The management of intracerebral tumours has always provided us with a challenge when deciding upon the best treatment approach. However, when such tumours are benign and located in close proximity to critical structures, tumour management becomes all the more challenging.

The treatment of vestibular schwannomas has always posed such problems because of their anatomical proximity to critical structures such as the brainstem and several cranial nerves. Through a comprehensive literature appraisal, this article evaluates the problems associated with conventional treatment options and discusses how technical advances over the past decades have affected disease management and therefore impacted on the range and type of treatment modalities employed. In addition, it highlights the role of alternative contemporary approaches in the management of vestibular schwannomas.

Background: Oro-pharyngeal mucositis is a common complication of radical radiotherapy for head and neck cancer and may be the major treatment dose-limiting factor. Symptomatic treatment, however, appears variable and often ineffective.

Aim: To assess current UK practice, review published literature to assess the evidence base for current mucositis interventions and develop an evidence-based protocol for local use based on this knowledge.

Methods: An open-ended, qualitative questionnaire was sent to twenty UK Radiotherapy Departments to provide a sample of the current use of symptomatic treatments, including analgesia. A literature search was conducted using Medline and Cochrane databases to provide an evidence-based recommendation for the development of an effective local management protocol.

Results: Sixteen departments returned completed questionnaires (80% response rate). Eleven different pharmaceutical preparations were being used for symptomatic relief, with benzydamine (Difflam Oral Rinse) and Mucaine being the most commonly prescribed (in five departments each). Eleven different analgesics were being prescribed ranging from soluble aspirin to continuous infusion of diamorphine. The conclusion of a Cochrane Collaboration systematic review of the literature found weak or no evidence for the use of current interventions as effective agents for the relief or eradication of treatment-related mucositis.

Conclusions: For such a common and important treatment toxicity, there is no consistent symptomatic management and there is no good evidence-base for the use of any of the presently prescribed medications. Clinical trials have involved small samples and little replication of studies. Evidence does exist for the importance of good oral hygiene before, during and after treatment, and this has formed the basis of our new departmental protocol with discontinuation of the use of commercial mouthwashes.

this paper aims to evaluate the range of techniques available to minimise both interfraction and intrafraction errors. the main interfraction errors are due to changes in volume of the rectum and bladder. intrafraction errors are mainly due to respiration and to a lesser extent cardiac motion. there are various methods of minimising internal organ motion that attempt to permit reduction of the internal margin around the clinical target volume (ctv).

techniques such as rectal balloon insertion and breathing control are evaluated to determine their role in reduction of margins for improved conformal radiotherapy. the paper concludes that rectal balloons have been shown to permit limited reduction of internal margins and morbidity levels. breathing control has not increased reproducibility, but has allowed for reduction in lung morbidity. reduction of margins can only be recommended when using breathing control in conjunction with daily ctv relocalisation.

although these techniques do have a role to play at the moment, it appears that attempting to maintain a static environment within the highly mobile patient is fraught with difficulties and we must accept that there is always going to be motion. rather than attempting to control the position of the tumour, future developments such as adaptive radiotherapy and tomotherapy may account for the movement.

radiotherapy skin care is a contentious issue surrounded by myth, damaging and frightening stories and unfounded guidance. this is compounded by the fact that, when seeking information, patients, relatives and staff are faced with a barrage of conflicting, poorly researched data. each of the five scottish cancer centres worked together to produce guidance for all health professionals who are involved in the care of patients with radiotherapy skin reactions. as a result, a “best practice statement” has been produced to give an overall view of radiotherapy skin reactions and their recommended care. this will guide best practice and dispel the many myths of care, which are still in existence, thus ensuring that equity of best practice care is available to all patients.

an investigation of human resource issues in radiotherapy physics services in the nhs, including an evaluation of the extent to which the management of human resources was strategic, was undertaken as part of mba level research by a radiotherapy clinical scientist. the research incorporated a telephone census of heads, or acting heads, of radiotherapy physics services. this census looked at the establishment and scale of radiotherapy physics services, issues around recruitment and flexibility, business management, strategy and strategy formation and human resource management practices.

a 96% response rate was obtained with 55 out of a potential population of 57 subjects participating in the survey. it was found that at the time of the survey, 11.0% of all radiotherapy physicist posts were vacant. this was due predominantly to recruitment difficulties. furthermore, 42% of radiotherapy physicists in post were relatively inexperienced, having spent less than 6 years in the discipline. eighty-seven per cent of services had re-graded radiotherapy physicist posts in order to recruit. additionally, 53% of services had changed their skill mix by increasing the ratio of technologists to physicists. fifty-nine per cent of those services did so because of difficulties in recruiting radiotherapy physicists.

whereas 38 respondents (69% of total) said they had a human resource strategy linked to the service's business strategy, only 12 respondents (22% of total) claimed to undertake appraisal and training needs analyses coupled with personal development plans and continuing professional development. relatively little succession planning was undertaken, and only 14 services (26% of total) had well-developed succession plans.

recommendations are made as to how human resource management in nhs radiotherapy physics services could be more strategic.