a b s t r a c tObjectives: The study aimed to assess the suitability of deformable image registration (DIR) software to generate synthetic CT (sCT) scans for dose verification during radiotherapy to the head and neck. Planning and synthetic CT dose volume histograms were compared to evaluate dosimetric changes during the treatment course. Methods: Eligible patients had locally advanced (stage III, IVa and IVb) oropharyngeal cancer treated with primary radiotherapy. Weekly CBCT images were acquired post treatment at fractions 1, 6, 11, 16, 21 and 26 over a 30 fraction treatment course. Each CBCT was deformed with the planning CT to generate a sCT which was used to calculate the dose at that point in the treatment. A repeat planning CT2 was acquired at fraction 16 and deformed with the fraction 16 CBCT to compare differences between the calculations mid-treatment. Results: 20 patients were evaluated generating 138 synthetic CT sets. The single fraction mean dose to PTV_HR between the synthetic and planning CT did not vary, although dose to 95% of PTV_HR was smaller at week 6 compared to planning (difference 2.0%, 95% CI (0.8 to 3.1), p = 0.0). There was no statistically significant difference in PRV_brainstem or PRV_spinal cord maximum dose, although greater variation using the sCT calculations was reported. The mean dose to structures based on the fraction 16 sCT and CT2 scans were similar. Conclusions: Synthetic CT provides comparable dose calculations to those of a repeat planning CT; however the limitations of DIR must be understood before it is applied within the clinical setting.

Highlights It is feasible to outline the paired major salivary glands (parotid, submandibular and sublingual) at baseline and during RT on DW-MRI. Serial measurements can identify volumetric and functional change on DW-MRI in the salivary glands. An increase in ADC in all major salivary glands were observed during RT. There is an association between xerostomia and ADC rise during RT which requires further investigation.

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It is safe to select older patients for radical radiotherapy (RT) delivered with VMAT based on performance status (PS) and comorbidities. 2. Patients 70 years and over are able to tolerate a course of RT for HNC. 3. Older patients can benefit from RT without the use of geriatric assessment and frailty tools. 4. The addition of frailty screening and geriatric assessment tools may identify previously unknown deficits and allow increased AHP support post treatment. 5. PS is the strongest predictor of survival in patients aged 70 and over receiving RT. | INTRODUCTIONConcerns regarding the ability of older patients with head and neck cancer (HNC) to tolerate and benefit from radical radiotherapy (RT) led to calls for the use of formal geriatric or frailty assessments to evaluate patient suitability for RT. Evidence for their use is emerging; however, implementation is not standard and selection of older patients for RT varies. Longer-term requirements for medical or social care are not well documented in this group. 1,2 In our centre, patients' suitability for RT is evaluated with an assessment of the Eastern Cooperative Oncology Group performance status (PS) and co-morbidities. Neither a validated comorbidity scale nor a geriatric or frailty assessment tool is utilized.

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Ian Colvin and Lisa Hay present the 'University of Cambridge School Classics' Project which has been developed to support school-level teaching. From humble beginnings like simple vocabulary testers, the program has since evolved to a large range of resources including schemes of work for civilisation topics, documentaries on aspects of ancient life, and support for reading authentic literature. By removing some of the 'performance' elements of a traditional classroom, these interactive resources can support positive learning habits, risk taking, and creativity. The core aim of the project remains to help make the classical world accessible to as many students as possible'.