Increasing radiation dose for better hepatic cancer control from radiation therapy (RT) is limited by the development of radiationinduced liver disease (RILD). Clinical syndrome of RILD occurs typically 2 weeks to 4 months after completion of RT. In severe cases, RILD can lead to liver failure and death. Using the Lyman-Kutcher- Burman NTCP model, the likelihood of developing RILD can be estimated based on the planned dose on the normal liver [1]. However, the models solely based on dose distribution which ignores individual liver sensitivity to RT that may allow safe delivery of higher radiation dose on some patients. Imaging can quantitatively assess normal tissue response to RT, and thereby it may be able to characterize individual liver tolerance to radiation and provide surrogates to early predict the development of RILD.

Background: We aimed to evaluate the outcomes and toxicity profile in patients with well differentiated thyroid carcinoma (WDTC) treated with intensity modulated radiation therapy (IMRT). Materials and methods: Between June 2007 and July 2011, 18 patients with WDTC received postoperative IMRT with mean radiation dose 66Gy (60-66) delivered with 7 dynamic beams. Median age was 50.5 years (23-66); of whom 10 were males (55.6%) and 8 were females (44.4%). Predominant histology was papillary in 17 patients (94.4%) and predominant T stage was T4 in 15 patients (83.3%). RAI therapy was given to all patients. Results: Median follow up was 53 months (6-55). At 48 months, the Kaplan-Meier estimates of locoregional control, distant control and overall survival were 88.9%, 83.2% and 89.4% respectively. Incomplete surgery, presence of lymphovascular invasion (LVI), and number of >4 positive lymph nodes were found as poor prognostic factors (0.0001). Acute grade 3 Mucositis was experienced in one patient (5.5%) and grade 3 skin toxicity was seen in 1 patient (5.5%). Late toxicities were few and of grade 2. Conclusion: Postoperative IMRT offers excellent locoregional and distant control rates and overall survival with minimal toxicity profile in the treatment of WDTC.

Radiation therapy (RT) has demonstrated strong clinical benefits for patients who present a high relapse risk after breast conserving surgery or radical mastectomy. Unfortunately, the benefits of RT can be offset by its possible impacts on cardiac toxicity and increased risk of death from cardiac events. Additionally, recent radiological and radiotherapy techniques have allowed clinicians to better define target volumes and customize irradiation so that doses to the heart and left coronary artery can be accurately quantified. Alternative treatment positions, such as the lateral and prone positions are also being used. These positions can adapt to the patient’s anatomy and thus better protect the heart and lungs. This paper will report the outcomes for a patient who received breast cancer treatment after her treatment position and technique were optimized for ideal target volume coverage and minimum irradiation to organs at risk (OAR), particularly to the heart and lungs.

Purpose: In this study the influence of clinical and morphological peculiarities of facial carcinoma on the results of treatment by means of Neodymium (Nd) laser radiation was estimated.

Methods: The light of high-energy mono pulsed Nd laser (λ = 1060 nm) was used to treat 2805 patients with 2940 histologically confirmed facial carcinoma, stages T1-2 N0 M0. Of those 2845 were classified as primary basal cell carcinoma (BCC) and 95 as squamous cells carcinoma (SCC). The patients were followed-up from 1 year to 13 years (median: 7 years) after treatment.

Results: The overall frequency of tumor recurrence after laser radiation was revealed in 2% of all irradiated tumors (median: 10.0 months). The rate of recurrence depended on type of tumors (1.9% in BCC and 5.3% in SCC), clinical peculiarities (3.5% in nodular-ulcerative and 4.5% infiltrative-ulcerative tumors), localization (3.2% in tumors located in nasolabial area) and tumor size.

Conclusion: Neodymium laser radiation is an effective method for treatment of facial carcinomas stages T1-2 N0 M0 whose results depend on tumor morphology, stage of the disease, clinical characteristics and localization

Adelaide Radiotherapy Centre is the private practice provider of radiation oncology services in South Australia. In 2004, it decided to have advanced trainees integrated into the practice. The purpose of this study is to - 1. Ascertain whether this has been a benefit for the trainees. 2. Decide whether the practice should continue with advanced training. 3. Decide methods to improve the training for trainees.

• Radiation oncology practised in public hospitals or private practice. • Adelaide Radiotherapy Centre is sole private practice provider of services in South Australia. • Corporate medicine not involved in radiation oncology. • Adelaide Radiotherapy Centre bought out by private company in 2008. • Rationale, benefits and disadvantages discussed.

Background: Standard treatment for well differentiated thyroid cancer is surgery followed by adjuvant radioactive iodine-131 (RAI) therapy. To concentrate RAI in thyroid tissue, levothroxine therapy is withheld for 3-4 weeks prior to RAI therapy along with low iodine diet (LID), which results in short term hypothyroidism, which ultimately can result into mild to severe symptomatic hyponatremia with fatal complications. It is very rare complication; has been reported only in four case reports so far.

Case presentation: Here in we present a case report of 62 years Saudi, known hypertensive female on thiazide diuretic with diagnosis of papillary thyroid cancer (pT2N0M0), who was admitted for RAI therapy after total thyroidectomy. Patient was on low iodine diet for 3 weeks and she was given recombinant human thyrotropin (rhTSH) for two days prior to admission. On second day of admission (18 hours of RAI therapy), she was found confused, disoriented and was unable to recognise her family members. Blood chemistry showed low serum sodium concentration (105 mEq/L). Further investigations confirmed hypotonic hyponatremia and she was managed accordingly and she made full recovery within 48 hours of diagnosis.

Conclusion: Although low iodine diet related hyponatremia is rare complication, but consequences can be worse in patients undergoing RAI therapy, especially elderly patients who are on diuretics. Therefore, physicians should recognize this rare side effect for prompt intervention.

Background: Aim was to evaluate the additional benefit of adjuvant chemotherapy in patients of early stage endometrial carcinoma (EC) with adverse features.

Materials and methods: Between June 2006 and July 2011, 56 patients with EC after surgery were randomized to receive either adjuvant radiotherapy (RT) [35 patients] or adjuvant sequential chemotherapy and radiotherapy (CRT) [21 patients]. Median age was 57.6 years (40-80). Predominant stages were FIGO IB (44.6%) and IIA (26.7%). Mean body mass index was 35.9 kg/m2 (23-72).

Results: Median follow-up was 55 months (6-60). The Kaplan-Meier estimates for loco regional control (LRC), distant metastasis control (DMC) and overall survival (OS) for RT and CRT arms were; 85.7% vs. 74.2% (p 0.04), 85.7% vs. 85.7% (p 0.9) and 82.8% vs. 81% (p 0.8) respectively. Patients in CRT arm had earlier and higher pelvic recurrences {hazard ratios of 2.21 (1.45-7.85)}. Acute hematological grade3 toxicity was higher in CRT arm (9.5%) and no difference in acute or delayed non-hematological toxicities was seen between two arms.

Conclusion: Adjuvant chemotherapy in patients with EC after surgery is associated with inferior LRC and no additional benefit in DMC and OS. If adjuvant chemotherapy is considered it shall be given after adjuvant radiotherapy.