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We conducted a retrospective analysis of patients with squamous cell carcinoma of the head and neck (SCCHN) treated with curative-intent radiotherapy at the National Cancer Institute of Sri Lanka to determine the impact of the treatment technique on disease-free survival (DFS).SCCHN patients treated with radical radiotherapy or adjuvant postoperative radiotherapy from 2016 to 2017 were included in the study. Data on the following variables were collected by reviewing clinical and radiotherapy treatment records: age, gender, tumour site, stage, time to delivery of radiotherapy, use of neoadjuvant chemotherapy, use of concurrent radiosensitising chemotherapy and treatment technique. DFS, defined as the time to death, tumour recurrence or loss to follow-up, was the primary end point and outcomes were compared between patients treated with intensity-modulated radiotherapy (IMRT) in linear accelerators and those treated with conventional radiotherapy in cobalt teletherapy units. Univariate and multivariate analyses were carried out on known prognostic variables.In total, 408 patients were included in the study, with 138 (34%) being treated with IMRT in the linear accelerator. More than 75% of patients were of stage III or IV at diagnosis. The 2-year DFS of the whole cohort was 25% (95% confidence interval 21-30%). Patients treated with IMRT in the linear accelerator had a superior DFS in comparison with those treated with conventional radiotherapy in the cobalt teletherapy units (P0.001, hazard ratio 0.64, 95% confidence interval 0.5-0.82). Higher stage, cobalt treatment and use of neoadjuvant chemotherapy were adversely associated with DFS on multivariate analysis.A large proportion of patients with SCCHN treated with curative-intent radiotherapy in Sri Lanka had locally advanced disease and DFS was superior in patients treated with IMRT in the linear accelerator.

Aims Cancer incidence varies across England, which affects the local-level demand for treatments. The magnetic resonance-linac (MR-linac) is a new radiotherapy technology that combines imaging and treatment. Here we model the demand and demand variations for the MR-linac across England. Materials and methods Initial clinical indications were provided by the MR-linac consortium and introduced into the Malthus radiotherapy clinical decision trees. The Malthus model contains Clinical Commissioning Group (CCG) population, cancer incidence and stage presentation data (for lung and prostate) and simulated the demand for the MR-linac for all CCGs and Radiotherapy Operational Delivery Networks (RODN) across England. Results Based on the initial target clinical indications, the MR-linac could service 16% of England's fraction burden. The simulated fractions/million population demand/annum varies between 3000 and 10 600 fractions/million at the CCG level. Focussing only on the cancer population, the simulated fractions/1000 cancer cases demand/annum ranges from 1028 to 1195 fractions/1000 cases. If a national average for fractions/million demand was then used, at the RODN level, the variation from actual annual demand ranges from an overestimation of 8400 fractions to an underestimation of 5800 fractions. When using the national average fractions/1000 cases, the RODN demand varies from an overestimation of 3200 fractions to an underestimation of 3000 fractions. Conclusions Planning cancer services is complex due to regional variations in cancer burden. The variations in simulated demand of the MR-linac highlight the requirement to use local-level data when planning to introduce a new technology., Highlights • Variations in local-level cancer incidence drive variations in treatment demand. • Using national averages can cause large under-/overestimation of treatment demand. • MR-linac demand is shown at the new Radiotherapy Operation Delivery Network level. • Local-level data should be used when planning to introduce a new technology.

The current COVID-19 pandemic presents a substantial obstacle to cancer patient care. Data from China as well as risk models suppose that cancer patients, particularly those on active, immunosuppressive therapies are at higher risks of severe infection from the illness. In addition, staff illness and restructuring of services to deal with the crisis will inevitably place treatment capacities under significant strain. These guidelines aim to expand on those provided by NHS England regarding cancer care during the coronavirus pandemic by examining the known literature and provide guidance in managing patients with urothelial and rarer urinary tract cancers. In particular, they address the estimated risk and benefits of standard treatments and consider the alternatives in the current situation. As a result, it is recommended that this guidance will help form a framework for shared decision making with patients. Moreover, they do not advise a one-size-fits-all approach but recommend continual assessment of the situation with discussion within and between centres.

The reference standard treatment for cervical cancer is concurrent chemoradiotherapy followed by magnetic resonance imaging (MRI)-guided brachytherapy. Improvements in brachytherapy have increased local control rates, but late toxicity remains high with rates of 11% grade ≥3. The primary clinical target volume (CTV) for external-beam radiotherapy includes the cervix and uterus, which can show significant inter-fraction motion. This means that generous margins are required to cover the primary CTV, increasing the radiation dose to organs at risk and, therefore, toxicity. A number of image-guided radiotherapy techniques (IGRT) have been developed, but motion can be random and difficult to predict prior to treatment. In light of the development of integrated MRI linear accelerators, this review discusses the potential value of MRI in external-beam radiotherapy. Current solutions for managing pelvic organ motion are reviewed, including the potential for online adaptive radiotherapy. The impacts of the use of MRI in tumour delineation and in the delivery of stereotactic ablative body radiotherapy (SABR) are highlighted. The potential role and challenges of using multi parametric MRI to guide radiotherapy are also discussed.

Bladder cancer has been seen by many to be one of the Cinderella cancers, despite being one of the most expensive cancers to treat. Survival has not improved in the last 30 years, levels of patient satisfaction in national patient surveys are low and highly specialist services are few compared with other common cancers. Alongside this is evidence of poor outcomes for certain groups of patients, particularly women and those in lower socioeconomic classes. It is on this background that the National Institute for Health and Care Excellence (NICE) commissioned a bladder cancer-specific management guideline with the aim to improve standards of care. The guideline, which has recently been published [1], emphasises the importance of patient-centred care, ensuring that the patient and their carers are involved in decision-making and that the full range of management options is available. An important part of this strategy will be to improve access to specialist multidisciplinary teams and clinical nurse specialists in particular. Evidence clearly shows that bladder cancer patients have a much lower level of access to clinical nurse specialists than patients with many other cancers. Improving this access should enable patients to navigate the often complex pathways and treatment choices better, and to improve the evaluation of a patient’s care needs through the application of holistic needs assessment. In addition, there is a specific recommendation to offer smoking cessation guidance where appropriate. Focusing onmuscle invasive bladder cancer (MIBC), what messages are there for the oncologist? The guideline

Madam d Recent clinical trials proving the benefi to f docetaxel chemotherapy in hormone-sensitive metastatic prostate cancer (HSMPC) have reported a greater risk of febrile neutropenia than seen in the castrate-resistant setting. STAMPEDE [1] reported 15%, CHAARTED [2] 6% and GETUG-AFU15 [3] 7% grade 3e5 febrile neutropenia in comparison with Tax-327 [4], which showed 3% febrile neutropenia. Clinical experience at The Christie suggested the risk of febrile neutropenia was higher than that experienced in these trials. ASCO guidelines [5] recommend using colony stimulating factors (CSFs) prophylactically when the febrile neutropenia risk is � 20%. An audit was conducted to establish febrile neutropenia rates in HSMPC patients referred to The Christie for docetaxel chemotherapy between 1 June 2015 and 1 February 2016. In total, 53 patients (all World Health Organization performance status 0/1) were eligible for inclusion. The median age was 65 years (range 43e79). The audit confirmed that 30% (16 of 53) of patients developed febrile neutropenia (defined as ANC