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Presents several letters to the editor referencing articles and topics discussed in previous issues of the journal "Australasian Radiology." Discussion on medical record that should contain details of the elicitation of the patient's choice to proceed with a treatment; Focuses on the use of adjuvant androgen deprivation which was surveyed in a report on three-dimensional conformal radiotherapy; Discussion on single fractions of radiotherapy as suitable for plantar fasciitis.

In February 1996 the Trans-Tasman Radiation Oncology Group (TROG) initiated a two-arm, multicentre, prospective randomized trial on radiotherapy for neuropathic pain due to bone metastases (TROG 96.05). This trial compares the response to a single 8-Gy fraction with 20 Gy in five fractions. The accrual target is 270 patients. In order to evaluate compliance with eligibility criteria after approximately 1 year of accrual, an independent audit of the first 42 randomized patients was commissioned. This found that only one of these patients did not have genuine neuropathic pain, but that this patient and seven others (19%) had infringements of other eligibility/exclusion criteria for the trial. Accordingly it was decided to continue the full audit up to 90 patients. This detected no further patients without genuine neuropathic pain, and found only one other eligibility infringement (1/48; 2%). It is concluded that this quality assurance (QA) measure undertaken early in the trial led to significantly improved clinician awareness of, and compliance with, eligibility/exclusion criteria. It also enabled an accurate comparison of outcome data for all randomized versus all eligible patients at the time of the preplanned first interim analysis at 90 patients. In view of the excellent compliance demonstrated in the second audit, a one-in-five sampling is proposed for future audits from centres that have already accrued at least five consecutive eligible patients. This is consistent with TROG QA guidelines now operational.

Radiosurgery refers to the treatment of small lesions localized by stereotactic technology using highly focused radiation. This review utilizes prospectively gathered data from the Royal Adelaide Hospital Radiosurgery unit to summarize experience with the first 62 patients (65 lesions) treated between November 1993 and May 1998. This experience included acoustic neuromas (23 patients), arteriovenous malformations (18), brain metastases (12), meningiomas (6), and glomus tumour, subependymoma, dural arteriovenous fistula (1 each). Although follow up is relatively short, the outcome in terms of morbidity and tumour control is thus far comparable with results reported in the literature. Radiosurgery provides a viable alternative to neurosurgery and conventional external beam radiotherapy for several benign and malignant intracranial lesions.

Two case studies of locally extensive clinical stage IIA Hodgkin's disease (HD) were presented to radiation oncologists at a meeting of the Australasian Radiation Oncology Lymphoma Group, and subsequently to non-attending members who were asked to indicate their recommended treatment. This paper discusses the 25 responses which were notable by considerable heterogeneity in philosophy and detail. There is clearly no consensus among Australasian radiation oncologists at present, although combined modality therapy (CMT) with Adriamycin, bleomycin, vinblastine, and dacarbazine (ABVD) followed by low-medium-dose involved field radiotherapy (25-36 Gy) was the most popular response. The literature on radiation dose and chemotherapy in CMT for HD is then reviewed. It seems very likely that low doses in the range of 25-30 Gy (at 1.5-2.0 Gy per fraction) are sufficient. The ABVD should be considered as the 'standard' regimen at present, although the optimal sequencing with radiation and number of cycles remain unknown. The heterogeneity of responses to management of the case studies raises questions about ongoing education processes in radiation and medical oncology. Hypothetical case management review may complement currently proposed methods of assessing continuing medical education.

The records of all patients with stage I and II Hodgkin's disease treated with radiotherapy alone at the Royal Adelaide Hospital between 1970 and 1986 were reviewed. The aim was to ensure the results were equivalent to the best reported series, particularly as treating such patients with chemotherapy alone has been shown to produce equivalent overall survival figures with improved relapse-free survival. There were 104 patients of whom 67 had undergone staging laparotomy. Fifty-seven patients were stage I and 47 stage II. Nine patients had B symptoms. Overall survival at 10 years was 83% with disease-specific survival being 86% and relapse-free survival 68%. These results compare favourably with those in the world literature. Multivariate analysis only revealed stage as an independent predictor of improved relapse-free survival. The use of radiotherapy for most patients with early stage Hodgkin's disease is continued at Royal Adelaide Hospital. However, careful selection criteria need to be applied to minimize the incidence of relapse after radiotherapy.

A case of unilateral vitreous relapse in a patient with primary central nervous system lymphoma (PCNSL) following sequential systemic chemotherapy and radiotherapy is reported. A literature review reveals that ocular involvement may occur in up to 15-25% of cases during the course of this disease. Full ophthalmological assessment, including slit lamp examination, should be included in the routine staging of PCNSL at the time of initial diagnosis and subsequently if relapse occurs.