Aim: To define the role of spiral CT in evolving an evidence-based 3D Conformal Radiotherapy (CRT) prostate protocol at Lincoln, UK.

Discussion: Tumour doses traditionally prescribed at this centre to the prostate planning target volume (PTV) (64 Gy in 32 fractions) cannot be further escalated without modification of existing technique and may currently be inadequate to obtain the highest probability of local control. Prostate CRT has been demonstrated to be well tolerated with both conventional and escalated doses, however as 3D CRT PTV margins are tightened, prostate position has to be reliably predicted to avoid geographic misses or unacceptable normal tissue toxicity. The question of prostate position variability might be addressed by sequential on-treatment spiral CT scans at this centre. Spiral CT offers specific advantages of speed, small detail conspicuity, and arbitrary axial reconstruction compared to conventional CT with no attached dose penalty. Spiral CT coupled to the next generation of radiotherapy treatment planning systems (RTPs) may soon replace the CT virtual-simulator. There are significant hardware discrepancies between some present generation CT couch tops and linac couch tops. Recently published CT studies that consider prostate position variability may be fundamentally and significantly flawed due to these couch top differences. Due to a paucity of reported evidence regarding immobilisation methods, a spiral CT study is warranted to assess efficacy of immobilization method for an evidence-based prostate protocol. Confirmative spiral CT research at this centre into prostate position variability is required to select adequate margins to form the PTV for an evidence-based 3D CRT prostate protocol. Such a spiral CT study could be integrated with the immobilisation study and may separate or define the correlation (which at present is both unclear and unreported) between pelvic immobilization and prostate position variability. Initial PTV margins defined by expanding the CTV in three dimensions using an ellipsoid with major axes 1.65 times one standard deviation of prostatic displacement reported in initial studies to obtain margins of 0.7 cm laterally, 0.7 cm cranio-caudally and 1.1 cm in the AP direction are presently indicated for this centre's evidence-based prostate protocol.

Conclusion: Spiral CT will provide the essential data set for 3D CRT planning for an evidence-based prostate protocol at Lincoln. Confirmative research using spiral CT is also warranted to assess daily prostate position variability and help define the prostate PTV for an evidence based prostate protocol at this centre.

Objective: The objective of this study was to directly compare the cost of conformal radiotherapy used with the RTo1 trial with that of non-conformal radiotherapy of the prostate.

Method: Two methods were employed to establish the cost, a simplistic top-down method and the more complicated bottom-up method that involved breaking down the cost elements of the respective treatments and undertaking a non-participative timing study on 37 patients undergoing radiotherapy. Costs were then ascribed based on the time the staff and equipment were utilised.

Results: The total cost of radiotherapy using the top-down method for both non-conformal radiotherapy and 32 fraction conformal radiotherapy was £2890.88, compared with £3342.58 for conformal radiotherapy using 37 fractions. The costs of the bottom-up method were £2485.67 for non-conformal radiotherapy, £2717.67 for 32 fraction conformal radiotherapy and £3110.52 for conformal radiotherapy using a 37 fraction regime.

Conclusions: Conformal radiotherapy of the prostate costs significantly more than non-conformal radiotherapy which reflects the increase in complexity of the technique. Cost differences arose due to increased time in the planning stage and in the actual treatment because of an increase in equipment and staffing costs during treatment.

The purpose of this Phase 2 Breast Skin Care Pilot Study was to compare the acute skin reaction in patients undergoing radiation therapy for early breast cancer who use Aloe vera gel on the irradiated skin, with the acute skin reaction in patients from our earlier study who followed a normal skin care routine. Two secondary objectives were to assess patient compliance with the use of Aloe vera gel and the ease of using two skin toxicity scoring tools.

A total of 109 patients undergoing radiotherapy following surgery for breast cancer between October 1997 and February 1998 consented to participate in this study. Each patient applied the Aloe vera gel three times daily to the irradiated area during radiation treatment. Skin reactions were assessed objectively on a weekly basis during radiation using the Radiation Therapy Oncology Group (RTOG) and the Acute Skin Reaction Index (ASRI) skin scoring tools and subjectively by patients. All patients were followed for up to 3 weeks following treatment.

The use of Aloe vera gel did not increase the acute skin reactions due to irradiation when compared with the two arms of the previous Phase 1 Breast Skin Care Study. This pilot study demonstrated that patients could safely use Aloe vera gel while undergoing radiation therapy treatments. All patients complied uniformly with the instructions of using the gel during the study. The ASRI skin scoring tool was easier to use and more sensitive in displaying differences in skin reactions in comparison to the RTOG scale.

Background: Radiotherapy skin reactions have been well documented in the past. Until recently, washing of the treated area and the use of perfumed products that contain metals has not been advocated during treatment. The aims of this study were to assess the skin reactions of patients using a non-metallic deodorant and to see whether there were any psychological benefits from being able to use the deodorant.

Method: 41 women attending for radiotherapy to either the breast or breast and axilla were recruited into the trial. They were randomised into one of two groups. Complete data was obtained for 36 patients. 20 patients used the deodorant and 16 did not. Any skin reactions noted were recorded on a weekly basis. Patients were also asked to complete a questionnaire relating to feelings and activities and to comment on the deodorant if they had used it.

Results: Skin reactions did seem to be slightly worse in the patients using deodorant, and it was only in this group of patients that axillary reactions were noted. However, neither of these results were statistically significant. The use of the deodorant did not have any impact on the psychological well being of the patients, but patients using it had found it pleasant to use and the majority said that they would use it again.

Conclusion: Further study is indicated to look at skin reactions using the deodorant with a larger sample of patients.

Patients who receive radiotherapy need to be informed about its effects. Available evidence is inadequate because it has focused on selected symptoms and has emphasized the objective characteristics of symptoms rather than the patients' own experience of them. This study therefore examined women's own accounts of physical side-effects during the first 12 months after treatment for early breast cancer. Semi-structured audiotaped interviews with 15 patients 1 week to 12 months after treatment were analysed qualitatively. The women described some symptoms that were consistent with what is already known, in particular fatigue and skin changes, but also others that have been previously neglected. The women's explanations for symptoms were an inextricable component of their experience of them. Surprisingly, many women blamed themselves for having caused their symptoms. These findings contribute to the evidence that is necessary to inform health care professionals' advice to patients. They can also guide future quantitative research into symptoms associated with treatment and ensure that this is grounded in patients' experience of symptoms rather than clinicians' assumptions about patients' experience.

This technical note describes a hinged lead alloy shielding block that could be used, in certain circumstances, for shaping a megavoltage X-ray field. The construction of the shield is described and the results of transmission and penumbra measurements are given.