Lung cancer is the most commonly diagnosed cancer in Canada and the leading cause of cancer-related mortality in both men and women in North America. Surgery is usually the primary treatment option for early-stage non-small cell lung cancer (NSCLC). However, for patients who may not be suitable candidates for surgery, stereotactic body radiation therapy (SBRT) is an alternative method of treatment. SBRT has proven to be an effective technique for treating NSCLC patients by focally administering high radiation dose to the tumour with acceptable risk of toxicity to surrounding healthy tissues. The goal of this comprehensive retrospective dosimetric study is to compare the dosimetric parameters between three-dimensional conformal radiation therapy (3DCRT) and volumetric-modulated arc therapy (VMAT) lung SBRT treatment plans for two prescription doses.

We retrospectively analysed and compared lung SBRT treatment plans of 263 patients treated with either a 3DCRT non-coplanar or with 2–3 VMAT arcs technique at 48 Gy in 4 fractions (48 Gy/4) or 50 Gy in 5 fractions (50 Gy/5) prescribed to the planning target volume (PTV), typically encompassing the 80% isodose volume. All patients were treated on either a Varian 21EX or TrueBeam linear accelerator using 6-MV or 10-MV photon beams.

The mean PTV V95% and V100% for treatment plans at 48 Gy/4 are 99·4 ± 0·6% and 96·0 ± 1·0%, respectively, for 3DCRT and 99·7 ± 0·4% and 96·4 ± 3·4%, respectively, for VMAT. The corresponding mean PTV V95% and V100% at 50 Gy/5 are 99·0 ± 1·4% and 95·5 ± 2·5% for 3DCRT and 99·5 ± 0·8% and 96·1 ± 1·6% for VMAT. The CIRI and HI5/95 for the PTV at 48 Gy/4 are 1·1 ± 0·1 and 1·2 ± 0·0 for 3DCRT and 1·0 ± 0·1 and 1·2 ± 0·0 for VMAT. The corresponding CIRI and HI5/95 at 50 Gy/5 are 1·1 ± 0·1 and 1·3 ± 0·1 for 3DCRT and 1·0 ± 0·1 and 1·2 ± 0·0 for VMAT. The mean R50% and D2cm at 48 Gy/4 are 5·0 ± 0·8 and 61·2 ± 7·0% for 3DCRT and 4·9 ± 0·8 and 57·8 ± 7·9% for VMAT. The corresponding R50% and D2cm at 50 Gy/5 are 4·7 ± 0·5 and 65·5 ± 9·4% for 3DCRT and 4·7 ± 0·7 and 60·0 ± 7·2% for VMAT.

The use of 3DCRT or VMAT technique for lung SBRT is an efficient and reliable method for achieving dose conformity, rapid dose fall-off and minimising doses to the organs at risk. The VMAT technique resulted in improved dose conformity, rapid dose fall-off from the PTV compared to 3DCRT, although the magnitude may not be clinically significant.

Radiation exposure to the thyroid gland during breast irradiation can lead to hypothyroidism and this can impact on the quality of life. The aim of this study was to analyse if there is any difference in the radiation dose received by the thyroid gland during supraclavicular irradiation for breast cancer, with two different neck positions—straight or when the head is turned to the contralateral side to the breast being treated, when using a conformal technique.

All patients who received chest wall/breast and supraclavicular irradiation for breast cancer in 2019 in our department were divided into two groups based on the neck position as SN (neck positioned straight) and TN (neck tilted to contralateral side). The volume of thyroid gland, the radiation dose and volume parameters for Dmax, Dmean, and V5 to V40 of the thyroid were tabulated.

There were 72 patients included in the study with a mean age of 59 years, with 39 in the SN group and 33 in the TN group. There was no significant difference in thyroid volume between the two groups. Dmean, V15, V20, V25, V30 and V35 were significantly lower in tilted neck patients as compared to straight neck patients.

Neck positioned to the contralateral side of the breast primary may be recommended for conformal CT-based radiation planning.

Key advances in cancer treatment have led to an increasing number of long-term cancer survivors. Knowledge of the long-term effects of cancer treatment on leukaemia survivors is to some degree limited. This article investigates the effects of the treatment of childhood leukaemia on the quality of life (QOL), the physical and the psychological wellbeing and general development of survivors. This article reviews current literature to examine existing gaps in knowledge and identify a potential focus of future research and clinical practice.

Online systematic searching, along with historical searching took place in order to retrieve relevant primary research papers for the review. Strict inclusion and exclusion criteria were applied to the literature, to create a manageable amount of research papers.

The extent of intellectual impairment among radiotherapy patients was significantly greater than those treated with chemotherapy only. Body composition, including endocrine function, is readily affected by cancer treatment. Early identification and interventions can greatly improve the QOL of survivors.

Further research into the effect of treatment modality on the extent of chronic effects, along with investigations into the needs of the whole family unit, is required. Future practice must take into account long-term implications while ensuring effective holistic care.

The aim of this work is to report on the tumour control probability (TCP) of a UK cohort of lung stereotactic ablative radiotherapy patients (n = 198) for a range of dose and fractionations common in the UK.

TCP values for 3 (54 Gy), 5 (55 and 60 Gy) and 8 (50 Gy) fraction (#) schemes were calculated with the linear-quadratic Marsden TCP model using the Biosuite software.

TCP values of 100% were computed for the 3 # and for 5 # (α/β = 10 Gy) cohorts; reduced to 99% (range 97–100) for the 5 # cohort only when an α/β of 20 Gy was used. The average TCP value for the 50 Gy in 8 # regime was 97% (range 92–99, α/β = 10 Gy) and 64% (range 48–79, α/β = 20 Gy). Statistical significant differences were observed between the α/β of 10 Gy versus 20 Gy groups and between all data grouped by fraction.

TCPs achievable with current planning techniques in the UK have been presented. The ultra-conservative 50 Gy in 8 # scheme returns a significantly lower TCP than the other regimes.

The data used in brachytherapy planning are obtained from homogeneous mediums. In practice, the heterogeneous tissues and materials affect the dose distribution of brachytherapy. It is aimed to investigate the effect of air cavities on brachytherapy dose distribution using a specially designed device.

In this study, the special device designed with different volumes of air and water to be irradiated and measured at different depths using EBT3 Gafchromic films. EBT3 Gafchromic films were preferred for this study because they can be cut to the shape of the experimental geometry, are water resistance and double directional usability.

In our study, sudden dose increases and decreases were observed at the water–air–water interfaces. Increases were 9, 11·8 and 15% in the 13, 18 and 22 mm apparatus, respectively. These effects were expected and the results were consistent with the literature and within the tolerance limits stated in the clinical dose guidelines. The most important result is that the percent depth–dose curve of the radiation passing through the air to the water and only passing through the water medium is different. The average differences were 1·97, 2·97 and 2·31% for the 13, 18 and 22 mm apparatus, respectively.

Although the effect of heterogeneity may be neglected according to clinical guidelines, it is suggested that the dose effect of heterogeneity is taken into account so that the dose can be estimated sensitively. Brachytherapy plans using dose data without considering air gaps may cause erroneous dose distributions due to heterogeneity of tissue.

An astroblastoma is a rare primary glial tumour occurring preferentially in young adults. It is characterised by a perivascular arrangement of tumour cells forming perivascular pseudorosettes mimicking ependymomas. The histogenesis of astroblastoma is unclear.

We present the history of a 13-year-old girl with chief complaints of headache associated with vomiting, blurring of vision on the left eye and a history of diplopia on the right eye. She underwent left parietal parasagittal craniotomy and near-total excision of tumour. She was planned for postoperative radiotherapy 5,940 cGy in 28 fractions along with concurrent temozolamide100 mg. She had no neurological deficit or complaints during her last visit.

Astroblastomas are a distinct clinic pathologic entity, with well-described radiologic, pathologic and cytogenetic features. Its recurrence is high, and efforts must be made to elucidate the role and usefulness of radiotherapy and chemotherapy in these tumours.

Dysphagia is common in patients presenting with oesophageal malignancy. This study aimed to determine the clinical effectiveness of biodegradable stents to help with malignant dysphagia due to radiotherapy for oesophageal cancer and furthermore to establish the complication and re-intervention rates associated with their use.

This was a retrospective, observational study of 22 patients between 2008 and 2013. Complications within 2 weeks and episodes of re-intervention required within 4 months of stent insertion prior to radiotherapy were recorded.

Pre-stent insertion, the mean O’Rourke dysphagia score was 3·5 (median 3, range 2–5). This improved to a mean score of 2·8 (median 3, range 1–4) 1–3 weeks following stent insertion. Complications occurred in seven patients (32%) in an immediate 2-week period, including: pain (2), dysphagia requiring dilatation (1), food obstruction not requiring intervention (1), food obstruction requiring intervention (2) and upper gastrointestinal bleed not requiring intervention (1). Re-intervention was required in 18% within a 4-month period.

We propose that biodegradable oesophageal stents are safe and may have benefit over self-expanding metal stents. We recommend they are placed alongside a radiologically inserted gastrostomy in a combined procedure prior to radiotherapy planning.

To assess local experience in Saudi Arabia of the effectiveness and tolerability of selective internal radiation therapy (SIRT) in patients with liver tumours.

In a retrospective study, patients with unresectable liver tumours treated with yttrium-90-labelled resin microspheres (SIR-Spheres®, Sirtex, Australia) at the King Fahad Specialist Hospital Dammam (KFSHD) were followed up for at least 12 months, or until death. Data were extracted from medical records. The primary outcome measure was overall survival (OS). Tumour response was recorded using the modified Response Evaluation Criteria in Solid Tumors (mRECIST): tumour control (TC) was defined as the proportion of patients with stable disease (SD), partial response (PR) and complete response (CR).

A total of 30 patients (21 males, 9 females) with hepatocellular carcinoma (76⋅7%), metastatic colorectal cancer (13⋅3%), cholangiocarcinoma (6⋅7%) or carcinoid tumour (3⋅3%) were evaluated. Mean OS was 16⋅98 months. Eighty-five percent of patients showed TC, 35% had SD, 15% a PR and 35% a CR. No severe complications were observed. Four deaths were considered unrelated to treatment.

In this cohort, SIRT showed similar efficacy to that in other studies, with an acceptable tolerability profile. SIRT appears a feasible procedure for liver tumour treatment in the KFSHD.

This study aimed to investigate the influence of calibration field size on the gamma passing rate (GPR) in patient-specific quality assurance (PSQA).

Two independent detectors, PTW OCTAVIUS 4D (4DOCT) and Arc Check, were utilised in volumetric modulated arc therapy plans for 26 patients (14 with Arc Check and 12 with 4DOCT). Plans were administered using Varian Unique machine (with 4DOCT) and Varian TrueBeam (with Arc Check), each employing different calibration factors (CFs): 4 × 4, 6 × 6, 8 × 8, 10 × 10, 12 × 12 and 15 × 15 cm2 field sizes. Gamma analysis was conducted with 2%2mm, 2%3mm and 3%3mm gamma criteria.

GPR exhibited variations across different CFs. GPR demonstrated an increasing trend below 10 × 10 cm² CFs, while it displayed a decreasing trend above 10 × 10 cm². Both detectors exhibited similar GPR patterns. The correlation between 4DOCT and Arc Check was strong in tighter criteria (2%2mm) with an R² value of 0·9957, moderate criteria (2%3mm) with an R² value of 0·9868, but reduced in liberal criteria (3%3mm) with an R² value of 0·4226.

This study demonstrates that calibration field sizes significantly influence GPR in PSQA. This study recommends the plan specific calibration field must obtain to calibrate the QA devices for modulated plans.

The comparative study of the plan quality between volumetric modulated arc therapy (VMAT) and 3D conformal therapy (3DCRT) for the treatment of selected representative childhood neoplasms was performed.

During the year 2013, 44 children with neoplasms were irradiated using VMAT. The 3DCRT plans were created retrospectively and compared with the VMAT plans for four tumour locations. The conformity parameters, dose volume histograms for target volume and organs at risk, number of monitor units and time used to deliver the single fraction were evaluated and compared for each plan. Additionally, for patients with brain tumour the comparison of different arcs configuration was made.

VMAT modality presented the superiority over older conformal methods with regard to the improvement in the dose conformity and normal tissue sparing. The noncoplanar arcs arrangement was beneficial in the decrease of high-dose volume and the protection of the organs at risk located oppositely to the target volume.

VMAT could be preferred technique for treating childhood neoplasms, especially when the complex-shaped target volume is localised close to the critical structures. The noncoplanar arcs arrangement could be the method of choice in the reirradiated patients and in these with laterally located brain tumours.

The head and neck cancers as a whole are the most common cancers among males in India. Technological advancements have led to an improvement in radiation therapy (RT) techniques with subsequent reduction in normal tissue complications. To correct patient set-up errors, an off-line correction method like no action level (NAL) protocol may be used as a preferred protocol particularly for a busy department. The objectives of the study were to measure the translational set-up errors using kV cone-beam computed tomography (CBCT) in patients undergoing intensity modulated radiotherapy (IMRT) in head and neck cancers and also to optimise clinical target volume (CTV) to planning target volume (PTV) margin using NAL protocol.

On the first 5 days of RT, patient’s position was verified by kV-CBCT and then weekly during the course of treatment. The comparison between the reference and kV-CBCT images was performed, and the shifts measured and recorded. The mean error from the initial five consecutive fractions was corrected on the sixth daily fraction. Displacements in all the directions were measured. The population systematic and random errors were determined and used to estimate PTV margins according to the van Herk formula.

A total of 322 images were analysed. Before correction, 15, 12 and 9% patients had systematic error ≥3 mm on X, Y and Z axes, but after correction this was reduced to 9, 0 and 0%. The total percentage of patients whose set-up margin was ≥5 mm before correction was 5, 6·25, 3·75%, but after correction it reduced to 1·88, 0, and 0·63%. The margins of total population were reduced to 63, 65 and 56% after correction on X, Y and Z axes, respectively.

A simple off-line NAL protocol can correct the set-up errors without daily on-line imaging in patients undergoing IMRT and hence acting as a resource sparing alternative. Five millimetre margin to CTVs was adequate and safe to overcome the problem of set-up errors in head and neck IMRT.

Radiotherapy randomised controlled trials provide evidence to support the development of new techniques and dose/fractionation regimens. Some radiotherapy trials have previously had to close early or revise targets due to low recruitment rates. Many authors have recommended research into recruitment strategies for many areas of medicine, however little work has been carried out in the specific field of radiotherapy.

Using a survey of research radiographers followed by radiotherapy patient interviews, this project provides perspectives on motives for patient participation in radiotherapy clinical trials, and how to best support people through this decision-making process.

The main factors influencing participation identified by the radiographers were altruism, treatment fatigue and concerns about the trial arms, lack of resources and lack of commitment from some medical colleagues. For patients the main factors were mainly emotional; altruism, and fears for efficacy of different trial arms featured, with requests for timely communication of trial information.

We recommend that strategies should be offered proactively to support patients through the decision-making process when considering trial participation. Research radiographers are ideally qualified to offer support and expert knowledge to these patients.

This single-case feasibility study presents an undergraduate radiotherapy student’s experiences of remote access to University treatment planning software in place of on-site practical learning. With clinical sites increasingly utilising telemedicine there is interest in educational applications of this technology.

This was an unplanned study with the student initiating remote access; additional tutor support was provided as requested. Subsequent discussion between the tutor and student formed the basis for the presented findings.

A second-year student planned five assessment cases from home, supported by regular on-campus tutorials. The student saved a 2-hour journey per practical and gained additional planning practice time. Unit performance was 10% less than a previous Unit, but student satisfaction with the format was high.

Educational remote access to treatment planning software is logistically feasible, although strict guidelines and formal tutor support is vital. Remote access can alleviate pressure on facilities and improve student time efficiency. Controlled and supported provision of remote access to planning software could enhance on-site practical teaching sessions for more mature independent learners. Further cohort-wide studies could clarify advantages, disadvantages and possible role of remote access for radiotherapy planning education.

While paediatric arteriovenous malformations (AVMs) often require aggressive therapeutic intervention due to their high bleeding incidence, choosing a course of treatment for deep and eloquent areas and asymptomatic cases is difficult. Sequelae are a concern in children, as they survive for longer after treatment. The authors have long recommended and implemented staged Gamma Knife radiosurgery (GKRS) in their treatment guidelines to maximise therapeutic effects.

Fifty-eight paediatric patients with AVM and ≤15 years old who underwent GKRS under general anesthesia from 2002 to 2020 were followed up for an average of 81·5 months. Obliteration dynamics and clinical outcomes were analysed.

The mean patient age was 10·5 years. The mean nidus volume was 6·6 cm3, the complete occlusion rate was 69%, the annual post-irradiation bleeding rate was 2·19% and nine (16%) cases had transient radiation-induced changes. One (1·7%) patient had sequela, and three (5·1%) developed encapsulated hematomas and cysts. Additionally, the 3- and 5-year cumulative occlusion rates were 39·0% and 53·3%, respectively. Multivariate analysis showed significantly higher occlusion rates in patients ≤12 years old and with a nidus volume of ≤4 cm3.

GKRS is a useful treatment for paediatric AVM; however, its use poses some challenges.

We reported the clinical and radiological outcome of an aggressive dural arteriovenous fistula (DAVF) after combined glue embolization and hypofractionated helical TomoTherapy (Hypo-HT).

Eleven patients whose radiological examinations are consistent with aggressive DAVF were treated with combined glue embolization and Hypo-HT 30–36 Gy in 5–6 fractions. The dosimetric analysis, clinical response and radiological imaging obliteration rate by magnetic resonance angiography or computed tomography angiography were investigated.

There were eight males and three females with a male and female ratio of 2·67. The mean age was 51·2 years old (range 37–69). Anatomical imaging sites of disease included transverse-sigmoid sinuses (n = 7), superior sagittal sinus (n = 3) and tentorium cerebelli (n = 1). The mean pitch and MF of treatment plans were 0·273 ± 0·032 and 1·70 ± 0·31, respectively. The average size of PTV were 15·39 ± 7·74 cc whereas the Reff,PTV was 1·50 ± 0·25 cm. The average Dmax and Dmin were 37·52 ± 3·34 and 31·77 ± 2·64 Gy, respectively. HI, CI and CI50 were 0·16 ± 0·06, 1·80 ± 0·56 and 7·85 ± 4·16, respectively. The Reff,Rx and Reff,50%Rx were 1·80 ± 0·24 and 2·90 ± 0·45 cm, respectively. The Reff between 50%Rx and 100%Rx was 1·10 ± 0·28 cm on average. With a mean follow up of 28·5 months (range 9–48), the complete recovery of symptoms was found in 72·7 % (eight patients) within 2–12 months after completion Hypo-HT. Partial recovery was reported in 18·2% (two patients). No clinical response was found in 9·1% (one patient). The total radiographic obliteration rate was 27·3% (three patients), subtotal obliteration was 27·3% (three patients) and partial obliteration was 45·4% (five patients).

Satisfactory clinical response of aggressive DAVF was found in all treated patients by combining glue embolization and Hypo-HT. All dosimetric parameters were acceptable. We still need an extended follow up time to assess further radiographic obliteration rate and late side effects of the treatment.