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BACKGROUND There are global variations in radiotherapy approaches for icGCT. An understanding of patterns of disease recurrence correlated with radiation techniques and doses is important in standardising and improving the quality of radiotherapy using high-precision techniques. METHODS AND RESULTS Data from 20 patients with tumour recurrence after treatment within the SIOP GCT96 study in the UK were analysed. Seven (35%) patients had germinoma and 13 (65%) had non-germinoma. Twelve patients had local recurrence, 5 had metastatic and 3 had local and metastatic disease. Radiotherapy details were retrieved in only 8 patients (40%). Six patients had received focal radiotherapy and two craniospinal radiotherapy. Of the patients who received focal radiotherapy, 4 had recurrence within the radiation portal, one had periventricular recurrence and one had marker-positive recurrence with no radiological lesions. Both patients who received CSI recurred within the CSF space. The main reasons for poor retrieval of treatment details were difficulty in retrieving archived information and that the study was conducted during a period before PACS or electronic radiotherapy records. CONCLUSION This study highlights the importance prospective data collection and analysis to understand the patterns of recurrence in icGCT. Even within a prospective study, radiotherapy techniques varied between centres. There is therefore an urgent need for centralised radiological review and prospective radiotherapy quality assurance measures in future clinical trials.

Summary Background Mesothelioma invades the tracts made by chest instrumentation. Prophylactic radiotherapy is effective at preventing malignant seeding at these sites. Methods We assessed the use and effectiveness of radiotherapy at our centre in 39 of the 40 patients identified with mesothelioma between January 2000 and September 2003. Results Thirty-seven (95%) patients received radiotherapy to their chest instrumentation site between 6 and 42 days (median 26 days) following the diagnosis of mesothelioma. The radiotherapy field size varied, from 4 cm square to 14×10.5 cm. The radiotherapy was given as 21 Gy in 3 fractions over 1 week. In 3 patients (8%), there was already tumour invasion of the skin at the time of radiotherapy. In 2 other patients (5%), there was tumour recurrence following radiotherapy; in both this was at the edge of the previous radiotherapy fields. Further treatment was administered to an adjacent field in both. One patient with an indwelling pleural catheter developed tumour growth at the catheter insertion site. This was treated successfully with radiotherapy, with no catheter damage. Conclusions Prompt radiotherapy referral and radiotherapy field selection is important to maximise the effect of radiotherapy given to prevent chest wall tumour growth. There was no tumour growth in areas that were treated with radiotherapy. Further chest interventions outside the radiotherapy field should be followed with further radiotherapy.

Brain metastases are a common manifestation of disseminated malignancy and the approach to management has for many years consisted of corticosteroids and brain irradiation [1]. Following palliative whole brain radiotherapy, median survival is in the region of 4 months [2–4] and is dependent on performance status, age and the activity of disease outside the CNS [5]. Patients with single brain metastases generally represent a favourable sub-group [6–7]. This is in part due to the solitary nature of the tumour and in part because patients with solitary brain metastases tend to have low tumour burden and hence favourable prognostic factors. Where the tumour is accessible, surgical excision has been shown to prolong median survival by 1–4 months compared to radiotherapy alone [8–10] although the benefit is confined to patients with controlled disease at extracranial sites [9]. Despite the palliative nature of various therapeutic interventions, the efficacy of treatment in terms of improvement in neurological deficit and quality of life is poorly described. While we can be purist about demanding such information, the palliative benefit of treatment primarily aimed at tumour eradication is inseparable from the symptomatic relief obtained with corticosteroids which most patients receive. Until some years ago the choice of surgery, radiotherapy and supportive care seemed the end of the story and the management decision had been described as a ‘no brainer’ [11]. The last decade has seen changes with more therapeutic options including radiosurgery, chemotherapy (and other systemic therapies) and the use of radiation sensitisers and this requires a more complex decision making process [12]. It remains to be seen whether the arrival of new therapies has had a significant impact on outcome, for either the individual patient or