRT), 46·5% 3D conformal RT (3DCRT) and 3·5% intensity-modulated RT (IMRT). The mean clinical target volume (CTV) and planning target volume (PTV) margins were 4·5 mm (range 0–15) and 3·9 mm (range 1–5), respectively. The doses ranged from 54 to 59·4 Gy. The median follow-up after RT was 1·7 years (range 0·2–4·7). 17·4% were lost to follow-up, 5·4% had recurrence, and the median time to recurrence after completion of RT was 2 years (range 0·7–2·9). The 3-year recurrence-free rate was 81·5%. Three patients had in-field and two had in-field and out-of-field recurrence. Among the cases with recurrence, three received SRT, one 3DCRT and one IMRT. Four were grade 2 and one was grade 3 tumour, and the CTV margin ranged from 0 to 5 mm, and the PTV margin ranged from 3 to 5 mm.

Local recurrence was seen in grade 2 and 3 meningiomas. SRT probably had more recurrence as they had lesser CTV margin. Increased CTV margin, escalated dose up to 59·4 Gy and 3DCRT/IMRT may be helpful in preventing local recurrences in grade 2 and grade 3 meningiomas.

Accurate and reproducible patient positioning is a critical step in radiotherapy for breast cancer. This has seen the use of permanent skin markings becoming standard practice in many centres. Permanent skin markings may have a negative impact on long-term cosmetic outcome, which may in turn, have psychological implications in terms of body image. The aim of this study was to investigate the feasibility of using a semi-permanent tattooing device for the administration of skin marks for breast radiotherapy set-up.

This was designed as a phase II double-blinded randomised-controlled study comparing our standard permanent tattoos with the Precision Plus Micropigmentation (PPMS) device method. Patients referred for radical breast radiotherapy were eligible for the study. Each study participant had three marks applied using a randomised combination of the standard permanent and PPMS methods and was blinded to the type of each mark. Follow up was at routine appointments until 24 months post radiotherapy. Participants and a blind assessor were invited to score the visibility of each tattoo at each follow-up using a Visual Analogue Scale. Tattoo scores at each time point and change in tattoo scores at 24 months were analysed by a general linear model using the patient as a fixed effect and the type of tattoo (standard or research) as covariate. A simple questionnaire was used to assess radiographer feedback on using the PPMS.

In total, 60 patients were recruited to the study, of which 55 were available for follow-up at 24 months. Semi-permanent tattoos were more visible at 24 months than the permanent tattoos. Semi-permanent tattoos demonstrated a greater degree of fade than the permanent tattoos at 24 months (final time point) post completion of radiotherapy. This was not statistically significant, although it was more apparent for the patient scores (p=0·071) than the blind assessor scores (p=0·27). No semi-permanent tattoos required re-marking before the end of radiotherapy and no adverse skin reactions were observed.

The PPMS presents a safe and feasible alternative to our permanent tattooing method. An extended period of follow-up is required to fully assess the extent of semi-permanent tattoo fade.

The aim of this study was to produce a low-cost anatomical model of adult male including lower limbs to evaluate the three-dimensional dose distribution for dosimetry measurements, especially in total body irradiation (TBI) and total skin electron therapy (TSET).

Computed tomography (CT) scan images of the atomic energy organisation RANDO phantom and lower limb CT scan images of 20 healthy persons were averaged. Selections of different body tissues substitute materials and phantom validation were performed according to previous studies worked on construction of radiation therapy phantoms.

The dosimetry aspect of the selected substitute materials from all considered methods showed that they were in good agreement with real human tissue, especially bone, with a percentage error of 0·5%. The results show that the electron densities obtained from the linear attenuation coefficient (reDLAC) for the tissue equivalent material used in the phantom is a better option for validation.

This validated phantom has numerous advantages over the origin type of RANDO phantom. Therefore, using it in TBI and TSET dosimetry is recommendable.

One of the stereotactic radiosurgery techniques is Gamma Knife radiosurgery, in which intracranial lesions that are inaccessible or inappropriate for surgery are treated using 201 cobalt-60 sources in one treatment session. In this conformal technique, the penumbra width, which results in out-of-field dose in tumour-adjacent normal tissues should be determined accurately. The aim of this study is to calculate the penumbra widths of single and 201 beams for different collimator sizes of Gamma Knife machine model 4C using EGSnrc/BEAMnrc Monte Carlo simulation code and comparison the results with EBT3 film dosimetry data.

In this study, simulation of Gamma Knife machine model 4C was performed based on the Monte Carlo codes of EGSnrc/BEAMnrc. To investigate the physical penumbra width (80−20%), the single beam and 201 beams profiles were obtained using EGSnrc/DOSXYZnrc code and EBT3 films located at isocentre point in a spherical Plexiglas head phantom.

Based on the results, the single beam penumbra widths obtained from simulation data for 4, 8, 14 and 18 mm collimator sizes along X axis were 0·75, 0·77, 0·90 and 0·92 mm, respectively. The data for 201 beams obtained from simulation were 2·61, 4·80, 7·92 and 9·81 mm along X axis and 1·31, 1·60, 1·91 and 2·14 mm along Z axis and from film dosimetry were 3·21, 4·90, 8·00 and 10·61 mm along X axis and 1·22, 1·69, 2·01 and 2·25 mm along Z axis, respectively.

The differences between measured and simulated penumbra widths are in an acceptable range. However, for more precise measurement in the penumbra region in which dose gradient is high, Monte Carlo simulation is recommended.

To determine the frequency, factors and reasons of patient non-adherence to radiotherapy (RT) in a tertiary cancer centre.

Inadvertent treatment interruptions often lead to prolongation of planned treatment time. In the case of RT with a curative intent, prolongation of planned treatment has been associated with inferior clinical outcomes. Delay or prolongation of treatment is associated with a relative risk of local recurrence by up to 2% per day for specific malignancies. Thus, it is critical to understand key factors that influence non-adherence to RT.

A retrospective observation audit was conducted comprising patients treated with radical, adjuvant or palliative RT at our centre from January 2018 to December 2018. Non-adherence was defined as premature permanent termination of planned treatment by the patient without recommendation or consultation from the treating clinician. All data were collected and analysed (retrospectively) with the help of Statistical Package for the Social Sciences (SPSS) version 22.

A total of 1,548 patients were included in the study of which 105 (6·7%) were non-adherent to planned RT. Of the total 105 patients, 44 (42%) were elderly (60 years and above). Treatment non-adherence was predominant in males (male:female = 1·85:1). More than 90% of non-adherent patients had stage III and IV cancer. A total of 77 patients (74%) out of 105 were more than 50 km away from our centre. A total of 66 (63%) out of 105 patients had completed more than 2 weeks of radiation (40% of planned RT) and then defaulted for radiation due to acute toxicities.

Treatment adherence is a major factor in determining successful outcomes among cancer patients treated with RT. This study reveals several factors that contribute to non-adherence to treatment.