Abstract Introduction: Radiotherapy for head and neck cancer (HNC) requires a thermoplastic immobilisation mask, which can heighten anxiety, yet this remains poorly recognised and inconsistently measured. Virtual reality (VR)-based rehearsal has been proposed as a preparatory strategy, but patient receptivity is unknown. This study examined the prevalence of state anxiety at mask fabrication, the practicality of administering the six-item State-Trait Anxiety Inventory (STAI Y-6) in a busy pre-treatment workflow and patient interest in VR-based preparation. Methods: In this cross-sectional study, 39 consecutively recruited adults with HNC at a tertiary cancer centre completed a 10-item questionnaire before their first CT simulation: the STAI Y-6 plus four study-specific items covering mask-specific anxiety, general treatment anxiety and interest in a guided VR rehearsal of the procedure. Associations between STAI Y-6 caseness and supplementary items were assessed using Monte Carlo-simulated chi-squared tests. Results: Recruitment was 93% (39/42), completion 100% and median completion time 3.6 minutes. The mean pro-rated STAI Y-6 score was 43.3 (SD 14.1, range 20–77). Seventeen participants (44%, 95% CI 29–59%) scored ≥41, the threshold for clinically meaningful state anxiety. Participants with elevated anxiety more often reported at least some mask-specific anxiety (71% vs 32%; p = 0.025) and more often expressed uncertainty about VR (p = 0.027). Conclusions: Nearly half of participants reported clinically meaningful anxiety at mask fabrication, and the STAI Y-6 was quick and acceptable to administer. Larger, multi-site studies with repeated assessment are needed to confirm prevalence and test targeted preparation such as VR.
Abstract Background: Non-seminomatous germ cell tumours (NSGCTs) are traditionally managed with surgery and chemotherapy, with radiotherapy rarely utilised because of perceived radioresistance. Management of oligoprogressive disease in patients unsuitable for further systemic therapy remains challenging. Case Presentation: We report the case of a 53-year-old man with recurrent NSGCT and oligoprogressive retrocrural lymph node metastasis, who was unsuitable for further chemotherapy because of severe neurological complications. He was treated with stereotactic ablative radiotherapy (SABR), 42 Gy in three fractions. Results: Treatment was well tolerated, with only Grade 1 asthenia and no significant gastrointestinal toxicity. Radiological and serological surveillance demonstrated sustained response at 15 months. Conclusion: This case demonstrates that SABR may represent a safe and effective local treatment option for selected patients with oligoprogressive NSGCT who are unsuitable for systemic therapy.
Abstract Introduction: Rare dermatologic disorders may complicate breast radiotherapy because treatment-related skin reactions can overlap with inflammatory flare, infection, or skin fragility. Evidence guiding radiotherapy delivery in Sweet’s-syndrome and inherited epidermolysis-bullosa (EB) remains limited. Case: Two patients receiving adjuvant breast radiotherapy were managed prospectively using a multidisciplinary protocol. A patient with Sweet’s syndrome received chest wall and regional nodal radiotherapy (50 Gy in 25 fractions) to minimise flare risk. A second patient with inherited EB received whole-breast radiotherapy (40 Gy in 15 fractions) to balance efficacy with skin fragility concerns. Both were treated using forward-planned Intensity-modulated-radiotherapy with daily cone beam computed-tomography verification. Structured toxicity review and skin-handling precautions were employed throughout treatment. Both completed treatment without interruption. The Sweet’s syndrome patient developed mild erythema only (grade 1) with no flare. The EB patient developed limited localised blistering (grade 1) without infection or extensive skin breakdown. Acute reactions resolved within six weeks, with no recurrent dermatologic flare at 6- and 12-month follow-up. Discussion: These cases suggest that rare inflammatory or fragility-related skin disorders do not preclude curative-intent breast radiotherapy when supported by multidisciplinary care. Recommendations: Individualise fractionation, minimise skin trauma, and incorporate structured toxicity monitoring and escalation pathways into routine management.
Abstract Purpose: Radiation-induced primary hypothyroidism is a common yet under-recognized toxicity after radiotherapy for undifferentiated nasopharyngeal carcinoma (UNPC). This study evaluated clinical and dosimetric predictors of hypothyroidism following intensity modulated radiotherapy (IMRT). Methods: We retrospectively analyzed 50 non-metastatic (M0) UNPC patients treated with IMRT at the Salah Azaiez Institute (2016–2019), with regular thyroid function follow-up (12–60 months). Dosimetric parameters were reviewed for associations with thyroid dysfunction. Results: Hypothyroidism developed in 66% of patients (median onset: 26 months). Its risk was increased with a mean thyroid dose ≥56.67 Gy. Sparing less than 9.9 cc of thyroid tissue from 60 Gy (VS60) strongly predicted hypothyroidism (AUC 0.952, 95% CI 0.886–1; sensitivity 93.9%; specificity 100%). Affected patients had smaller thyroid glands (14.73 ± 6.14 vs. 19.17 ± 7.07cc; p = 0.026) and higher mean thyroid doses (59.8 ± 4.27 vs. 55.19 ± 3.41Gy; p < 0.001). Female sex ( p = 0.035), higher T stage ( p = 0.007), and nodal involvement ≥N2 ( p = 0.003) were also significant predictors. Conclusions: Radiation-induced hypothyroidism is a frequent, dose-dependent toxicity in UNPC. Preserving ≥9.9 cc of thyroid tissue below 60 Gy may reduce risk. Prospective validation is needed to confirm reliable dose thresholds.
Abstract Introduction: SGRT can accurately monitor VMAT DIBH breast radiotherapy patients. Camera occlusion may provide difficulties for SGRT systems, such as VisionRT’s AlignRT, during rotational imaging (CBCT) and treatments (VMAT). Therefore, appropriate regions of interest (ROIs) need definition to ensure robust monitoring. Equally, operators must know where camera occlusion most likely occurs to optimise workflows. Methods: A CT scan of an anthropomorphic phantom was performed to mimic a breast patient’s DIBH treatment position. A VMAT plan was produced, and six ROIs drawn on an AlignRT terminal. An ROI sensitivity test was performed, and approximate percentage surface area of occlusion was determined for all ROIs. Postural video was also utilised to determine where camera occlusion is most likely to occur. Results: No full camera occlusion was demonstrated using the phantom. However, postural video demonstrated camera occlusion was more probable between 10 and 60 degrees for CBCT arcs due to lateral camera occlusion. Sensitivity test results showed ROIs were more sensitive to vertical and lateral translations when both lateral cameras are blocked at CBCT50. Larger ROIs may be less sensitive and more robust when cameras were occluded. Additionally, the greatest approximate percentage of occlusion occurred at the superior lateral aspects of ROIs. Conclusion: Gantry angles at higher risk of camera occlusion have been described between 10 and 60 degrees for CBCT to assist operators with troubleshooting, and a clinical workflow proposed. An ROI for VMAT DIBH breast rotational imaging and treatment has also been suggested to reduce the impact of camera occlusion.
