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In many areas of health care, practice standards have become an accepted method for professions to assess and improve the quality of care delivery. The aim of this work is to present the development of practice standards for radiation oncology in Australia, highlighting critical points and lessons learned. Following a review of radiotherapy services in Australia, a multidisciplinary group with support from the Australian Government developed practice standards for radiation oncology in Australia. The standards were produced in a multistep process including a nationwide survey of radiotherapy centres and piloting of the standards in a representative subset of all Australian radiotherapy centres. The standards are grouped into three sections: Facility management (covering staffing, data management, equipment and processes); Treatment planning and delivery (providing more detailed guidance on prescription, planning and delivery); Safety and quality management (including radiation safety, incident monitoring and clinical trials participation). Each of the 16 standards contains specific criteria, a commentary and suggestions for the evidence required to demonstrate compliance. The development of the standards was challenging and time consuming, but the collaborative efforts of the professions resulted in standards applicable throughout Australia and possibly further afield., (Copyright © 2015 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.)

Aims: There are limited outcome data after radiotherapy treatment for clinically localised, castration-resistant prostate cancer. We report our single institution experience on patient outcomes in this group using high-dose palliative radiotherapy (HDPRT)., Materials and Methods: A retrospective review of patient hospital records was conducted in prostate cancer patients treated with palliative intent radiotherapy and restricted to those who had castration-resistant disease, no evidence of regional or distant disease and who received a local radiotherapy dose equivalent to 40 Gy or greater., Results: Fifty-one patients met the study criteria, 88% of these had high-risk disease at initial diagnosis. The median time to delivery of HDPRT was 66 months and the median follow-up from HDPRT was 54 months. Grade 3 or worse toxicity was experienced in 8%. The estimated freedom from local failure, cause-specific survival and overall survival at 5 years were 81, 65 and 35%, respectively. Local procedures were a significant contributor to local morbidity, with the most common procedure a transurethral resection of the prostate (27% patients). Only two patients died from complications of local failure., Conclusion: HDPRT was well tolerated and provided a high rate of local control in a clinically localised castration-resistant prostate cancer population. Although prostate cancer remained the most frequent cause of death, some patients had extended survival without evidence of disease progression., (Crown Copyright © 2014. Published by Elsevier Ltd. All rights reserved.)

Aims: It has been suggested that large rectal filling is associated with an increased risk of prostate motion in radiotherapy. The aim of the present study was to determine if there is a correlation between rectal distension on planning computed tomography and the intrafraction and interfraction stability of the prostate gland during a course of radical radiotherapy for prostate cancer if a protocol was used to rescan patients with excessive rectal diameter during planning., Materials and Methods: The computed tomography planning scans of 89 patients with adenocarcinoma of the prostate treated with conformal radiotherapy were reviewed. All patients had three gold seed fiducial markers implanted into the prostate before planning computed tomography. About one in five patients had repeat computed tomography because their rectum was judged to be too large at the time of the first planning computed tomography. Rectal distension was assessed on planning computed tomography using outlines following European Organization for Research and Treatment of Cancer guidelines by measuring the rectal volume, the average cross-sectional area and the mean anterior-posterior diameter of the rectum. Daily kV images were obtained before and after treatment delivery to determine positional matching of the fiducial markers in the superior-inferior, anterior-posterior and right-left dimensions., Results: In total, 2860 pre- and post-treatment daily kV image pairs were obtained of 89 patients (average 32.1 image pairs per patient). The median rectal cross-sectional area was 7.3cm(2) (range 2.8-17.1), the median rectal volume was 54.8cm(3) (range 20.9-128.2), and the median anterior-posterior rectal diameter was 3.03cm (range 1.58-8.30). Unifactor linear regression models showed no statistically significant relationship between intra- and interfraction prostate stability and rectal volume on planning computed tomography., Conclusions: No statistically significant relationship between rectal distension on planning computed tomography and the intra- and interfraction stability of the prostate gland was identified if patients with a large rectal volume were rescanned for planning.

Aims: Waiting time for radiotherapy is a major problem in radiation oncology practice. The aim of this paper is to present the experience of the Peter MacCallum Cancer Centre in trialling a number of strategies to reduce patient waiting times., Materials and Methods: All patients starting megavoltage radiotherapy with curative intent in three separate 1-week blocks had their waiting times recorded. The cohorts were each 8 weeks apart and were before (September), during (November) and after (January) the introduction of a priority points system., Results: Median waiting time was 35 days in September, 42 days in November and 31 days in January. The number of extremely long waits (>90 days) decreased to 1 by January. Significantly more patients were pre-booked for treatment in January (27/51) compared with September (17/65; P = 0.003) and November (12/65; P < 0.001). Pre-booked patients had shorter waiting times compared with patients who was not pre-booked (P < 0.0001). Difficulties at one particular treating location contributed to the longer median waiting times in November. Although there had no significant difference in waiting time in non-breast unit patients between the three cohorts, there was a decrease in waiting times in breast unit patients, especially between November and January (P = 0.0008). There was no significant increase in delay to starting treatment in other treating units, resulting in more equitable access across all units., Conclusions: A combination of encouraging pre-booking and the introduction of a priority points system has led to a decrease in waiting times, especially among breast unit patients.

Renal cell carcinoma is a tumour that is well recognized to metastasize widely and to behave in an unpredictable manner. We report a patient with a renal cell carcinoma that metastasized to the thyroid and resulted in death from associated respiratory compromise. The clinical features of cancers metastasizing to the thyroid are discussed and the apparent over-representation of renal cell carcinoma in symptomatic thyroid metastases is highlighted. The uncertainty about whether metastases arise more frequently in pre-existing abnormal thyroid glands is also reviewed.

The management of the primary tumour in muscle-invasive bladder cancer is determined more by geographical location than by firm evidence of the superiority of either surgery or radiotherapy over the other. Recent technological advances in both specialties may change their acceptability and efficacy, but as yet none has been fully evaluated. The effect of chemotherapy on primary tumour control may also influence management choices. There is a need to reexamine the merits of surgery and radiotherapy in the modern era.

A 33-year-old man subsequently diagnosed as having sarcoidosis presented with the clinical features of a testicular tumour with metastatic spread to para-aortic lymph nodes. Histological examination of the testis and para-aortic lymph node biopsy showed florid granulomatous change and a Kveim test was positive. This is a previously unreported presentation of sarcoidosis and emphasizes that histological confirmation of malignancy is essential prior to institution of cytotoxic therapy.