To investigate the optimal radiotherapy treatment planning technique for Glioblastoma Multiforme (GBM) patients. Step and Shoot (S&S) Intensity Modulated Radiotherapy (IMRT), Dynamic Multi Leaf Collimator (DMLC) and Volumetric Modulated Arc Therapy (VMAT) plans were compared in terms of Planning Target Volume (PTV) and Organ at Risk (OAR) Dose Volume Constraints (DVCs). The study also investigated whether the optimal treatment technique varied depending on the plan complexity.

360 Background: Our aim was to evaluate the clinical, radiological and biochemical response achieved by 4 months of neo-adjuvant (NA) combination hormone therapy (HT) comprising abiraterone acetate (AA), prednisolone and gonadotrophin-releasing hormone (GnRH) agonist in treatment-naïve high-risk localised prostate carcinoma (HRLPC) prior to radical radiotherapy (RRT). Methods: This single-arm phase II clinical trial recruited 45 patients between 07/15 and 02/2020. Patients presenting with RTOG HRLPC, planned for RRT combined with short or long-term HT, were eligible. Patients completed 4 months of NA combined AA and GnRH agonist. The primary outcomes assessed at 4 months were 1) the mean percentage reduction at 99 days in prostate gland volume (PGV) via transrectal ultrasound, 2) the change in PSA levels, and 3) the percentage of patients achieving a complete clinical and biochemical response as defined by normalisation of DRE and PSA <0.1ng/ml. The secondary endpoints included the decrease in testosterone level, PSA kinetics and change in urinary symptoms. Adverse events (AE) in the form of HT-related symptoms and sexual function were also assessed. Results: The mean percentage reduction in PGV from baseline at day 99 was 42.4 % [CI 38.6-46.2]. Of 11 patients, who may have been deemed unsuitable for brachytherapy due to large PGV (>50cm3) at initial assessment, 9 patients achieved PGV reduction. The median reduction in PSA from baseline at 4 months was 13.7 ng/mL (3 – 146). A total of 33 patients (80.5%) achieved a PSA value of <0.1ng/ml at day 126. The median reduction from baseline reached 13.6ng/mL (range 3-144) at day 43 and remained unchanged up to 2 months post radiotherapy. A total of 16 patients (48.5% of 33 patients with day 126 assessment) had a complete clinical and biochemical response. By day 43, every patient had a testosterone level of <0.5nmol/L. The median International Prostate Symptom Score at baseline was 9 (range 0-32). The median change from baseline at day 126 was -1 (range -30-10), indicating minimal improvement. 95.6% of patients experienced an AE related to AA. There was no grade 4 or grade 5 AE. A total of 18 patients (40%) experienced, the most common of which was hypertension or elevated liver enzymes. 5 patients (11.1%) discontinued AA secondary to AE. The percentage of patients with normal erectile function and normal intercourse satisfaction decreased from 44.4% and 46.7% respectively at baseline to 2.3% by day 126. The percentage of patients with normal overall satisfaction decreased from 72.5% at baseline to 50% at day 126. Conclusions: NA HT with AA and GnRH agonist achieved a very high rate of undetectable PSA for HRLPC and substantial PGV reduction which may lead to improved eligibility for brachytherapy. Sexual function and satisfaction were significantly impacted. Clinical trial information: NCT02160353 .

On Friday, May 14, 2021, the Health Service Executive, the organization providing public health services in the Republic of Ireland, was the victim of a significant cyberattack on its information technology systems. All systems were subsequently shut down to prevent further damage and to allow cybersecurity experts to investigate the attack. As a result, oncology services were severely disrupted, with the cessation of radiation therapy treatments in all public radiation therapy departments. Ireland has 5 large public and 6 smaller private radiation therapy centers in total. Because of the widespread adoption of electronic medical records in radiation therapy departments, it wasn't possible to retrieve patient details of those who were undergoing radiation therapy at the time of the cyberattack. In total, 513 patients nationally had their radiation therapy interrupted. A national radiation therapy cyberattack response team was formed immediately to oversee the response to the attack. The immediate concerns were radiation therapy emergencies and category 1 patients where gaps in treatment would have an adverse effect on outcome. Communication with patients and the public was also established as a priority and agreements were reached with the private sector for the treatment of patients affected by the cyberattack. The national media was used to alert patients of the need to communicate with their radiation therapy department. Dedicated phone lines were established. Locally, radiation therapy departments held daily crisis meetings with key staff members, including information technology personnel. Individual centers employed different technologies for treatment planning and data storage, so local solutions to the cyberattack to reestablish radiation therapy for patients were developed. In addition, national documentation on prioritization of patients to resume treatment was produced and a national approach was made to compensate for gaps in treatment caused by the attack. All 5 centers had reestablished radiation therapy by May 30, although there has been a long aftermath to the cyberattack. In this article, we provide an overview of the effects of the cyberattack on our national radiation therapy service and our strategy to resume patient treatment in a timely fashion.

The efficacy and safety of primary re-irradiation for MSCC are not known. Our aim was to establish the efficacy and safety of biologically effective dose-based re-irradiation.Patients presenting with MSCC at a previously irradiated spine segment, and not proceeding with surgical decompression, were eligible. A 3 Gray per fraction experimental schedule (minimum 18 Gy/6 fractions, maximum 30 Gy/10 fractions) was used, delivering a maximum cumulative spinal dose of 100 Gy2 if the interval since the last radiotherapy was within 6 months, or 130 Gy2 if longer. The primary outcome was a change in mobility from week 1 to week 5 post-treatment, as assessed by the Tomita score. The RTOG SOMA score was used to screen for spinal toxicity, and an MRI performed to assess for radiation-induced myelopathy (RIM).Twenty-two patients were enroled, of whom eleven were evaluable for the primary outcome. Nine of eleven (81.8%) had stable or improved Tomita scores at 5 weeks. One of eight (12.5%) evaluable for late toxicity developed RIM.Re-irradiation is an efficacious treatment for MSCC. There is a risk of RIM with a cumulative dose of 120 Gy2.Cancer Trials Ireland (ICORG 07-11); NCT00974168.

Background The optimal EBRT schedule for MSCC is undetermined. Our aim was to determine whether a single fraction (SF) was non-inferior to five daily fractions (5Fx), for functional motor outcome. Methods Patients not proceeding with surgical decompression in this multicentre non-inferiority, Phase 3 trial were randomised to 10 Gy/SF or 20 Gy/5Fx. A change in mobility from baseline to 5 weeks for each patient, was evaluated by a Modified Tomita score: 1 = ‘Walk unaided’, 2 = ‘With walking aid’ and 3 = ‘Bed-bound’. The margin used to establish non-inferiority was a detrimental change of −0.4 in the mean difference between arms. Results One-hundred and twelve eligible patients were enrolled. Seventy-three patients aged 30–87 were evaluated for the primary analysis. The 95% CI for the difference in the mean change in mobility scores between arms was −0.12 to 0.6. Since −0.4 is not included in the interval, there is evidence that 10 Gy/SF is non-inferior to 20 Gy/5Fx. One grade 3 AE was reported in the 5Fx arm. Twelve (26%) patients in the 5Fx arm had a Grade 2–3 AE compared with six (11%) patients in the SF arm ( p = 0.093). Conclusion For mobility preservation, one 10-Gy fraction is non-inferior to 20 Gy in five fractions, in patients with MSCC not proceeding with surgical decompression. Clinical Trial Registration Cancer Trials Ireland ICORG 05-03; NCT00968643; EU-20952.

Radiotherapy (RT) is a key treatment modality in the curative treatment of patients with non-small cell lung cancer (NSCLC). Incorrect definition of the gross, or clinical, target volume is a common source of error which can lead to a reduced probability of tumour control. This was a pilot and a phase II study. The pilot evaluated the technical feasibility of integrating positron emission tomography–computed tomography (PET-CT) fusion. The primary outcome of the phase II study was to evaluate the safety of PET-CT scan–based RT by evaluating the rate of loco-regional recurrence outside the PET-CT planning target volume (PTV) but within conventional 3-D PTV. Patients underwent standard post-treatment follow-up, including repeated three monthly CT scans of the thorax. In case of loco-regional recurrence, three categories were considered, with only extra-PET scan PTV and intra-CT scan PTV recurrences considered as a failure. Our hypothesis was that the rate of these events would be < 10%. Twelve patients were recruited; the study closed early due to poor recruitment. The primary endpoint of the pilot was met; it was feasible to deliver a PET-CT-based plan to ≥ 60% of patients. Two patients had intra-PET scan PTV recurrences, six had extra-PET scan PTV and extra-CT, and three patients had both. Another patient had extra-PET scan PTV and extra-CT as well as extra-PET scan PTV and intra-CT scan PTV recurrence. PET-based planning has the potential to reduce radiation treatment volumes because of the avoidance of mediastinal lymph nodes that are PET negative.

TITLE:Cancer Trials Ireland (ICORG) 06-34: A multi-centre clinical trial using three-dimensional conformal radiation therapy to reduce the toxicity of palliative radiation for lung cancer. NCT01176487. BACKGROUND & PURPOSE:Trials of radiation therapy for the palliation of intra-thoracic symptoms from locally advanced non-small cell lung cancer (NSCLC) have concentrated on optimising fractionation and dose schedules. In these trials, the rates of oesophagitis induced by this "palliative" therapy have been unacceptably high. In contrast, this non-randomised, single-arm trial was designed to assess if more technically advanced treatment techniques would result in equivalent symptom relief and reduce the side-effect of symptomatic oesophagitis. MATERIALS & METHODS:Thirty-five evaluable patients with symptomatic locally advanced or metastatic NSCLC were treated using a three-dimensional conformal technique (3-DCRT) and standardised dose regimens of 39 Gy in 13 fractions, 20 Gy in 5 fractions or 17 Gy in 2 fractions. Treatment plans sought to minimise oesophageal dose. Oesophagitis was recorded during treatment, at two weeks, one month and three months following radiation therapy and 3-6 monthly thereafter. Mean dose to the irradiated oesophagus was calculated for all treatment plans. RESULTS:Five patients (14%) had experienced grade 2 oesophagitis or dysphagia or both during treatment and 2 other patients had these side effects at the 2-week follow-up. At follow-up of one month after therapy, there was no grade two or higher oesophagitis or dysphagia reported. 22 patients were eligible for assessment of late toxicity. Five of these patients reported oesophagitis or dysphagia (one had grade 3 dysphagia, two had grade 2 oesophagitis, one of whom also had grade 2 dysphagia). Quality of Life (QoL) data at baseline and at 1-month follow up were available for 20 patients. At 1-month post radiation therapy, these patients had slightly less trouble taking a short walk, less shortness of breath, did not feel as weak, had better appetite and generally had a better overall quality of life than they did at baseline. They did report being slightly more tired. CONCLUSIONS:This trial is the first of its kind showing that 3-DCRT provides patients with lower rates of oesophageal toxicity whilst yielding acceptable rates of symptom control. (Sponsored by Cancer Trials Ireland (ICORG) Study number 06-34, the Friends of St. Luke's and the St. Luke's Institute of Cancer Research.).

OBJECTIVENeoadjuvant "long-course" chemoradiation is considered a standard of care in locally advanced rectal cancer. In addition to prostatectomy, external beam radiotherapy and brachytherapy with or without androgen suppression (AS) are well established in prostate cancer management. A retrospective review of ten cases was completed to explore the feasibility and safety of applying these standards in patients with dual pathology. To our knowledge, this is the largest case series of synchronous rectal and prostate cancers treated with curative intent.METHODSEligible patients had synchronous histologically proven locally advanced rectal cancer (defined as cT3-4Nx; cTxN1-2) and non-metastatic prostate cancer (pelvic nodal disease permissible). Curative treatment was delivered to both sites simultaneously. Follow-up was as per institutional guidelines. Acute and late toxicities were reviewed, and a literature search performed.RESULTSPelvic external beam radiotherapy (RT) 45-50.4 Gy was delivered concurrent with 5-fluorouracil (5FU). Prostate total dose ranged from 70.0 to 79.2 Gy. No acute toxicities occurred, excluding AS-induced erectile dysfunction. Nine patients proceeded to surgery, and one was managed expectantly. Three relapsed with metastatic colorectal cancer, two with metastatic prostate cancer. Five patients have no evidence of recurrence, and four remain alive with metastatic disease. With a median follow-up of 2.2 years (range 1.2-6.3 years), two significant late toxicities occurred; G3 proctitis in a patient receiving palliative bevacizumab and a G3 anastomotic stricture precluding stoma reversal.CONCLUSIONPatients proceeding to synchronous radical treatment of both primary sites should receive 45-50.4 Gy pelvic RT with infusional 5FU. Prostate dose escalation should be given with due consideration to the potential impact of prostate cancer on patient survival, as increasing dose may result in significant late morbidity. Review of published series explores the possibility of prostate brachytherapy as an alternative method of boost delivery. Frequent use of bevacizumab in metastatic rectal cancer may compound late rectal morbidity in this cohort.ADVANCES IN KNOWLEDGETo our knowledge, this is the largest case series of synchronous rectal and prostate cancers treated with curative intent. This article contributes to the understanding of how best to approach definitive treatment in these patients.

TPS4145 Background: Neoadjuvant therapy is increasingly the standard of care in the management of locally advanced adenocarcinoma of the esophagus and junction (AEG). The MAGIC and CROSS regimens were superior to surgery only in randomized controlled trials (RCTs) that included AEG but were not powered on this cohort, and no completed RCT has directly compared neoadjuvant chemotherapy and chemoradiation. This trial, uniquely powered on AEG, and including comprehensive modern staging, compares both these Level I regimens. Methods: This open label, phase III RCT randomizes patients in a 1:1 fashion to receive either pre and postoperative chemotherapy as per the MAGIC regimen [Etoposide, Cisplatin, Fluorouracil (Capecitabine)] or neoadjuvant chemoradiation as per the CROSS protocol (Carboplatin and Paclitaxel with concurrent radiotherapy, 41.4Gy/23Fr, over 5 weeks). The power calculation is a 15% difference in 3 year overall survival, power at 80%, two-sided alpha level of 0.05, requiring 366 subjects over a five year period, with analysis performed one year after last subject recruited. Eligibility includes: AEG, types I, II, and III, staged (CT-PET and EUS) as cT2-3, N0-3, M0 and surgically resectable, with good performance status and no major co-morbidities. The primary endpoint is overall survival, with a minimum 3 year follow up. Secondary endpoints include: disease free survival, recurrence rates, clinical and pathological response rates, toxicities of induction regimens, post-operative pathology and tumor regression grade, operative in-hospital complications, and health-related quality of life. Pre-treatment bio-resourcing of tumor and blood will enable correlative translational studies. Conduct to Date: The trial activated in February 2013 at the national center in Ireland, 35 patients are randomized to date. Other centers in Ireland and Europe will commence in 2014. Clinical trial information: NCT01726452.

e15069 Background: CRT with CP has been established as an efficacious and well-tolerated treatment option for non-metastatic oesophageal and junctional tumors. For selected patients (pts) deemed unsuitable for radical resection, a modified regimen as definitive therapy (DEF) has been adopted, as previously reported. This study examined the influence of age in the uptake of CRT with neoadjuvant (NA) intent. Methods: Pts were identified from institutional pharmacy database. Inclusion criteria were: 1) non-metastatic esophageal or esophagogastric tumor and 2) receipt of weekly CP with concurrent radiotherapy. Electronic health records were reviewed to extract pts demographics and clinical details. Intended therapies (NA vs DEF) and actual therapies received were recorded. Pts were divided into ≥70 years old and <70 years old cohort for comparison. An exploratory logistic regression analysis was performed to investigate influence of age and other variables. Results: Between August 2010 and January 2014, sixty-five pts were identified, of which 46 (71%) were males and median age was 69 years (range: 40-83). All pts had ECOG PS of 0-1. Forty-six (71%) were adenocarcinoma. Majority were cT3 (n=54, 87%), while 38 (60%) were cN0. Thirty-two pts (49%) were ≥70 years old. Median Charlson co-morbidity index for the ≥70 cohort was 4 (range: 0 – 8). In the ≥70 group, 14/32(44%) were planned for NA, compared to 24/33(73%) in <70 group (p=.02). Pts proceeding to radical surgery were 10(71%) in ≥70 and 18(75%) in <70 cohort (p>.05). Pts ≥70 and <70 did not proceed to surgery due to disease progression (1 vs 0), co-morbidities (1 vs 5) and declined (2 vs 1). 18/32(56%) in ≥70 and 9/33(27%) <70 were in DEF group. An exploratory multivariate logistic regression analysis identified ECOG PS 0 vs 1 [OR 4.9 (95% CI 1.2 - 22.5)], and Charlson index ≥3 vs <3 [OR 0.2 (95% CI 0.0 - 0.7), p=.02) as predictive for NA therapy but not age, gender, nodal status or histologic subtypes. Conclusions: Even though older pts were less likely to be offered NA CRT, rate of proceeding to surgery was similar. ECOG PS and co-morbidities instead of absolute age were significant predictive factors.

e14551 Background: Delivery of neoadjuvant chemoradiotherapy (NACRT) in LARA is predicated on MRI staging. Small series of direct-to-surgery patients (pts) suggested high rates of over/under-staging of pts. Tumour bed fibrosis reflects the extent of NACRT response and could be used as a surrogate of pre-therapy tumour stage. Comparing to fibrosis-based staging, we sought to examine 1.) rates of staging discrepancy and 2.) true magnitude of response to NACRT. Methods: Consecutive pts with diagnosis of LARA who received NACRT were identified from institutional database between January 2011 and November 2013. Demographics and clinical stages were extracted from health records. Histopathology reports were reviewed to obtain post-NACRT staging and to estimate pre-therapy staging based on extent of fibrosis according to AJCC 7th edition. Results: 60 pts were identified with a median age of 66 years (range: 27 – 85), of which 42 (70%) were males. Distribution of clinical, fibrosis-based, and post-therapy T- and N- stages are tabulated below. Pathologic complete response was observed in 15% of patients. By fibrosis-based staging, 22% may be deemed over-treated based on clinical trial eligibility. Compared to fibrosis-based staging, clinical T-stage over-/under-staged in 28% and 17% of cases, respectively, while clinical N-stage over-/under-staged in 38% and 13% of cases, respectively. With respect to treatment response, T-stage was down-staged in 47% and up-staged in 13% of cases based on clinical staging but down-staged in 35% as per fibrosis-based staging. N-stage was down-staged in 52% and up-staged in 12% of cases based on clinical staging but only down-staged in 23% of cases. Conclusions: MRI-based staging of LARA may be discordant with true disease stage in up to 1/3 of cases, and the rates of disease downstaging achieved might have been over-estimated. More sensitive pre-treatment staging modalities would be required. Clinical staging Fibrosis-based staging n % n % p T2 6 10 17 28 0.03 T3 46 77 33 55 T4 8 13 10 17 N0 16 27 31 52 0.02 N1 34 57 23 38 N2 10 17 6 10 ypT0 9 15 ypT1 2 3 ypT2 15 25 ypT3 28 47 ypT4 6 10 ypN0 42 70 ypN1 13 22 ypN2 5 8

PURPOSE:To report acute toxicity resulting from radiotherapy (RT) dose escalation and hypofractionation using intensity-modulated RT (IMRT) treatment combined with androgen suppression in high-risk prostate cancer patients. METHODS AND MATERIALS:Sixty patients with a histological diagnosis of high-risk prostatic adenocarcinoma (having either a clinical Stage of > or =T3a or an initial prostate-specific antigen [PSA] level of > or =20 ng/ml or a Gleason score of 8 to 10 or a combination of a PSA concentration of >15 ng/ml and a Gleason score of 7) were enrolled. RT prescription was 68 Gy in 25 fractions (2.72 Gy/fraction) over 5 weeks to the prostate and proximal seminal vesicles. The pelvic lymph nodes and distal seminal vesicles concurrently received 45 Gy in 25 fractions. The patients were treated with helical TomoTherapy-based IMRT and underwent daily megavoltage CT image-guided verification prior to each treatment. Acute toxicity scores were recorded weekly during RT and at 3 months post-RT, using Radiation Therapy Oncology Group acute toxicity scales. RESULTS:All patients completed RT and follow up for 3 months. The maximum acute toxicity scores were as follows: 21 (35%) patients had Grade 2 gastrointestinal (GI) toxicity; 4 (6.67%) patients had Grade 3 genitourinary (GU) toxicity; and 30 (33.33%) patients had Grade 2 GU toxicity. These toxicity scores were reduced after RT; there were only 8 (13.6%) patients with Grade 1 GI toxicity, 11 (18.97%) with Grade 1 GU toxicity, and 5 (8.62%) with Grade 2 GU toxicity at 3 months follow up. Only the V60 to the rectum correlated with the GI toxicity. CONCLUSION:Dose escalation using a hypofractionated schedule to the prostate with concurrent pelvic lymph node RT and long-term androgen suppression therapy is well tolerated acutely. Longer follow up for outcome and late toxicity is required.

Lung cancer represents the most deadly type of malignancy. In this work we propose a machine learning approach to segmenting lung tumours in Positron Emission Tomography (PET) scans in order to provide a radiation therapist with a "second reader" opinion about the tumour location. For each PET slice, our system extracts a set of attributes, passes them to a trained Support, Vector Machine (SVM), and returns the optimal threshold value for distinguishing tumour from healthy voxels in that particular slice. We use this technique to analyse Four different PET/CT 3D studies. The system produced fairly accurate segmentation, with Jaccard and Dice's similarity coefficients between 0.82 and 0.98 (the areas outlined by the returned thresholds vs. the ones outlined by the reference thresholds). Besides the high level of geometric similarity, a significant correlation between the returned and the reference thresholds also indicates that during the training phase, the learning algorithm effectively acquired the dependency between the extracted attributes and optimal thresholds.

PurposeA planning study to compare helical tomotherapy (HT) and intensity-modulated radiotherapy (IMRT) for the treatment of anal canal cancer.Materials and methodsSixteen (8 males and 8 females) patients with anal cancer previously treated radically were identified. HT and IMRT plans were generated and dosimetric comparisons of the plans were performed. The planning goals were to deliver 54Gy to the tumor (PTV54Gy) and 48Gy to the nodes at risk (PTVNode) in 30 fractions.ResultsPTVs: HT plans were more homogeneous for both men and women. Male patients: HT vs. IMRT: Dmax: 55.87±0.58 vs. 59.17±3.24 (p=0.036); Dmin: 52.91±0.36 vs. 44.09±6.84 (p=0.012); female patients: HT vs. IMRT: Dmax: 56.14±0.71 vs. 59.47±0.81 (p=0.012); Dmin: 52.36±0.87 vs. 50.97±1.42 (p=0.028). OARs: In general, HT plans delivered a lower dose to the peritoneal cavity, external genitalia and the bladder and IMRT plans resulted in greater sparing of the pelvic bones (iliac crest/femur) for both men and women. Iliac crest/femur: the difference was significant only for the mean V10Gy of iliac crest in women (p⩽0.012). External genitalia: HT plans achieved better sparing in women compared to men (p⩽0.046). For men, the mean doses were 18.96±3.17 and 15.72±3.21 for the HT and IMRT plan, respectively (p⩽0.017). Skin: both techniques achieved comparable sparing of the non-target skin (p=NS).ConclusionsHT and IMRT techniques achieved comparable target dose coverage and organ sparing, whereas HT plans were more homogeneous for both men and women.

The benefit of postoperative radiotherapy (RT) has been demonstrated in elderly patients aged 65 years or older with glioblastoma multiforme. Hypofractionated RT schedules can reduce the time and morbidity of treatment while maintaining comparable survival outcomes to lengthy conventional RT. Current international randomized clinical trials are studying the optimized hypofractionated RT regimens, hypofractionated RT in comparison with temozolomide chemotherapy and hypofractionated RT in comparison with the same RT plus temozolomide. Given the guarded prognosis of the elderly and frail patients, quality of life and side effects of treatment should be closely examined. As more than half of cancers in the world occur in developing countries, hypofractionated RT could be better utilized as a cost-effective treatment for this group of patients.

PURPOSE:Prostate cancer is the leading form of cancer diagnosed among North American men. Most patients present with localized disease, which can be effectively treated with a variety of different modalities. These are associated with widely different acute and late effects, which can be both physical and psychological in nature. HRQoL concerns are therefore important for these patients for selecting between the different treatment options.MATERIALS AND METHODS:One year after receiving radiotherapy for localised prostate cancer 117 patients with localized prostate cancer were invited to participate in a quality of life (QoL) self reported survey. 111 patients consented and participated in the survey, one year after completion of their treatment. 88 patients received EBRT and 23 received EBRT and HDRBT. QoL was compared in the two groups by using a modified version of Functional Assessment of Cancer Therapy-Prostate (FACT-P) survey instrument.RESULTS:One year after completion of treatment, there was no significant difference in overall QoL scores between the two groups of patients. For each component of the modified FACT-P survey, i.e. physical, social/family, emotional, and functional well-being; there were no statistically significant differences in the mean scores between the two groups.CONCLUSION:In prostate cancer patients treated with EBRT alone versus combined EBRT and HDRBT, there was no significant difference in the QoL scores at one year post-treatment.

BACKGROUND:We report the case of a patient with treated Stage Ia seminoma who was found to have an elevated beta human chorionic gonadotrophin (hCG) on routine follow - up. This instigated restaging and could have lead to commencement of chemotherapy.CASE PRESENTATION:The patient was a bodybuilder, and following a negative metastatic work - up, admitted to injecting exogenous beta hCG. This was done to reduce withdrawal symptoms from androgen abuse. The patient remains well eight years post diagnosis.CONCLUSION:This case highlights the need for surgical oncologists to conduct vigilant screening of young male patients with a history of testicular germ cell tumours and who may indulge in steroid abuse.