The aim of this study was to find the optimal radiotherapy (RT) method using three-dimensional (3D) conformal RT (CRT), physical wedge-based CRT (WB-CRT) and dynamic intensity-modulated RT (D-IMRT) techniques for stomach cancer.

Ten patients with gastric cancer were selected for this study. For each patient, three different treatment plans were generated. 3D-CRT, WB-CRT and IMRT plans were evaluated in terms of dosimetry. Treatment plans were compared with respect to the planning target volume and organs at risk (OARs) volumes including right and left kidney doses (V13, V20 and V28), heart mean and maximum doses, spinal cord maximum doses, dose homogeneity index, conformity index (CI), delivery time and the monitor unit counts for the treatment. Statistical analysis was performed using the SPSS (Statistical Package for the Social Sciences) v25.1 software (IBM Inc., Chicago, IL, USA).

In stomach plans, IMRT showed a significantly lower dose for the left and right kidneys than that of WB-CRT or 3D-CRT (p < 0·05). Compared with WB-CRT or 3D-CRT, IMRT reduced the V28, V20, V13 and mean dose to bilateral kidneys (p < 0·05). IMRT plans indicated better dosimetry for at the Dmean of the liver and heart. Concerning the calculated CI, values for IMRT plans gave significant results than other plans (p < 0·05).

IMRT plans provided better protection for the kidneys, liver, heart and spinal cord. For the treatment of stomach cancer, considering the dose to the OARs, IMRT appears to be the most superior technique.

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 determine the feasibility of non-daily image-guided radiotherapy (RT) with volumetric-modulated arc therapy for pelvic cancer.

Daily cone beam computed tomography (CBCT) images data of 21 patients (542 fractions) with pelvic cancer were used to simulate 5 non-daily imaging (DL) protocols (Alternate day: AD, First 5 + Weekly: FF+WL, Weekly: WL, First 5 fractions: FF and Alternate week: AW protocol). The residual errors in the lateral (X), longitudinal (Y), and vertical (Z) directions and 3D vector shifts of each non-DL protocol were explored. The planning target volume (PTV) margins were calculated using the van Herk’s formula according to population systematic and random error. Finally, the average time of each process from the start to stop of the treatment was used to calculate the number of patients treated per day to assess the treatment delivery capacity for different imaging protocols.

The 3D vector shift for the FF+WL protocol produced the greatest proportion of residual error ≤ 0·5 cm and showed the smallest random error in all three directions. However, the FF protocol produced the greatest proportion of residual error > 0·5 cm and revealed the largest magnitudes of systematic error in all three directions. Only the AD protocol can explore the PTV margin of less than 0·5 cm in all three directions. The AW protocol showed the maximum capacity of the treatment delivery, showed the highest number of patients treated per day. In contrast, the AW protocol also affects the treatment accuracy, showed the large residual error and PTV margin.

Reducing the frequency of image-guided RT results in a high residual error. Non-daily image-guided RT strategies for pelvic irradiation should be applied for margins more than 0·5 cm. The number of patients treated per day, residual error and PTV margin are information to determine non-daily protocol applications that balance treatment delivery capacity and treatment accuracy.

To compare dose to target and organs at risk (OARs) in conventional plan (2D) versus computed tomography (CT)-based three-dimensional (3D) plan in vaginal cuff brachytherapy (VBT) and to compare the effect of bladder distension on target and OARs dosimetry.

Post-hysterectomy patients with an indication for VBT were included in the study. All patients underwent planning CT scans with a full bladder and an empty bladder protocol. For each CT, two plans were generated—one library-based 2D plan and another CT-based 3D plan. Dosimetric parameters were recorded for clinical target volume (CTV) and OARs.

A total of 92 observations were made from data collected from 46 patients. Difference between CTV dose in terms of 2D and 3D plans were not statistically significant for CTV (p = 0·11). Significant reduction in D0·1cc, D1cc and D2cc dose parameters were observed in bladder, rectum, sigmoid and bowel doses with the 3D plan (p < 0·001). Bladder distension showed a 20% reduction in dose for bowel (p < 0·001). Bladder distension also showed a 6·12% (p = 0·047) increase in D2cc, but there was a significant reduction in the mean dose to the bladder.

Our study demonstrates the dosimetric benefits with 3D CT-based planning for VBT over 2D-based conventional planning and benefit of bladder distension in the reduction of bowel dose without compromising dose to the target volume.

Stereotactic radiosurgery (SRS) has proven itself as an effective tool in the treatment of intracranial lesions. Image-guided high dose single fraction treatments have the potential to deliver ablative doses to tumours; however, treatment times can be long. Flattening filter free (FFF) beams are available on most modern linacs and offer a higher dose rate compared to conventional flattened beams which should reduce treatment times. This study aimed to compare 6 MV FFF and 10 MV FFF to a 6 MV flattened beam for single fraction dynamic conformal arc SRS for a Varian Truebeam linac.

In total, 21 individual clinical treatment plans for 21 brain metastases treated with 6 MV were retrospectively replanned using both 6 MV FFF and 10 MV FFF. Plan quality and efficiency metrics were evaluated by analysing dose coverage, dose conformity, dose gradients, dose to normal brain, beam-on-time (BOT), treatment time and monitor units.

FFF resulted in a significant reduction in median BOT for both 6 MV FFF (57·9%; p < 0·001) and 10 MV FFF (76·3%; p < 0·001) which led to reductions in treatment times of 16·8 and 21·5% respectively. However, 6 MV FFF showed superior normal brain dose sparing (p < 0·001) and dose gradient (p < 0·001) compared to 10 MV FFF. No differences were observed for conformity.

6 MV FFF offers a significant reduction in average treatment time compared to 6 MV (3·7 minutes; p = 0·002) while maintaining plan quality.

Salivary duct carcinoma (SDC) is an extremely rare and aggressive subtype of salivary gland cancer with high morbidity and mortality and poor response to treatment. The current options of treatment include radical surgery followed by radiotherapy (RT) with or without chemotherapy. The aim of this study was to analyse the patterns of recurrences, possible predictors of outcome and role of RT in a cohort of patients with non-metastatic SDC.

A retrospective review of patients treated between 2010 and 2019 with histologically proven non-metastatic SDC was conducted.

Sixteen patients were included in the series. Median follow-up was 25 months. Progression-free survival (PFS) and overall survival (OS) at 12 months were 61% and 80%, respectively. Seven out of the 16 patients had disease progression, distant metastases being most frequent. Four patients died due to disease progression. PFS was significantly worse for patients with pathological neck node positivity (p = 0·036) and peri-parotid nodes (p = 0·007). Local control was significantly associated with RT (p = 0·011). Addition of any chemotherapy, regardless of either concurrent or adjuvant, had no impact on the PFS or OS. Pathological neck node positivity with nodal stage of N2 or higher correlated significantly with worse OS (p = 0·031).

Salivary ductal carcinoma is an aggressive malignancy with high metastatic potential. Inferior prognosis was observed among patients who had metastatic deposits in either cervical nodes or peri-parotid nodes on histopathology. As systemic failures are more predominant among these patients, larger prospective trials are needed to formulate an optimum strategy for choice and sequencing of first-line systemic therapy.

The control points (CP) play a significant role in the delivery of segmented based Intensity-Modulated Radiation Therapy (IMRT) delivery, particularly in dynamic mode. The number of segments is determined by control points and these segments will transfer from one to the other either during beam ON called dynamic delivery or during beam OFF called static delivery or step and shoot. This study was aimed at indirect estimation of the total monitor units (MU) to be delivered per field by exploiting the control points and also to find the MUs at any nth segment.

This study was performed in the Eclipse treatment planning software version 13.8.0. The details of control points, metre set weight per segment, leaf positions for each segment, field size, etc. were taken into consideration.

TPS calculated MU value and analytically estimated MU value were compared and the percentage of difference was estimated. The overall mean percentage of deviation was 1·03% between the TPS calculated method and the analytical method. The paired sample t-test was performed and, p-value <0·05, no significant difference was found. The analytical relationship determined to estimate the total number of MU delivered for any nth control point was also evaluated.

The control points are a potential parameter in the conventional IMRT delivery. Through this study, we have addressed the indirect method to estimate the monitor units delivered per segment.

Brain metastases (BM) are common in patients with HER2-positive and triple-negative breast cancer. In this study we aim to report clinical outcomes with LINAC-based stereotactic radiosurgery/radiotherapy (SRS/SRT) for BM in patients of breast cancer.

Clinical and dosimetric records of breast cancer patients treated for BM at our institute between May, 2015 and December, 2019 were retrospectively reviewed. Patients of previously treated or newly diagnosed breast cancer with at least a radiological diagnosis of BM; 1–4 in number, ≤3·5 cm in maximum dimension, with a Karnofsky Performance Score of ≥60 were taken up for treatment with SRS. SRT was generally considered if a tumour was >3·5 cm in diameter, near a critical or eloquent structure, or if the proximity of moderately sized tumours would lead to dose bridging in a single-fraction SRS plan. The median prescribed SRS dose was 15 Gy (range 7–24 Gy) and SRT dose was 27 Gy in 3 fractions.

Clinical assessment and MR imaging was done at 6 weeks post-SRS and then every 3 months thereafter. Intracranial progression-free survival (PFS) and overall survival (OS) were calculated using Kaplan–Meier method and subgroups were compared using log rank test.

Total, 40 tumours were treated in 31 patients. The median tumour diameter was 2·3 cm (range 1·0–4·6 cm). SRS and SRT were delivered in 27 and 4 patients, respectively. SRS/SRT was given as a boost to whole brain radiotherapy (WBRT) in four patients and as salvage for progression after WBRT in six patients. In general, nine patients underwent prior surgery. The median follow-up was 7·9 months (0·2–34 months). Twenty (64·5%) patients developed local recurrence, 10 (32·3%) patients developed distant intracranial relapse and 7 patients had both local and distant intracranial relapse. The estimated local control at 6 months and 1 year was 48 and 35%, respectively. Median intracranial progression free survival (PFS) was 3·73 months (range 0·2–25 months). Median intracranial PFS was 3·02 months in patients who received SRS alone or as boost after WBRT, while it was 4·27 months in those who received SRS as salvage after WBRT (p = 0·793). No difference in intracranial PFS was observed with or without prior surgery (p = 0·410). Median overall survival (OS) was 21·7 months (range 0·2–34 months) for the entire cohort. Patients who received prior WBRT had a poor OS (13·31 months) as compared to SRS alone (21·4 months; p = 0·699).

In patients with BM after breast cancer SRS alone, WBRT + SRS and surgery + SRS had comparable PFS and OS.

To identify prognostic factors and investigate patient survival after whole-brain radiotherapy (WBRT) for initial brain metastases arising from non-small cell lung cancer (NSCLC).

Patients diagnosed with NSCLC between 1 January 2010 and 30 September 2019, and who received WBRT upon first developing a brain metastasis, were investigated. Overall survival was determined as related to age, sex, duration between initial examination and brain metastasis detection, stage at the first examination, presence of metastases outside the brain, blood analysis findings, brain metastasis symptoms, radiotherapy dose and completion, imaging findings, therapeutic course of chemotherapy and/or radiation therapy, histological type, and gene mutation status.

Thirty-one consecutive patients (20 men and 11 women) with a mean age of 63·8 years and median survival of 129 days were included. Multivariate analysis with stepwise testing was performed to investigate differences in survival according to gene mutation status, lactate dehydrogenase (LDH) level, irradiation dose, WBRT completion and Stage status. Of these, a statistically significant difference in survival was observed in patients with gene mutation status (hazard ratio: 0·31, 95% CI: 0·11–0·86, p = 0·025), LDH levels <230 vs. ≥230 IU/L (hazard ratio: 4·08, 95% CI: 1·45–11·5, p < 0·01) received 30 Gy, 30 Gy/10 fractions to 35 Gy/14 fractions, and 37·5 Gy/15 fractions (hazard ratio: 0·26, 95% CI: 0·09–0·71, p < 0·01), and stage IV versus non-stage IV (hazard ratio: 0·13, 95 CI:0·02–0·64, p < 0·01)

Gene mutation, LDH, radiation dose and Stage are prognostic factors for patients with initial brain metastases who are treated with WBRT.

The role of the Consultant Radiographer (CR) is crossing traditional boundaries to encompass duties and responsibilities normally performed by the medical profession. Changes and streamlining of radiotherapy (RT) services result as therapeutic radiographers are taking on the responsibility of informed consent.

This article discusses and evaluates the legal, ethical and practical aspects of informed consent within the trust and how they have implemented the introduction of CR-led consent. It reports on the impact on the waiting times for treatment and user experience for myeloma patients receiving RT for pain relief from bone metastases.

A literature search was conducted using PubMed, CINAHL, Medline and Cochrane library using the term ‘informed consent’. The legal, ethical and practical aspects were compared to the current system and then was used to inform the development of a new pathway. Data were analysed from the department’s statistics for waiting times and the number of treatment courses.

CR-led informed consent has streamlined the patient pathway and has improved patient care and experience.

The aim was to evaluate the feasibility of an intraoral stent (10 and 20 mm thickness) in radiotherapy of tongue cancer, and to measure the reduction in acute mucositis in the palate.

There were six patients in the intervention group, and seven patients in the control group. Target coverage was measured by the minimum dose covering 98% of the clinical target volume (CTV). Data were collected from the planning CT and daily cone-beam computer tomography (CBCT).

The 10 and 20 mm stent yielded a mean distance of 26 and 36 mm, respectively, between the tongue and the hard palate. We found comparable dose coverage of the CTV in the treatment plan, and on the CBCT. The stent reduced mean dose to the hard palate by 61.0% (p = 0.002). Dose to the soft palate was not reduced (p = 0.18). Average Common Terminology Criteria for Adverse Events (CTCAE) mucositis scores of the hard palate were 0 and 0.8 in the intervention and control group, respectively. The mucositis scores of the soft palate were 1.2 and 1.8.

Use of an intraoral stent substantially reduced the dose to the hard palate. CTV coverage was maintained. We did not find any significant reduction in visually scored radiation-induced mucositis.

This study aimed to evaluate and compare simultaneous integrated boost-based volumetric modulated arc therapy (SIB-VMAT) of head-and-neck plans optimised using segmented and non-segmented intermediate-risk target volumes.

CT data of 20 patients with locally advanced laryngeal cancer treated with radical chemoradiation were included retrospectively. Both segmented [planning target volume (PTV) IR!] and non-segmented PTV (PTV IR) volumes were created for the intermediate-risk volume. Correspondingly, two VMAT plans were generated for every CT dataset. Dosimetry parameters obtained from cumulative dose volume histogram and the quality indices such as conformity and homogeneity indices were evaluated for both plans and were statistically analysed.

Maximum dose of PTV IR! was observed to be higher in the non-segmented plans (7281·45 versus 7075·75 cGy) and was statistically significant (p = 0·002). Homogeneity index (HI) of PTV IR! in segmented plans fared better compared to non-segmented plans (0·1 versus 0·12, p = 0·01). All other dosimetry parameters were found to be similar in both plans.

This study shows that using segmented volumes for planning will lead to more homogenous plans with regard to intermediate- and low-risk volumes, especially under controlled settings.

This National Cancer Database (NCDB) analysis was performed to evaluate the outcomes of adjuvant chemotherapy (AC) versus observation for resected pancreatic adenocarcinoma treated with neoadjuvant therapy (NT).

The NCDB was queried for primary stages I–II cT1-3N0-1M0 resected pancreatic adenocarcinoma treated with NT (2004–2015). Baseline patient, tumour and treatment characteristics were extracted. The primary end point was overall survival (OS). With a 6-month conditional landmark, Kaplan–Meier analysis, multivariable Cox proportional hazards method and 1:1 propensity score matching was used to analyse the data.

A total of 1,737 eligible patients were identified, of which 1,247 underwent post-operative observation compared to 490 with AC. The overall median follow-up was 34·7 months. The addition of AC showed improved survival on the multivariate analysis (HR 0·78, p < 0·001). AC remained statistically significant for improved OS, with a median OS of 26·3 months versus 22·3 months and 2-year OS of 63·9% versus 52·9% for the observation cohort (p < 0·001). Treatment interaction analysis showed OS benefit of AC for patients with smaller tumours.

Our findings suggest a survival benefit for AC compared to observation following NT and surgery for resectable pancreatic adenocarcinoma, especially in patients with smaller tumours.

Head and neck cancer (HNC) accounts for 5% of all new cancer cases and most were locally advanced. Positron emission tomography/computed tomography (PET/CT) in radiotherapy practice in locally advanced head and neck squamous cell carcinoma (HNSCC) is being used in staging and proper contouring. Proper staging is essential for accurate treatment decision.

This is a prospective phase II study conducted as a single institute centre to evaluate the role of PET/CT-treatment in staging, contouring and response evaluation of 30 patients with locally advanced HNSCC in contrast to CT scan. Our cases did not undergo radical surgery for the primary tumour, and biopsy was taken with PET/CT post-treatment to evaluate response.

Median age of patients was 49·4 years (minimum age of 32 years and maximum of 68 years). Males were predominant 22 (73·3%). Nasopharynx was the predominant site 16/30 (53·3%). PET/CT changed the overall staging in 40% of the patients (upstaged in 36·7% and downstaged in 3·3%). Gross tumour volume (GTV) of PET/CT was smaller in 23 patients (76·7%) and larger in 5 (16·7%) than the GTV of conventional CT, whereas GTV of lymph nodes of PET/CT was larger in 20 patients (67·7%) and smaller in 4 (13·3%). PET/CT study detected bone metastasis in two nasopharyngeal carcinoma patients and two cases of 2nd primary tumours which were not detected using conventional CT. The Cox-regression model showed that the median standardised uptake volume (SUV) of the initial tumour had been a dependent predictor of death in patients with HNSCC (p-value = 0·033) where the risk of death was 0·725 times among patients with high SUV of the initial tumour. Consequently, the size of GTV of the tumour was significant in the prediction of death (p = 0·018).

18F-FDG-PET/CT is useful for staging, radiotherapy delineation as well as aiding proper decision making, in addition to assessment of treatment response in HNSCC patients.

Induction chemotherapy (iC) followed by concurrent chemoradiation has been shown to improve overall survival (OS) for locally advanced pancreatic cancer (LAPC). However, the survival benefit of stereotactic body radiation therapy (SBRT) versus conventionally fractionated radiation therapy (CFRT) following iC remains unclear.

The National Cancer Database (NCDB) was queried for primary stage III, cT4N0-1M0 LAPC (2004–15). Kaplan–Meier analysis, Cox proportional hazards method and propensity score matching were used.

Among 872 patients, 738 patients underwent CFRT and 134 patients received SBRT. Median follow-up was 24·3 and 22·9 months for the CFRT and SBRT cohorts, respectively. The use of SBRT showed improved survival in both the multivariate analysis (hazards ratio 0·78, p = 0·025) and 120 propensity-matched pairs (median OS 18·1 versus 15·9 months, p = 0·004) compared to the CFRT.

This NCDB analysis suggests survival benefit with the use of SBRT versus CFRT following iC for the LAPC.

Partial breast irradiation (PBI) can reduce the volume of treatment and number of treatment sessions in low-risk breast cancer patients. Stereotactic body radiotherapy (SBRT) allows the administration of high doses per fraction thereby reducing the number of fractions and reducing the dose to the surrounding tissues. The objective of this study is to review the literature on the use of SBRT in PBI using the Cyberknife® (CK) unit.

In this review, we analysed the literature in PubMed and MEDLINE with articles published in the last 10 years. All citations were evaluated for relevant content and validity.

We include articles in the English language with information about PBI, SBRT in PBI, the use of the CK unit in PBI and other applications of SBRT in breast carcinoma. A total of 68 articles were found and 28 articles were selected for inclusion in this review.

The treatment of PBI using the CK unit has clear advantages in reducing the treatment volume, and therefore theoretically reducing side effects and good cosmetic results with adequate tumour control. However, the placement of fiducial markers is necessary, requiring an adequate learning curve for the placement of the markers and longer treatment times.

To identify treatment outcome, dose uniformity, treatment time, toxicity among 3D conformal therapy (3D-CRT), intensity-modulated radiation therapy (IMRT), volumetric-modulated arc therapy (VMAT) for non-small-cell lung cancer (NSCLC) based on literature review.

A literature search was conducted using PubMed/MEDLINE, BMC—part of Springer Nature, Google Scholar and iMEDPub Ltd with the following keywords for filtering: 3D-CRT, IMRT, VMAT, lung cancer, local control and radiobiology. A total of 14 publications were finally selected for the comparison of 3D-CRT, IMRT and VMAT to determine which technique is superior or inferior among these three.

Compared to 3D-CRT, IMRT delivers more precise treatment, has better conformal dose coverage to planning target volume (PTV) that covers gross tumour with microscopic extension, respiratory tumour motion and setup margin. 3D-CRT has large number of limitations: low overall survival (OS), large toxicity, secondary malignancies.

It is difficult to choose the best technique for treating NSCLC due to patient conditions and technique availability. A high-precision treatment may improve tumour control probability (TCP) and patient’s quality of life. VMAT, whether superior or not, needs more clinical trials to treat NSCLC and requires longer dose optimisation time with the greatest benefit of rapid treatment delivery, improved patient comfort, reduced intrafraction motion and increased patient throughput compared to IMRT and 3D-CRT.

Pancreatic cancer is the 12th most commonly diagnosed cancer and the 3rd leading cause of cancer mortality and accounts for approximately 2·7% of all newly diagnosed cancer cases and 6·4% of all cancer mortalities in Canada. It has a very poor survival rate mainly due to the difficulty of detecting the disease at an early stage. Consequently, in the advancement of disease management towards the concept of precision medicine that takes individual patient variabilities into account, several investigators have focused on the identification of effective clinical biomarkers with high specificity and sensitivity, capable of early diagnosis of symptomatic patients and early detection of the disease in asymptomatic individuals at high risk for developing pancreatic cancer.

We searched several databases from August to December 2020 for relevant studies published in English between 2000 and 2020 and reporting on biomarkers for the management of pancreatic cancer. In this narrative review paper, we describe 13 clinical and emerging biomarkers for pancreatic cancers used in screening for early detection and diagnosis, to identify patients’ risk for metastatic disease and subsequent relapse, to monitor patient response to specific treatment and to provide clinicians the possibility of prospectively identifying groups of patients who will benefit from a particular treatment.

Current and emerging biomarkers for pancreatic cancer with high specificity and sensitivity has the potential to account for individual patient variabilities, for early detection of disease before the onset of metastasis to improve treatment outcome and patients’ survival, help screen high-risk populations, predict prognosis, provide accurate information of patient response to specific treatment and improve patients monitoring during treatment. Thus, the future holds promise for the use of effective clinical biomarkers or a panel of biomarkers for personalised patient-specific targeted medicine for pancreatic cancer.

Nasopharyngeal carcinoma (NPC) is a prevalent disease in Southern China. Radiation therapy remains the primary treatment modality for NPC due to its high radiation sensitivity. Conventional volumetric-modulated arc therapy (VMAT) can achieve excellent target volume coverage and superior conformal dose distributions while sparing organs at risk (OARs). However, VMAT may also produce substantial volume of low-dose region in the surrounding normal tissue. Our oncology centre has incorporated the concept of anterior cervical field with VMAT in clinical practice of NPC treatment planning. The purpose of this treatment-comparison case study is to demonstrate the lower neck OARs sparing ability of hybrid volumetric-modulated arc therapy (hybrid-VMAT) over conventional VMAT for NPC.

Four patients diagnosed with NPC of different clinical lymph node staging (N staging) were enrolled for this treatment-comparison case study. Planning target volumes and OARs were delineated with reference to Radiation Therapy Oncology Group (RTOG) 0225/0615. Additional OARs from lower neck region, including thyroid, trachea, cervical spine and pharyngeal constrictor muscles (PCMs), were also delineated. Two treatment techniques, hybrid-VMAT and VMAT, were created for each patient’s dataset.

Both treatment techniques produced adequate target coverage and reduced radiation dose to the OARs as suggested in RTOG 0225/0615. Hybrid-VMAT plans achieved superior dose reduction in larynx, oesophagus, middle PCM, inferior PCM, cervical spine and trachea comparing with VMAT plans. Hence, the clinical usability and functional outcome of hybrid-VMAT should be further investigated for NPC radiation therapy.

Paratesticular sarcoma are extremely rare malignant tumours. Unlike other sites, they tend to be lower grade and have higher propensity of lymphatic spread. They tend to fail locally and occasionally in the regional lymph nodes. In the absence of target volume delineation guidelines and technical illustration of conformal planning, we have made an attempt to illustrate conformal planning methodology and define target volume based on current evidence in a case of paratesticular sarcoma.

We are presenting a case of 62-year-old male who presented with 15-cm scrotal swelling and underwent high inguinal orchidectomy with ligation of spermatic cord. Histopathology presented a well-differentiated leiomyosarcoma of epididymis. Post-operative radiotherapy target volume included the tumour bed, ipsilateral inguinal nodes and lower pelvic nodes as the clinical target volume.

Adjuvant radiotherapy using advanced delivery technique such as volumetric arc technique can provide good dose distribution with good sparing of organs at risk. The downside of conformal radiation delivery is that it is a resource-intensive and has no established target volume delineation guidelines.