This study aimed to determine the potential role and guidelines for implementation of skill-based peer mentoring for radiotherapy planning education.

After four weekly mentoring sessions, both Year 3 mentors (n=9) and Year 2 mentees (n=9) were invited to complete a short online questionnaire relating to the impact of the initiative. The tool contained a mixture of Likert-style questions concerning student enjoyment and perceived usefulness of the initiative as well as more qualitative open questions that gathered perceptions of the peer mentoring process, implementation methods and potential future scope.

Several key discussion themes related to benefits to each stakeholder group, challenges arising, improvements and potential future directions. There were high levels of enjoyment and perceived value of the mentoring from both sides with 100% of the 18 respondents enjoying the experience. The informal format encouraged further learning, while mentors reported acquisition of valuable skills and gains in knowledge.

Peer mentoring has a valuable and enjoyable role to play in radiotherapy planning training and helps consolidate theoretical understanding for experienced students. An informal approach allows for students to adopt the most appropriate mentoring model for their needs while providing them with a free space to engender additional discussion.

Radiation-induced nausea and vomiting (RINV) is a common side effect of single fraction palliative radiotherapy. Patients experiencing RINV have significantly reduced quality of life and a prescription of prophylactic antiemetics, principally 5-HT3 antagonists, is recommended. There is a growing body of evidence relating to indications for this, but as yet there are no national guidelines.

A retrospective audit aimed to determine the extent to which patients at high and moderate emetogenic risk receiving single fraction radiotherapy were prescribed prophylactic emetic medication in line with the current evidence base.

A total of 60 patients were included in the audit; of these patients, 50 were consented for the risk of nausea and/or vomiting. Prophylactic antiemetics were only prescribed to 28 (46·7%) of all audited patients. Out of the 50 patients who provided informed consent, only 24 (48%) were prescribed an antiemetic prior to their treatment.

Antiemetic prescribing for single fraction patients at moderate to high emetogenic risk at a large regional centre is underutilised in relation to published evidence. Amended guidance and further audits are recommended to ensure that this patient group is best supported.

The aim of this study is to compare three-dimensional conformal radiotherapy (3D-CRT), intensity-modulated radiotherapy (IMRT) and tomotherapy techniques used in the treatment of prostate cancer with target and critical organ doses to be included.

The target dose was studied with 4-and 6-field 3D-CRT, 7-field IMRT and tomotherapy techniques used to treat ten patients for prostate cancer and the dose volume histograms of critical organs were analyzed. The same target volumes, critical organs doses prescribed and treatment times for the three techniques were compared. Total dose of 76 Gy was given using 6 MV and 18 MV for 3D-CRT, 6 MV for IMRT and tomotherapy techniques.

When we compare the three techniques, for rectum V35(p:0·001), V65(p:0·001), D50(p:0·020) and D25(p:0·002), for bladder V50(p:0·027), V65(p:0·006), V100(p:0·006) and for femoral head, the V50(p:0·001) dose was found to be significantly different and more favourable in the tomotherapy technique. Significant differences were found with IMRT planning in 50% of bladder volume (p:0·002). There is no significant difference between the three techniques for doses of 100% volume of rectum and 25% of volume of bladder. The minimum dose that healthy tissue received which was outside the tumour volume was investigated.

Doses to critical organs were lower using the tomotherapy technique. However, the minimum doses that healthy tissue received were higher for the tomotherapy technique. When the beam on times were compared for all three techniques, a significant difference was found in favor of tomotherapy.

The use of bowel preparation strategies to reduce the degree of rectal distension during prostate radiotherapy is well documented. This retrospective pilot study analysed and compared a probiotic agent against a psyllium-supplemented diet to establish the feasibility of probiotics as a bowel preparation for patients receiving radical radiotherapy for prostate cancer.

A retrospective chart review of five patients taking probiotics and five taking psyllium husk (psyllium) during their course of radiotherapy treatment was conducted. On treatment, cone beam computed tomography (CBCT) scans were compared with planning CTs to quantify inter-fractional variation in rectal volume and distension.

Forty-five CBCT scans were available in both the psyllium and probiotics groups for analysis. Variation in mean difference in rectal volume from planning (ΔRV), mean rectal cross-section area (CSA) and mean relative cross-section area (CSArel) was significantly increased for the probiotics group compared with the psyllium group (p=0·001, 0·008 and 0·007, respectively). No statistically significant differences in mean ΔRV, CSA and CSArel were detected between the two groups.

This retrospective analysis suggests that a probiotics-based bowel preparation that utilises Lactobacillus acidophilus and Bifidobacterium lactis may result in increased rectal volume and CSA variation throughout treatment in comparison with a psyllium-supplemented diet.

Merkel cell carcinoma is a rare and aggressive primary cutaneous neuroendocrine carcinoma with a high risk of loco-regional and distant metastasis. It is predominantly seen in the elderly, on the head and neck or extremities. Although treated primarily with surgery, some patients are too frail. A World Health Organization performance status of two or more with co-existing medical co-morbidities, or the site of the disease adjacent to a critical structure, can prevent surgical management. In this cohort of patients, primary palliative radiotherapy has been found to achieve excellent tumour regression and improve quality of life. A new palliative split-course hypofractionated regime has been used in North Middlesex University Hospital in this cohort of patients. The purpose of this case series was to provide supporting evidence on the efficacy of this dose and fractionation regime and review the literature for the palliative management of Merkel cell carcinoma.

In total, four patients were treated with the palliative split-course hypofractionated regime. The regime consisted of an initial 20 Gray in 5 fractions over 1 week, a 2-week gap and then a further 20 Gray in 5 fractions over 1 week. Tolerability and response to treatment were evaluated by history and clinical examination.

The split-course hypofractionated regime was well tolerated, achieved excellent tumour regression and improved quality of life in all four patients. Since then, a further three patients have been successfully treated with the above regime. This case series demonstrates the efficacy of this dose and fractionation in a select group of patients too frail for radical management and adds to the evidence base for the optimal palliative management of Merkel cell carcinoma.

Nasopharyngeal carcinoma with local extension to the external auditory meatus is rarely reported.

We present two cases of nasopharyngeal carcinoma with invasion to the external auditory meatus. First case at initial presentation; and the second at disease recurrence. Both patients presented with unilateral otologic symptoms corresponding to the affected site; as well as being heavily node positive. Otoscopic examination and 18F-fluorodeoxyglucose positron-emission topography demonstrated the involvement of external auditory meatus.

These two cases highlight the need of careful otoscopic examination and functional imaging to diagnose such cases.

To introduce a method to generate a ‘dose–volume histogram (DVH) band’ for plan evaluation of photon therapy and explore its various potentials.

Intensity-modulated radiotherapy (IMRT) plans for head and neck cancer patients were analysed, retrospectively, for setup errors noted during treatment. From the maximum observed random errors, absolute displacement was calculated using Euclidian formula. The original plan with same beam parameters and leaf sequence were used to generate six plans with shifts applied in three axes in six directions. The DVH curves from these six plans were superimposed to form the DVH band. Plans were reviewed with set tolerance criteria.

Method to generate and visualise DVH band was developed. DVH bands were created for 20 patients with head and neck cancer who underwent treatment with IMRT. It was found that seven out these 20 plans were rejected as they crossed the set tolerance criteria using DVH band as an evaluation tool.

DVH band in photon therapy can help the clinician visualise the impact of setup errors at planning and may help select the plan with lesser influence of setup errors over another.

Prostate positional variability has been widely explored with seminal vesicle (SV) variability, coming into the forefront only in recent years. While planning target volume (PTV) margins and preparation protocols ameliorate the effects of bladder and rectum volume changes on prostate, studies on SV variation have looked at only position, not volume variability.

The aim of this study was to investigate whether the inter-fraction volume variability of the VSs can exist in patients receiving radiotherapy to the prostate.

SV variability was investigated by comparing four on-treatment cone beam computer tomography scans to a planning computer tomography (CT) image for two patients receiving prostate radiotherapy. For each case, variation in volumes (cm3) was compared with intra-observer variation.

SV volume variability was seen in both patients, with the largest change in volume being 78·38%. This variance was considerably (between 2 and 10 times) larger than the measured intra-observer variance.

This study identified the potential for daily SV volume variability in patients receiving prostate radiotherapy. Future large-scale studies are warranted to identify the extent of this motion and potential clinical impact. Evidence-informed PTV margins and possible SV volume control protocols may need to be adopted.

The aim of our study is to retrospectively report the radiobiological aspects for intensity-modulated proton therapy (IMPT) against intensity-modulated radiation therapy (IMRT) for patients with head and neck cancer treated at our institution. A secondary goal is to reinforce current model-based approaches to head and neck cancer patient selection for IMPT.

Eighteen patients were evaluated with prescription doses ranging from 50 to 70 Gy delivered in 2 Gy per fraction. The dose volume histograms (DVH) were used to calculate equivalent uniform dose (EUD), tumour control probability (TCP) and normal tissue complication probability (NTCP) for biophysical comparison using mechanistic mathematical dose response models. Absolute values of TCP and NTCP were then compared between IMPT and IMRT.

The dose models demonstrate a minimal radiobiological advantage for IMPT compared to IMRT in treating head and neck cancers. Absolute values of TCP were slightly higher, while absolute values of NTCP were slightly lower for IMPT versus IMRT.

Further studies are needed to determine if the radiobiological advantage indeed translates to a therapeutic advantage for patients.

To assess helical tomotherapy (TOMO) current clinical application and practice in mainland China.

Data were collected for all TOMO units clinically operational in mainland China by 30 April 2016, including (a) the distribution of installation and staffing levels; (b) types of cancers treated; (c) utilisation efficiency; (d) quality assurance; (e) maintenance; (f) optional features; and (g) satisfaction levels. The data were collected as a census and analysed qualitatively and quantitatively.

As of 30 April 2016, 23 TOMO units were used clinically by 22 hospitals in mainland China. In the same period, 22,558 cancer patients were treated. For TOMO units with more than a year of clinical utilisation, a median of 378 cases were treated annually per machine. The median daily operation was 10·5 hours, and treatment headcount was 38·3 patients. The median service outage rate was 2·6%, and the most common cause was malfunction of the multi-leaf collimator. In terms of overall satisfaction levels, 3 hospitals were very satisfied, 16 were satisfied and 3 considered their satisfaction level as average.

The overall operation of TOMO is good, but there are some problems due to running at full capacity, lack of clinical efficacy research and insufficient quality assurance regulations.