Wilms tumor (WT) is the most common renal malignancy in children, with a peak incidence between the ages of 3 and 4 years. This study aimed to evaluate the clinicopathological features, treatment characteristics and survival outcomes of patients managed for WT at the study site.

This was a quantitative cross-sectional study involving 137 pediatric patients diagnosed with and managed for WT between 2012 and 2021. Total population sampling was used for participant selection. Data were analyzed using SPSS software, with Kaplan-Meier and Cox regression analysis used to estimate survival rates and examine prognostic factors. P-values < 0·05 were considered statistically significant.

The 2- and 5-year overall survival (OS) rates were 75% and 70%, respectively, while the disease-free survival (DFS) rates at 2- and 5-years were both 79%. Pathological staging significantly impacted OS and DFS (p = 0·000), while age, gender, weight and risk stratification did not show statistically significant differences. The left kidney was the most common primary site (51%), with an even male to female gender ratio of 1:1. Metastases were most common in the chest (n = 19, 13·8%) and lungs (n = 13, 9·5%).

Pathological stage was the most significant prognostic factor for both OS and DFS, emphasizing the importance of early detection and timely intervention. While the 2- and 5-year OS and DFS rates represent an improvement over previous studies in Ghana, they remain suboptimal compared to outcomes in high-income countries. A holistic, coordinated institutional treatment regimen has enhanced patient compliance, survival outcomes and follow-up care.

Radiotherapy is a critical component of head and neck cancer (HNC) management that requires reliable patient immobilization. Using thermoplastic masks helps to ensure reproducible patient positioning during radiotherapy, thus reducing the risk of a geographical miss. However, the use of these masks can also induce anxiety and distress, which can negatively impact treatment adherence and quality of life outcomes.

The research was a quantitative cross-sectional study that determined the prevalence and severity of thermoplastic mask-induced anxiety and assessed the scope of coping mechanisms used by HNC patients. Data were collected using a structured questionnaire from recruited participants and analysed with the Statistical Package for Social Sciences software, version 26·0. Relevant clinical and treatment-related data were retrieved from patients’ hospital-based medical records. Descriptive and inferential statistical analyses such as chi-square tests and likelihood ratios were conducted, with p-values < 0·05 considered statistically significant.

In all, there were 145 HNC patients with a male to female ratio of 1·9:1 and a median age of 52·8 years (IQR 20·7), ranging from 18 to 82 years. There was a high prevalence of thermoplastic mask-induced anxiety both during mask moulding (93·8%) and radiation therapy sessions (94·5%). Most participants (95·2%) adopted coping mechanisms including distraction (58%) and visualization techniques (46%).

Even though there was a high level of awareness and utilization of coping mechanisms, the high prevalence of thermoplastic mask-induced anxiety highlights a critical aspect of HNC patient care that may be overlooked in resource-limited settings.

The technological development of radiotherapy equipment enabled the changing of the dose rate over time during irradiation. Further, techniques, such as volumetric modulated arc therapy (VMAT), are becoming more widespread. This study aimed to assess the changes in radiation isocenter and beam alignment with different dose rates and investigate the dose error during VMAT plan delivery.

The Winston–Lutz (WL) test and three-dimensional water phantom profiles were measured at different dose rates using 4, 6 and 10 MV and flattening filter-free (FFF) at 6 and 10 MV of X-rays. Furthermore, the change in alignment with the dose rate was reproduced through beam parameter adjustments, and the change in dose difference (DD) in the VMAT plan was assessed.

The WL test revealed a 0·1–0·3 mm radiation isocenter displacement with dose rate. Further, the beam profile measurement results demonstrated a 0·3 mm beam centre position displacement in both the lateral and gun-target directions caused by the change in dose rate. VMAT plan delivery with a beam whose centre position changed by 0·3 mm caused a 0·2–3% decrease in the previous DD rate.

The radiation isocenter and beam alignment changed based on the dose rate. Evaluating the change in beam alignment at multiple dose rates is recommended when performing irradiation with different dose rates.

Given the increased risk of cardiac toxicity with higher doses, cardiac sparing is crucial for left-sided breast cancer patients. Deep inspiration breath hold (DIBH) is one approach, but its reproducibility is questioned. This study evaluates the reproducibility of DIBH with an active breathing coordinator (ABC) device, focusing on its dosimetric impact in maintaining consistent cardiac sparing for patients undergoing partial breast irradiation (PBI).

Thirty-three patients undergoing PBI with a prescription dose of 30 Gy in five fractions were randomly selected. Each patient was treated with 6 MV photons using volumetric modulated arc therapy (VMAT) with DIBH using an ABC device. Prior to each fraction, kilo-voltage cone beam computed tomography (kV-CBCT) images were acquired to assess inter-fractional heart motion. Contours of the whole heart and left anterior descending artery (LAD) were transferred from the planning CT to CBCTs and back, using rigid alignment and isocentre shifts to represent treatment positions. Agreement between delivered and planned doses assessed DIBH reproducibility.

Throughout the entire treatment course, changes in mean and maximum cardiac doses were less than 16·4 cGy and 264·8 cGy, respectively. Changes in mean and maximum LAD doses were less than 54·0 cGy and 160·2 cGy, respectively. Overall, the mean cardiac dose increased by 2·4 ± 6·6 cGy, and the maximum by 23·3 ± 58·0 cGy. The mean LAD dose increased by 4·8 ± 18·5 cGy, and the maximum by 17·0 ± 51·0 cGy.

DIBH can be effectively reproduced with the ABC device, limiting inter-fractional cardiac dose changes.

Radiotherapy aims to provide either curative treatment or palliation, with radiation transmission through shielding blocks ideally not exceeding 5% of the incident dose.

This study assessed the attenuation efficacy of Cerrobend shielding blocks, determining the thickness required for achieving 95% attenuation and evaluating the adequacy of currently used blocks.

An experimental study was conducted using a 1·25 MeV cobalt-60 teletherapy machine. Radiation intensities transmitted through Cerrobend blocks of varying thicknesses (1–5 cm) were measured with a calibrated ionization chamber and electrometer. Measurements were performed with a fixed field size of 10 cm × 10 cm at a 100-cm source-to-chamber distance, minimizing scatter. Baseline and transmitted intensities were recorded, with each measurement repeated five times for precision.

The percentage transmission, linear attenuation coefficients and thickness required for 5% transmission were calculated using regression analysis. Radiation intensity decreased exponentially with increasing Cerrobend block thickness, from 15·01 nC (0 cm) to 0·939 nC (5 cm thickness). Regression analysis showed a strong negative linear relationship (y = −0·5386x + 2·6705; R2 = 0·992). The thickness required for maximum transmission of 5% was determined to be 6 cm, while the routinely used 5 cm blocks at the study site allowed 8% transmission, exceeding the recommended threshold. Minimal environmental variations ensured measurement consistency.

The study demonstrated that 6 cm Cerrobend blocks were necessary to achieve the recommended 95% attenuation, whereas the 5 cm blocks in use resulted in suboptimal shielding. This highlights the need to revise shielding practices to improve radiation protection and patient safety in resource-constrained radiotherapy settings.

Optimal radiotherapy technique selection for left-sided breast cancer remains challenging. This study compared volumetric-modulated arc therapy (VMAT), VMAT+IMRT (VMAT+IMRT) and IMRT+VMAT (IMRT+VMAT) using an innovative integrated scoring system and risk factor (RF) assessment.

Retrospectively analysed 41 patients with left-sided breast cancer. Treatment plans were evaluated using an integrated scoring system considering tumour coverage and organs at risk (OARs) sparing. RF analysis assessed potential adverse effects on the heart and lungs. Correlation analysis explored relationships between integrated scores and risk factors.

VMAT showed the best overall integrated score (1·0931 ± 0·1707), followed by IMRT+VMAT (1·2011 ± 0·2440) and VMAT+IMRT (1·2264 ± 0·2499). VMAT had the highest percentage of Excellent OAR plans (14·6%), while VMAT+IMRT and IMRT+VMAT showed better PTV coverage (53·7% and 51·2% Excellent, respectively). RF analysis revealed: VMAT (heart RF: 0·341, lung RF: 0·671), VMAT+IMRT (heart RF: 0·294, lung RF: 0·750) and IMRT+VMAT (heart RF: 0·533, lung RF: 0·546). Correlation analysis showed strong positive correlations between integrated scores and lung RF for VMAT (r = 0·671) and VMAT+IMRT (r = 0·750), with IMRT+VMAT showing moderate correlations for lung (r = 0·546) and heart (r = 0·533) RFs.

VMAT demonstrated the best balance between PTV coverage and OAR sparing, hybrid techniques improved target coverage but increased risk to OAR. The RF analysis highlighted varying impacts on heart and lung across techniques. This analysis provides valuable insights for technique selection, potentially improving treatment outcomes and reducing complications in left-sided breast cancer radiotherapy.