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Objective: The objective of this study was to explore the experiences of head and neck cancer (HNC) survivors who returned to valued activities to understand how they reconstruct their lives following HNC diagnosis and treatment. Methods: A qualitative research approach based on social constructionist theory was used. A total of 21 in‐depth semi‐structured interviews were conducted with adults diagnosed with any type of HNC in the previous 6 years. Reflexive thematic analysis was used to identify themes. Results: HNC presents a unique trauma following which some survivors navigate paths back to meaningful activities. The experiences of HNC survivors who adapted to life after treatment described internal and external change and development, identified by three themes; Mindfulness; Gratitude; and Adaptation. Conclusion: People diagnosed with HNC frequently experience lasting effects and other survivorship issues, however some survivors were able to return to valued activities and recreate a meaningful lifestyle reflecting the possibility of post traumatic growth. This study provides insight into the experiences of head and neck cancer survivors who were able to make meaning and find internal and external growth following treatment. These findings can be used to inform advanced communication skills training for oncology health professionals and psychoeducational courses for people diagnosed with head and neck cancer in the future. [ABSTRACT FROM AUTHOR]

Abstract: Aim: The aim of this study was to examine stakeholders' views of how the establishment of the South West Radiation Oncology Service in Bunbury, Western Australia, has affected treatment decision‐making, and the extent to which patients are involved in the decision‐making process. Methods: Semi‐structured in‐depth interviews were undertaken with 21 service providers involved in the treatment and care of people with cancer, and 17 adults diagnosed with cancer who opted to undergo radiotherapy (RT) treatment at the Service. Data were subject to thematic analysis using the qualitative data analysis software NVivo 10. Results: Patients were overwhelmingly positive about their experiences at the Service, praising the quality of the care provided and noting the convenience associated with receiving treatment locally. Most patients reported feeling involved in decision‐making, but tended to rely on and generally adopt advice from medical professionals regarding type and location of treatment. Although service providers in the region had become more aware of the regional RT service and referrals had increased, some patients continued to travel to the metropolitan area for treatment. Reasons identified for this included the need for more specialized RT treatment and the more extensive range of allied health services offered. Conclusion: Increased convenience and a lower financial burden are key reasons why rural cancer patients prefer treatment at a regional RT service rather than travelling to metropolitan centers. These factors highlight the need for ongoing improvement in access to local RT services so that disparities in cancer outcomes between rural and metropolitan patients are reduced. [ABSTRACT FROM AUTHOR]

Introduction Comprehensive oncology services have recently been introduced in the Northern Territory ( NT) enabling delivery of concurrent chemo-radiotherapy ( CCRT) in locally advanced head and neck squamous cell carcinoma ( LAHNSC). The purpose of this study is to assess feasibility, compliance and toxicity of CCRT in remote Australia. Methods Chart review was conducted for all patients >18 years, with biopsy-proven LAHNSC, receiving curative intent CCRT between January 2010 and September 2012. Results The study population comprised of 26 patients, 20 Caucasian and 6 Indigenous, having a median age of 58 years, with most common sites of involvement being the oropharynx ( n = 16) and the oral cavity ( n = 6). Major risk factors were smoking and alcoholism. Cardiovascular disease, viral hepatitis, latent tuberculosis and strongyloidosis were the major comorbidities. Fifty-eight per cent ( n = 15) required assisted feeding. All patients received intensity modulated radiotherapy. Systemic therapy comprised of cisplatin or carboplatin/cetuximab. Most common acute (grade 3/4) toxicities were mucositis, dysphagia and dermatological in 54%, 31% and 23% respectively. Complications were infection and gastrostomy insertion related. Hospitalisation occurred in 23%, treatment break >2 days in 38%, with no difference in toxicities between indigenous and nonindigenous patients. Platinum use was associated with greater nausea ( P = 0.003), renal dysfunction ( P = 0.03) and ototoxicity ( P = 0.04) and cetuximab with dermatological reactions ( P = 0.05). At median follow-up of 16 months, overall survival was 58% with progression-free survival of 50%. Conclusions We have demonstrated good compliance rates, tolerance and feasibility outcomes. The seeming preponderance of LAHNSC in the NT is cause for concern. [ABSTRACT FROM AUTHOR]

Introduction The aims of the study were to evaluate interobserver variability in contouring the brachial plexus ( BP) using the Radiation Therapy Oncology Group ( RTOG)-approved protocol and to analyse BP dosimetries. Methods Seven outliners independently contoured the BPs of 15 consecutive patients. Interobserver variability was reviewed qualitatively (visually by using planning axial computed-tomography images and anteroposterior digitally reconstructed radiographs) and quantitatively (by volumetric and statistical analyses). Dose-volume histograms of BPs were calculated and compared. Results We found significant interobserver variability among outliners in both qualitative and quantitative analyses. These were most pronounced for the T1 nerve roots on visual inspection and for the BP volume on statistical analysis. The BP volumes were smaller than those described in the RTOG atlas paper, with a mean volume of 20.8 cc (range 11-40.7 cc) compared with 33 ± 4 cc (25.1-39.4 cc). The average values of mean dose, maximum dose, V60 Gy, V66 Gy and V70 Gy for patients treated with conventional radiotherapy and IMRT were 42.2 Gy versus 44.8 Gy, 64.5 Gy versus 68.5 Gy, 6.1% versus 7.6%, 2.9% versus 2.4% and 0.6% versus 0.3%, respectively. Conclusion This is the first independent external evaluation of the published protocol. We have identified several issues, including significant interobserver variation. Although radiation oncologists should contour BPs to avoid dose dumping, especially when using IMRT, the RTOG atlas should be used with caution. Because BPs are largely radiologically occult on CT, we propose the term brachial-plexus regions ( BPRs) to represent regions where BPs are likely to be present. Consequently, BPRs should in principle be contoured generously. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate interobserver variability in contouring lumbosacral plexuses (LSP) using the protocol developed by Yi et al. (IJROBP 2012; 84: 376-82) and to review LSP dosimetries for conventional radiotherapy and intensity-modulated radiotherapy (IMRT) for pelvic cancers. Methods and Materials: Using the above-mentioned protocol, seven outliners independently contoured LSPs of 10 consecutive patients (five patients treated with conventional radiotherapy and five with IMRT). Interobserver variability was reviewed visually by using planning axial CT images and anteroposterior digitally reconstructed radiographs. Dosimetries of LSPs were also calculated and compared. Results: There was a notable learning curve for each outliner; duration to outline the first patient was 45-185 minutes, versus 15-50 minutes after six patients. We found significant interobserver variability among outliners below the level of the S2 nerve roots. The LSP volumes (mean volume range of 40.9-58.4 cc) were smaller than those described in the atlas paper (71-138 cc). The mean values of mean dose, maximum dose, V40 Gy, V50 Gy and V55 Gy, respectively, for patients treated with conventional radiotherapy versus those treated with IMRT were 35.5 Gy versus 33.6 Gy, 52.2 Gy versus 52.2 Gy, 61.3% versus 54.4%, 14.9% versus 18.8% and 0% versus 2.5%. Conclusion: We conclude that the protocol developed by Yi et al. is a useful set of guidelines but suggest that additional at-risk components of the LSP also be contoured. We recommend that radiation oncologists practise 'nerve-sparing' radiotherapy by contouring LSPs, especially when using IMRT. We propose the term 'lumbosacral plexus regions' (LSPRs) to highlight the fact that LSPs are not always radiologically visible, only the regions where they are likely to be present. [ABSTRACT FROM AUTHOR]

Introduction There is a perception that Indigenous patients are less likely to attend radiotherapy treatment. This study sought to determine if a difference in radiotherapy treatment compliance rates exists between Indigenous and non- Indigenous patients. Secondly, we aimed to ascertain which patient, disease and treatment factors affect compliance in Indigenous patients. Methods All patients treated with radiotherapy at the Alan Walker Cancer Care Centre between March and October 2010 were analysed. Data regarding compliance rates (defined as those who chose and completed the recommended course of treatment), patient, disease and treatment factors were collected, and chi-squared and Fisher's exact tests were applied. Results A total of 41 courses were delivered to Indigenous patients and 224 courses delivered to non- Indigenous patients in this period. There was no difference in compliance between Indigenous and non- Indigenous patients (83% vs. 81%, P = 0.75). Of the factors assessed, it was found that there was an association between toxicity grade and compliance ( P = 0.048). Conclusions From this cohort, we cannot support the perception that Indigenous patients have overall poorer compliance with recommended radiation treatment courses. In this study, the only factor which correlated significantly with compliance was toxicity grade. It is felt that a number of factors, which negatively impact on compliance, can potentially be counteracted by a culturally sensitive model of care. [ABSTRACT FROM AUTHOR]

Microcystic adnexal carcinoma (MAC) is a rare cutaneous tumour where the role of radiotherapy remains undefined. We contrast our institutional experience with current literature, define the local control rate and suggest a role for adjuvant radiotherapy in the treatment of this cancer. From 1992-2008, a retrospective review was undertaken for MAC treated with curative intent involving surgery and adjuvant radiotherapy at the Royal Brisbane Hospital and Mater Hospital Brisbane. Clinical, pathologic and treatment details as well as patterns of recurrence were analysed. Fourteen cases of MAC received local excision and adjuvant radiotherapy. The median age was 71 years old, with nine of the cases in men. All cases occurred in the head and neck region with mean tumour size of 20.5 mm and mean depth of invasion of 9.9 mm. Peri-neural invasion occurred in 56% of cases and 69% had positive surgical margins. Various adjuvant radiotherapy schedules were used to treat the primary site resulting in a crude local control rate of 93%. Primary and nodal relapses were subsequently salvaged with further treatment. While Mohs micrographic surgery may be considered the gold standard, wide local excision and adjuvant radiotherapy offers comparable control rates. Doses of 50 Gy or greater should be prescribed with generous margins (3-5 cm) owing to its tendency for peri-neural and deep invasion. There was no evidence that radiotherapy can cause aggressive transformation of the tumour. The role for definitive radiotherapy remains uncertain. [ABSTRACT FROM AUTHOR]

To determine the overall survival and gastrointestinal toxicity for patients treated with salvage definitive chemo-radiotherapy after primary surgery for locoregional relapse of oesophageal carcinoma. A retrospective review of 525 patients who had a resection for oesophageal or oesophagogastric carcinoma at Princess Alexandra Hospital identified 14 patients treated with salvage definitive radiotherapy or chemo-radiotherapy, following localized recurrence of their disease. We analysed the patient and treatment characteristics to determine the median overall survival as the primary end point. Gastrointestinal toxicity was examined to determine if increased toxicity occurred when the stomach was irradiated within the intrathoracic radiotherapy field. The median overall survival for patients treated with curative intent using salvage definitive chemo-radiotherapy was 16 months and the 2-year overall survival is 21%. One patient is in clinical remission more than 5 years after therapy. Age <60 years old and nodal recurrence were favourable prognostic factors. Treatment compliance was 93% with only one patient unable to complete the intended schedule. Fourteen per cent of patients experienced grade 3 or 4 gastrointestinal toxicity. Salvage definitive chemo-radiotherapy should be considered for good performance status patients with oesophageal carcinoma who have a locoregional relapse after primary surgery. The schedule is tolerable with low toxicity and an acceptable median survival. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "Should the treatment paradigms for oral and oropharyngeal cancers be changed now: the role of human papilloma virus?," by R. C. Dwivedi and colleagues in the 2011 issue.