Sinonasal teratocarcinosarcoma (TCS) are highly aggressive and rare malignant tumours arising from the heterogeneous admixture of components of all the three germ cell layers. There are <60 cases that have been reported in the literature. In spite of aggressive therapy, the average survival is <3 years with multimodality therapy. In total, 70% of the patients who survived >1 year received regimen of combined surgery and adjuvant therapies and this suggests that aggressive therapeutic approaches may improve the treatment outcome.

We are reporting a case study of sinonasal TCS treated with initial surgery followed with concurrent chemoradiotherapy using intensity-modulated radiotherapy (IMRT) technique. The concurrent chemotherapy and adjuvant chemotherapy consisted of carboplatin and etoposide.

This aggressive treatment protocol of concurrent chemoradiation along with adjuvant chemotherapy is well tolerated and produced 5-year locoregional control and survival without any long-term morbidities.

Our treatment protocol was well tolerated and the outcome in this individual patient has been encouraging. This could justify a combined modality approach with post-operative simultaneous-integrated boost-IMRT and chemotherapy (concurrent and adjuvant) for future patient with sinonasal TCS.

Success with acupuncture-like transcutaneous nerve stimulation (ALTENS) in the treatment of radiation-induced xerostomia has not been reported after an extended time.

We report a case of successful ALTENS therapy 5 years after radiation treatment.

The patient discontinued treatments in a second course due to complete resolution of symptoms.

This case report demonstrates a potential for offering ALTENS to those long suffering from radiation-induced xerostomia.

To demonstrate the importance of fluid management in the perioperative period by presenting a case of hyponatraemic seizures following prostate brachytherapy.

A 61-year-old gentleman, who had prostate cancer but was otherwise well, developed confusion and word-finding difficulties the day after prostate brachytherapy. This was followed by tonic–clonic seizures that necessitated treatment, intubation and ventilation, and admission to the intensive care unit. Investigations revealed serum sodium of 116 mmol/L. Fluid balance was inadequately recorded, but the patient had drank more than 3 L of water before he developed hyponatraemia.

Postoperative severe hyponatraemia and hyponatraemic encephalopathy develop because of anti-diuretic hormone release and hypotonic fluid administration. These are medical emergencies and should be managed in an intensive care unit. Symptoms range from headache, nausea and confusion to seizures, respiratory arrest and death, and are related to cerebral oedema. Treatment is done using hypertonic sodium chloride to increase the serum sodium to safe levels. Care should be taken to avoid overly rapid correction of serum sodium. Complete documentation of fluid balance is essential to allow proper assessment of fluid status. Patients should be advised on appropriate oral fluids in the postoperative period.

To evaluate the survival outcomes and toxicities experienced by non-metastatic head and neck cancer (HNC) patients receiving modulated radiotherapy (RT).

A total of 608 HNC patients treated consecutively from March 2010 to December 2014 with common subsites (oral cavity, oropharynx, hypopharynx, larynx and nasopharynx) of HNCs formed the study group. Eligible patients included those treated with radical or postoperative RT between March 2010 and December 2014. More than 90% patients received modulated RT [intensity-modulated radiotherapy (IMRT) or volumetric-modulated arc therapy (VMAT)] with concurrent chemotherapy as per stage guidelines. Demographic parameters and disease-related factors were analysed. Disease-free survival (DFS) was calculated from end date of RT till last follow-up or last date of disease control. Overall survival (OS) was calculated from date of registration to last follow-up date if alive. The primary endpoint was survival. The statistical analyses were performed using SPSS version 20.0 and Kaplan–Meier method was used for calculation survival.

Among the evaluable patients, the median age was 60 years (range: 16–93) with male preponderance (male:female – 513:95). Majority were squamous cell carcinoma 93·4% (568/608). The subsites treated were oral cavity 36·8% (224). oropharynx 26·4% (161), larynx 19·7% (120), hypopharynx 10% (62) and nasopharynx 6·4% (41). RT intent was radical in 63·5% (386) and postoperative in 36·5% (222), with 59·5% (362) receiving concurrent chemotherapy. At last follow-up, 348 (57·2%) patients were alive, 169 (27·7%) patients had succumbed to disease and 120 (24·6%) patients had recurrent disease. Out of 120 recurrent cases loco-regional recurrence, nodal recurrence and distant metastases were seen in 62 (51·7%), 25 (20·8%), 33 (27·5%), respectively. In the entire study cohort at 2 year OS and DFS was 80 and 79% whereas 3 years OS and DFS was 70 and 75%, respectively.

In our study, 2 years and 3 years OS and DFS rates are found comparable to the international data with acceptable toxicity profile with the use of modulated RT. It seems to be possible because of stringent departmental protocols and good medical physics support. Our data re-validates need and benefit of advanced RT techniques like IG-IMRT and VMAT for both postoperative and radical HNC treatment at the cost of minimal long-term side effects. Future stringent follow-up and quality of life issues are being considered in a prospective manner.

The objective was to determine diode characteristics before actual dose verification on human phantom and patients.

The reliability and stability of equipment, signal stability, precision, dose response linearity, field flatness, perturbation of radiation dose, plastic to water conversion factor (Kpl), ionisation chambers (ICs) and diode calibration were determined. Correction factors for tray (CFtray), wedge (CFwedge), field size (CFFS), SSD (CFSSD), angle (CFangle) and block (CFblock) were found. Patient dose monitor, Isorad diode (n-type) and IC (PTW Frieburg), Co-60 unit (Theratron), ATOM Adult male human phantom (Model 701-D, CIRS) were used.

Good signal stability, precise data, and linear dose response, variation of 0·500% and 5·000% in field flatness and perturbation tests, respectively, were noted. Kpl was 1·006 for IC PTW Frieburg TW30013, 0114. The diode calibration factor was 0·989. CFtray, CFFS, CFSSD, CFangle, CFblock were 1·001, 1·001, 0·997, 1·006 and 0·990, respectively. CFwedge were 1·024, 1·030 and 1·038 for 30°, 45° and 60° wedges, respectively. The verification of above correction factors (CFs) on Nasopharynx and lung of human phantom was also done.

To assess the relapse-free survival (RFS) and the factors influencing local recurrence in patients with desmoid fibromatosis (DF) treated at our centre and to determine the role of post-operative radiotherapy (RT) in improving local control.

A retrospective analysis of 51 patients treated for DF from January 2004 to December 2013 was undertaken. The RFS was calculated using the Kaplan–Meier curve. Univariate analysis was done to assess correlation with tumour size, site, the extent of surgery, margin status and adjuvant RT with RFS.

The median age was 28 years with a male:female ratio of 1:3. The most common location of the tumour was anterior abdominal wall (47%). The median tumour size was 10 cm. Wide local excision was done in most patients. Complete resection with negative margin was achieved in eight patients. Post-operative RT was indicated for 43 patients of whom 19 received RT. At a median follow-up of 37 months, RFS in the complete resection with margin negative group was 100%. RFS for the patients with positive or close margins who received RT was 79% and for those who did not receive RT, it was 87%.

Complete excision with negative margins gives the best local control in DF. The benefit of post-operative RT could not be ascertained.

Monte Carlo calculation method is considered to be the most accurate method for dose calculation in radiotherapy. The purpose of this research is comparison between 6 MV Primus LINAC simulation output with commissioning data using EGSnrc and build a Monte Carlo geometry of 6 MV Primus LINAC as realistically as possible. The BEAMnrc and DOSXYZnrc (EGSnrc package) Monte Carlo model of the LINAC head was used as a benchmark.

In the first part, the BEAMnrc was used for the designing of the LINAC treatment head. In the second part, dose calculation and for the design of 3D dose file were produced by DOSXYZnrc. The simulated PDD and beam profile obtained were compared with that calculated using commissioning data. Good agreement was found between calculated PDD (1·1%) and beam profile using Monte Carlo simulation and commissioning data. After validation, TPR20,10, TMR and Sp values were calculated in five different field.

Good agreement was found between calculated values by using Monte Carlo simulation and commissioning data. Average differences for five field sizes in this approach is about 0·83% for Sp. for TPR20,10 differences for field sizes 10×10 cm2 is 0·29% and for TMR in five field sizes, the average value is ~1·6%.

In conclusion, the BEAMnrc and DOSXYZnrc codes package have very good accuracy in calculating dose distribution for 6 MV photon beam and it can be considered as a promising method for patient dose calculations and also the Monte Carlo model of primus linear accelerator built in this study can be used as method to calculate the dose distribution for cancer patients.

The main objective of this study was to compare dosimetric characterisation of high-dose-rate brachytherapy (HDR-BT) with external beam intensity-modulated radiation therapy (EX-IMRT) as a means of delivering boost dose.

Five HDR patients were selected for IMRT planning. Patients underwent ultrasound-guided catheter placement for HDR. Computed tomography (CT) images were obtained and imported into the Nucletron PLATO Brachytherapy system. The prostate, urethra, bladder and rectum were contoured on axial slices. The dose was calculated and optimised by graphical optimisation. The CT images of these structures were exported from the PLATO to Eclipse workstation for IMRT planning. For each patient, the dose–volume histogram (DVH) of HDR and IMRT plans were generated, drawn on the same scale and compared.

The dose distribution in HDR plans was non-uniform and conformed peripherally inside the planned target volume (PTV). A small volume of the prostate received a very high dose from HDR.In IMRT plans, a uniform dose distribution was observed. The DVH curves for PTV dropped sharply and reached to a zero volume of the prostate at about 6·4 Gy. In HDR plans, the DVH curves for PTV showed a long tail up to a very high dose. About 10% of the prostate received about 13·3 Gy, which is 222% of the prescribed dose (6 Gy) in HDR plans. In contrast, the same volume in IMRT plans received <6 Gy (100%). The average dose for V90 was about 6·3 Gy for HDR and 5·8 Gy for IMRT plans. At a prostate volume of V100 level, the average dose in all plans was 5·0 Gy from HDR and 5·4 Gy from IMRT plans. In HDR plan, the V100 dose for urethra varied from 0·6 to 3·0 Gy (average 1·8 Gy). The range in IMRT plans varied from 3·6 to 6 Gy with an average of 4·7 Gy. At V90 level, the dose range in HDR and IMRT plans varied from 2·5 to 4·7 Gy (average 3·8 Gy) and 4·8 to 5·4 Gy (average 5·3 Gy), respectively. In general, the dose to the bladder and rectum was comparatively lower in HDR than in IMRT plans.

HDR brachytherapy may reduce normal tissue toxicities in prostate boost treatments, even though the dose homogeneity inside the PTV is far worse than in IMRT treatments. Another advantage of HDR over IMRT is that the organ motion is not a significant concern as in IMRT.

For palliative radiotherapy treatments, two types of simulation are available at our Centre: conventional (or 2D) and virtual. Each has its advantages: conventional simulation requires less preparation time whereas virtual simulation allows accurate visualisation and identification of target volumes in 3D. We propose a new approach where treatment field parameters are determined on diagnostic CT scans, and then reproduced with reference to a patient’s bony landmarks using conventional simulation. This combines the benefits of both methods. We argue that the slight differences in set-up between diagnostic and simulation CT scans will have little impact on the determination of the target volume in palliative treatment settings.

In total, 12 patients who had diagnostic scans done within a month before their virtual simulation were randomly selected. Both scans were retrieved retrospectively for the study. An independent radiation oncologist contoured the target volumes on both scans and their relative positions were compared by fusing the digitally reconstructed radiographs generated from the respective scans. A 2D Conformity Index (2DCI) was then calculated and tabulated for 0, 0.5, 1.0, 1.5 and 2 cm margins to evaluate the accuracy of this approach and determine the margins required to account for the inherent variability of this method. In addition, the deviation or offset of the centre of field (COF) was also measured and analysed.

The median 2DCI (0 margin) was 0.85. For margins of 0.5, 1.0, 1.5 and 2.0 cm, the median 2DCIs were 0.97, 1, 1 and 1, respectively. The median displacement of the COF in the superior–inferior direction was 0.7 cm and that in the right–left direction was 0.2 cm.

Our pilot study suggests that our approach is feasible. We recommend adding an additional margin of up to 0.5 cm (to the usual treatment margins) to ensure good coverage of the target volume when using this method.

Standard external beam radiotherapy is a treatment option for patients with localised prostate cancer and is used in patients with low-, intermediate- and high-risk disease with androgen deprivation according to the risk of the disease. In the last few years, hypofractionated radiotherapy has been demonstrated to be as safe as standard radiotherapy if given over a shorter time than standard radiotherapy with larger doses per fraction. External radiotherapy for localised prostate cancer typically delivers 37–42 fractions of 1·8–2·0 Gy per fraction given 5 days per week over 7·5–8·5 weeks. Hypofractionated radiotherapy delivers 20–28 fractions of 2·5–2·6 Gy per fraction given 5 days per week over 4–5·6 weeks.

A retrospective analysis of assessment of 30 patients was undertaken from 2016 to 2018. The aim of this study was to evaluate the 2-year outcomes of 30 patients with prostate cancer treated with hypofractionated radiotherapy 70 Gy in 28 fractions.

Biochemical failure with hypofractionated radiotherapy was found in a total of 20% of patients. In the classification by risk groups, there were no biochemical failures in low-risk patients; in the low intermediate course, 3·3% of patients; in the high intermediate group, 3·3% patients; and in the high-risk group, the largest documented biochemical failure was in 13·3% of patients. For acute urinary toxicity, grade I was 56·6%; grade II, 6·6%. For acute rectal toxicity, grade I was 46·6%; grade II, 3·3%.

This is one of the first studies of hypofractionated radiotherapy in prostate cancer in Latin America, and the results of this study demonstrated that the outcomes were similar to the standard regimen in all risk groups.

CyberKnife is the most advanced form of stereotactic body radiotherapy (SBRT) system that uses a robotic arm to deliver highly focused beams of radiation; however, a limitation is that it only irradiates from ceiling to floor direction. In patients with posterior lungs tumour who are positioned supine, normal lung tissue may suffer undesirable radiation injuries. This study compares the treatment planning between the prone set-up and the supine set-up for lung cancer in CyberKnife SBRT to decrease normal lung dose to avoid radiation side effects.

A human phantom was used to generate 108 plans (54 for prone and 54 for supine) using the CyberKnife planning platform. The supine and prone plans were compared in terms of the dosimetric characteristics, delivery efficiency and plan efficiency.

For posterior targets, the area of low-dose exposure to normal lungs was smaller in the prone set-up than in the supine set-up. V10 of the lungs was 7·53% and 10·47% (p < 0·001) in the anterior region, and 10·78% and 8·03% (p < 0·001) in the posterior region in the supine and prone set-up plans, respectively.

The comparison between the prone set-up and the supine set-up was investigated with regard to target coverage and dose to organs at risk. Our results may be deployed in CyberKnife treatment planning to monitor normal tissue dose by considering patient positioning. This may assist in the design of better treatment plans and prevention of symptomatic radiation pneumonitis in lung cancer patients.

To explore student therapeutic radiographers’ understanding of obesity and cancer and to identify if student therapeutic radiographers believe that radiographers should have a role within weight management.

This study used a self-completed online questionnaire (google forms) to collect data from Radiotherapy and Oncology students, studying at one Higher Education Institution, to gain an understanding of their current knowledge of weight management. A retrospective margin of error calculation was carried out, showing a 9% margin of error with a 90% confidence level.

In total 57 responses were received, n = 50 BSc students and n = 7 pre-registration MSc students. Three key barriers to openly discussing weight loss management with service users emerged from the questionnaire data; these were a lack of time, lack of clear guidelines and lack of confidence. These barriers could potentially be addressed by improving education and training, making it easier for therapeutic radiographers to openly discuss weight management with service users.

Awareness of guidelines was suboptimal, with 82% (n = 47) of respondents unaware of any guidelines. In addition to this, the majority of students identified a lack of confidence as a barrier to them providing weight management advice. Despite this, 54·4% of respondents agreed that radiographers should have a role in providing weight management advice, with 22·2% of respondents being unsure. Findings suggest that behaviour change is required amounts both students and staff members, so that healthcare professionals are more inclined to have healthy weight management discussions. Perhaps more specialist roles need to be developed, so that healthy weight management discussions can become a norm.

To analyse the presentation, diagnosis and patterns of care of extraosseous Ewing sarcoma treated at our institution between 2008 and 2018.

Electronic medical records of extraosseous Ewing sarcoma patients treated at our institution between January 2008 and April 2018 were reviewed. Kaplan–Meier curves were plotted to assess the overall and disease-free survival with 95% confidence intervals. A univariate analysis was carried out to assess the impact of variables such as surgical excision, completeness of surgery, completeness of chemotherapy and addition of radiation therapy on the survivorship.

The records of 65 patients treated at our institution were available for review. The mean age was 26·4 years. The most frequent sites of extraosseous Ewing tumour were kidney—9/65 (13·8%) and brain—10/65 (15·4%). Sixteen (24·6%) patients presented with inoperable/metastatic disease at diagnosis. The other 49 (75·4%) had localised disease at presentation. The median overall survival of the 49 non-metastatic patients was 46 months, and the disease-free survival was 45 months.

Extraosseous Ewing sarcoma is a rare and aggressive tumour diagnosed by molecular techniques. Multi-modality treatment including surgical resection with wide margins, adjuvant radiation when indicated and completion of systemic chemotherapy results in optimum outcomes.