SGRT can accurately monitor VMAT DIBH breast radiotherapy patients. Camera occlusion may provide difficulties for SGRT systems, such as VisionRT’s AlignRT, during rotational imaging (CBCT) and treatments (VMAT). Therefore, appropriate regions of interest (ROIs) need definition to ensure robust monitoring. Equally, operators must know where camera occlusion most likely occurs to optimise workflows.

A CT scan of an anthropomorphic phantom was performed to mimic a breast patient’s DIBH treatment position. A VMAT plan was produced, and six ROIs drawn on an AlignRT terminal. An ROI sensitivity test was performed, and approximate percentage surface area of occlusion was determined for all ROIs. Postural video was also utilised to determine where camera occlusion is most likely to occur.

No full camera occlusion was demonstrated using the phantom. However, postural video demonstrated camera occlusion was more probable between 10 and 60 degrees for CBCT arcs due to lateral camera occlusion. Sensitivity test results showed ROIs were more sensitive to vertical and lateral translations when both lateral cameras are blocked at CBCT50. Larger ROIs may be less sensitive and more robust when cameras were occluded. Additionally, the greatest approximate percentage of occlusion occurred at the superior lateral aspects of ROIs.

Gantry angles at higher risk of camera occlusion have been described between 10 and 60 degrees for CBCT to assist operators with troubleshooting, and a clinical workflow proposed. An ROI for VMAT DIBH breast rotational imaging and treatment has also been suggested to reduce the impact of camera occlusion.

Person-centred care is only possible by first caring for the staff who provide it. This study assesses job satisfaction, burnout and related factors to gain an insight into the experiences of the Radiotherapy workforce in the North West of England.

A quantitative survey was distributed across three radiotherapy centres in the North West, employing validated instruments including the Job Satisfaction Survey, Maslach Burnout Inventory and questions adapted from the NHS Staff Survey. Free-text responses were included to allow participants to expand on their answers.

208 members of staff participated. 41.3% of participants felt satisfied with their job, with significant variation between professional groups. Mean emotional exhaustion scores were low, but moderate levels of depersonalisation and low personal accomplishment suggest signs of burnout. Only 30.4% of respondents felt there were enough staff to do their job properly, and 29.4% are considering leaving the organisation.

Although staff continue to find meaning and fulfilment in patient care, this is offset by emotional strain, limited progression opportunities and workforce turnover. The North West radiotherapy workforce is highly committed but at risk of long-term burnout, underscoring the need for sustained workforce planning and investment in staff wellbeing.

Surface-guided radiotherapy (SGRT) allows patient prepositioning based on a 3D surface instead of conventional skin marks. The primary aim was to investigate the feasibility of SGRT using ExacTrac Dynamic (ETD) for prepositioning patients receiving breast radiotherapy in free breathing compared to conventional skin-marker setup, secondary to assess intrafraction motion using surface data.

Twenty-one patients receiving whole- or partial-breast radiotherapy in free breathing were included. Each patient was set up using both skin marks and SGRT for different fractions in a non-systematic order. The setup offset was evaluated using 3D couch shifts from subsequent image guidance. Intrafraction motion was analysed for all monitor units (MU) delivered, and systematic patient movement was assessed by analysing the average surface shift per main tangential field compared to baseline. The shift between main fields represented the intrafraction movement.

No significant difference was found in mean population setup offset between SGRT and skin-marker setup. SGRT demonstrated reduced random errors in vertical and longitudinal direction and reduced systematic errors in lateral direction. Intrafraction motion was limited with a vector displacement of 0·9 mm. A small but significant inter-field movement of −0·3 mm was, however, detected vertically.

Surface-guided setup using ETD is a viable alternative for prepositioning patients receiving breast radiotherapy in free breathing compared to conventional skin-marker setup. It is, however, advisable to use subsequent IGRT for final positioning. Patient motion can be tracked effectively using ETD surface monitoring.

This study aims to investigate the key characteristics of a device to support patients with hearing impairments in utilising deep inspiration breath-hold (DIBH) radiation therapy (RT).

A qualitative approach was adopted. Semi-structured interviews were conducted both online and in person with 11 participants, including key stakeholders from a range of backgrounds: radiation oncologists, radiation therapists, medical physicists, RT service managers, industry vendors, and deaf service users. Data were analysed using thematic analysis, following the six-step approach outlined by Braun and Clarke.

Participants’ attitudes towards a device were explored across four key themes:

• • Device characteristics

• • Shape and size

• • Interference with treatment

• • Associated challenges

Thematic analysis identified several unifying themes, including the importance of co-designing a device incorporating both vibrational and visual elements. Overall, participants expressed a preference for a small and wireless device.

This study identified potential characteristics for a device to support patients with hearing impairments in accessing DIBH during their radiation therapy treatment. A device incorporating both visual and vibrational elements may be optimal for addressing the diverse needs of patients in this cohort.

Breast cancer is the most common malignancy among women worldwide, including Morocco. Radiotherapy plays a key role after surgery by eliminating residual disease and reducing local recurrence. This study compares the dosimetric and biological performance of intensity-modulated radiation therapy (IMRT) and volumetric-modulated arc therapy (VMAT) for breast cancer treatment using the Halcyon linear accelerator.

IMRT and VMAT treatment plans were retrospectively compared in 25 breast cancer patients. Dosimetric evaluation was performed using dose–volume histograms for the planning target volume and organs at risk. Biological assessment included normal tissue complication probability (NTCP), secondary cancer complication probability (SCCP), and tumour control probability (TCP) calculated with established predictive models.

Both techniques achieved comparable target coverage (V95%), with a slight advantage for VMAT. VMAT showed improved dose homogeneity and conformity, while IMRT required higher monitor units. IMRT provided superior sparing of organs at risk, particularly the lungs, heart, and contralateral breast. NTCP and SCCP estimates were lower with IMRT, suggesting reduced risks of radiation pneumonitis and secondary malignancies. TCP was marginally higher with VMAT, without statistical significance.

IMRT offers better protection of healthy tissues, whereas VMAT improves target dosimetric quality and treatment efficiency.

Governance structures in radiotherapy are central to ensuring patient safety, yet significant variation exists in how errors are reported, analysed and mitigated globally. This literature review evaluates current international approaches to radiotherapy error governance, highlighting barriers to consistent reporting and opportunities for system-wide improvement.

A structured search of peer-reviewed literature and policy documents was undertaken using a Preferred Reporting Items for Systematic Reviews and Meta-Analyses methodology. The search yielded 42 relevant articles, reviewed for themes relating to governance frameworks, safety culture, incident reporting systems and technology’s role in error reduction.

Findings reveal inconsistent adoption of Safety I and Safety II models, underreporting due to blame culture, and limited integration of artificial intelligence (AI) into governance frameworks. Successful strategies included pre-treatment peer review, multidisciplinary safety boards and AI-assisted risk management tools. Despite advancements, gaps persist in standardising incident definitions, fostering transparency and promoting a just culture.

The review suggests the need for international alignment on governance practices, wider integration of AI and proactive learning from near misses. Radiographers and radiation oncology teams are urged to engage in shaping safety governance through open reporting, system design and education. Implications for practice: Improved governance not only reduces harm but also supports continuous quality improvement in radiotherapy services.

Manual contouring (MC) is time-consuming work in radiotherapy planning for rectal cancer. Artificial intelligence (AI) can reduce the time required for clinical target volume (CTV) and organs-at-risk (OARs) delineation. In this study, we evaluated the quality of auto-segmented CTVs and OARs.

Dose-planning data were collected from ten patients who underwent preoperative radiotherapy for locally advanced rectal cancer in 2024. Auto-segmented structures from the AI-Rad and Contour+ software tools were added. Constructed AI-CTVs, based on Contour+ segmentations and AI-OARs, i.e., bladder, femoral heads and bowel bag, by both AI tools, were compared to their MC counterparts by use of quantitative metrics, volumetric/surface Dice similarity coefficients (vDSC/sDSC) and maximum/average Hausdorff distance (HD/aHD). The constructed AI-CTVs and MC counterparts were graded by two radiotherapists with two qualitative methods.

The median vDSC, sDSC, HD and aHD values of our constructed AI-CTVs compared with the MC-CTVs were 0.86, 0.61, 23.19 and 0.62 mm, respectively. For both AI tools, the agreement in the OAR metrics was overall good but less similar for the bowel bag. The qualitative evaluations of the AI-CTVs, compared to the MC-CTVs, were in clear favour of the MC-CTVs. The cranial-anterior nodal levels were anatomical areas with poorer coverage, where the contouring guidelines differed.

The quality of our constructed AI-CTVs was inferior to the MC-CTVs. Thus, the auto-segmentation methods need further development on this aspect for use in the clinical setting. In contrast, the agreement of the quantitative metrics for the OARs was overall good, except for the bowel bag.

This study investigates the effect of sagging correction errors on image quality and geometric coordinate accuracy.

This study utilised the Elekta radiotherapy system, ball bearing (BB), Catphan phantom and MultiMet-WL phantom. Ten distinct flex maps (FMs) were acquired by positioning the BB at the accuracy isocentre and introducing shifts of 0.2, 0.4 and 0.6 mm in the left, table and up directions, respectively. Cone-beam computed tomography images of the Catphan phantom were acquired using 10 FMs. The images were analysed for modulation transfer function (MTF) values and geometric coordinates. Additionally, the Winston–Lutz (W-L) test was conducted under reference couch positions and with a 0.3 mm couch shift.

For the Catphan phantom analysis, the standard deviations of MTF10% across FMs were 0.19. The centre-of-gravity coordinates of the insert exhibited shifts of approximately 0.2, 0.4 and 0.6 mm when comparing reference images to those acquired with the shifted FMs. The results of the W-L test with a 0.3 mm couch shift showed radiation isocentre deviations exceeding 1 mm compared to the reference couch positions.

Minor sagging correction calibration errors did not remarkably impact image quality; however, they altered the geometric coordinates of the image isocentre. These calibration errors decreased the accuracy of off-isocentre positioning.

Head and neck (HN) radiotherapy contour quality directly impacts local control (LC) and survival; however, few departments peer review (PR) contours prior to radiotherapy planning (RTP). This study reports outcomes of a single institution’s formal HN contour PR process.

A formal HN contour PR process was implemented. Prior to RTP, HN radiation oncologists reviewed contours, provided feedback and assigned contour grades as follows: R0 (no change), R1 (minor revision, not high risk) or R2 (major revision; high risk). The PR task was completed and the contour grade was recorded. Cochran-Armitage trend test was performed.

Pilot PR process was performed over a 7-month period for 88 patients, followed by a maintenance phase. Contours were graded as follows: R0 (N = 51), R1 (N = 20) and R2 (N = 17). Over time, the number of R2 revisions decreased (p = 0.0001); month 1 (N = 7), month 2 (N = 3), month 3 (N = 5), month 4 (N = 2) and months 5–7 (N = 0). Conversely, the number of R0 revisions improved over time (p = 0.0203); month 1 (N = 5), months 2–3 (N = 9), month 4 (N = 5), month 5 (N = 8), month 6 (N = 12) and month 7 (N = 3). Each radiation oncologist demonstrated reduction in R2 revisions during the pilot. During maintenance, all 3 radiation oncologists demonstrated low rates of R2 revisions of less than 3 cases per year.

Incorporation of HN contour PR into routine clinical workflow is feasible. The collective experience of multiple high-volume HN radiation oncologists led to improved contour quality in the pilot for each radiation oncologist and continued to ensure high quality in the maintenance phase.

Radiotherapy (RT) is a highly effective breast cancer treatment. However, RT can deliver radiation dose to the healthy tissues of the shoulder, increasing the potential for long-term shoulder morbidity. This study compared the dose delivered to key shoulder muscles between common RT techniques and patient positioning.

The treatment plans of 54 patients were analysed, including those treated in the prone and supine positions. Eight shoulder muscles were contoured on each patient’s computer tomography scan. The following breast treatment techniques were analysed: hybrid-intensity-modulated RT (hybrid IMRT), wedged field, two partial arcs volumetric-modulated arc therapy (VMAT), hybrid VMAT, and 3-field supraclavicular technique. Moreover, the effect of patient positioning was also evaluated (supine versus prone). Muscle radiation exposure was compared for the mean dose and the percent muscle volume exposed to V15 Gy and V30 Gy.

The mean dose and exposed volume for the pectoralis major and pectoralis minor were similar between hybrid IMRT, wedged field, VMAT, and hybrid VMAT. VMAT and hybrid VMAT delivered a greater mean dose to most posterior shoulder muscles compared to hybrid IMRT, though overall exposure remained generally low for these muscles. The 3-field supraclavicular technique increased radiation exposure to all shoulder muscles, particularly to the pectoralis major, the pectoralis minor and the supraspinatus. Prone positioning significantly reduced V15 Gy and V30 Gy exposure for both anterior and posterior shoulder muscles.

Shoulder muscle exposure was similar between hybrid IMRT, wedged field, VMAT and hybrid VMAT. The anterior shoulder muscles were consistently exposed to radiation with all RT techniques investigated in this study. In comparison, the 3-field supraclavicular technique substantially increased the radiation exposure to the posterior shoulder muscles. Lastly, delivering radiation in the prone position spared the anterior and posterior shoulder muscles. These findings inform treatment planning decisions aimed at mitigating the risk of long-term shoulder dysfunction.

This study investigated the dose difference (DD) in the surrounding dose area using the real-time motion tracking (RTMT) system in tomotherapy.

Seven stereotactic ablative body radiotherapy treatment plans with a single lesion were used for the investigations. Each treatment plan was evaluated for the Gamma passing rate (GPR) analysis in a static target motion using the ArcCHECK® phantom. Subsequently, each plan was matched with 8 clinical respiratory cycles to simulate moving target motion. The DD was calculated through point-to-point comparison and expressed as the frequency of the DD levels. The DD frequency was analysed for significant correlations with the target travelling distance, target size and respiratory frequency.

The GPR for criteria of 3%/2mm and 3%/3mm revealed values of 97·8 ± 1·9% and 99·5 ± 0·6%, respectively, for static motion. The highest frequency of DD was in the 5 – 10% range. A significant correlation was found between the target travelling distance and the frequency of percent DD at the 2·0 – 3·0% and 10·0 – 15·0% levels, as well as between target size and the frequency of percent DD at the 0·0 – 4·0% and 10·0 – 25·0% levels. Finally, no significant correlation was found between the frequency of percent DD and respiratory frequency.

RTMT introduced the DD in the surrounding treatment area. The DD was found to be up to 15·0% at 119·5 mm (water-equivalent distance) from the phantom centre. The DD was varied depending on the target travelling distance and size, but it did not depend on the respiratory frequency.

The aim of this study was to identify potential risk factors for acute and late genitourinary toxicities and to determine, using a logistic regression model, which of these factors are also significant and robust predictors of these toxicities.

We conducted a retrospective study by analysing the patient records and their treatment plans from 2013 to 2021. In total, a cohort of 46 patients with clinically staged cT1c-T4N0-1M0 prostate adenocarcinoma was treated with three-dimensional conformal radiotherapy (3D-CRT) with doses ranging from 66 to 80 Gy. Post-radiotherapy genitourinary toxicities were classified and graded according to the Common Terminology Criteria for Adverse Events (CTCAE v4.0).

Median follow-up was 57·5 months (range: 39 – 88 months). In univariable analysis, patient age (p = 0·040), the prostate volume (p = 0·0423), the clinical prostate volume irradiated at the prescribed dose (p = 0·029) and the volume of the bladder receiving doses varying from 60 to 70 Gy were correlated with acute GU toxicities. Arterial hypertension (p = 0·022), some pre-existing urinary symptoms, a history of catheterisation (p = 0·044) and acute genitourinary toxicity (p = 0.009) were linked to late genitourinary toxicities. The logistic regression model found that the prostate volume (p = 0·0423) and the clinical prostate volume irradiated at the prescribed dose (p = 0·029) were predictive of acute GU toxicity. Hypertension (p = 0·039) and acute toxicities were predictive of late GU toxicity.

The results of our study showed that it is essential to identify patients at risk of toxicities from the start of radiotherapy and to offer more proactive monitoring and management.

For any patient’s cancer journey, effective communication and helpful information are key to staying informed and reducing anxiety; for radiotherapy, ideally before treatment commencement. This paper details the initial design and service evaluation of a virtual tour (VT) aimed at familiarising patients with the department before treatment starts.

Created by local digital science students, with input from hospital Patient Public Involvement groups, patients were recruited (after their initial planning visit) into non-VT and VT groups; the latter viewing the VT before their first treatment. Both groups completed identical online surveys with Likert-style questions and free-text entry to assess knowledge and understanding.

Twenty-three completed survey responses were received: 9 and 14 from the non-VT and VT groups, respectively.

• • 66.7% of the non-VT group felt anxious attending the department for the first time; compared with 28.6% in the VT group. Key comments included ‘not now that I’ve seen the video’

• • 92.9% of the VT group understood the queue calling and changing room systems compared with 55.6% in the non-VT group.

• • 85.7% of the VT group knew what to expect in the treatment room, compared to 33.3% in the non-VT group. Key comments included ‘the video helped’.

Other comments included ‘excellent idea’ and ‘alleviates the concerns about where to go and what to expect ahead of that first visit’.

The implementation of the VT has proved beneficial to patients, providing key information prior to treatment start, alleviating concerns and resulting in improved patient experience without the need for an extra visit.

Few breast cancer radiotherapy studies include either patients with a hearing impairment or non-English speakers. Literature about healthcare and cancer care in general provided insights into reports by patients of disparities. Given technological advancements, it is reasonable to believe communication barriers should be surmountable, prompting a survey of radiotherapy departments to assess the status quo.

A survey was conducted of all UK National Health Service (NHS) radiotherapy departments in England. A questionnaire was designed to determine if a deep inspiration breath hold (DIBH) technique was used for breast cancer radiotherapy, the equipment that was used and whether patients with a hearing impairment or other language barriers received the same treatment.

A total of 22 radiotherapy departments responded to the survey. All respondents reported using DIBH as a heart-sparing technique; 100% (n = 22) reported offering DIBH to non-English speakers and 73% (n = 16) DIBH to patients with a hearing impairment. 45% (n = 10) stated that they use verbal instruction only, and 23% (n = 5) a combination of both verbal and visual aids and references.

The study highlights some novel efforts in radiotherapy departments to increase equitable access to DIBH; however, the results indicate that verbal communication methods still dominate practice, and these are not inclusive of all hearing-impaired patients. Such methods would also require translation for non-English speakers. The study suggests that more work needs to be done before equitable access is achieved for patients with a hearing impairment or other language barrier.

Predicting radiotherapy (RT) tooth dose guides pre-RT dental management, reducing osteoradionecrosis (ORN) risk through informed extraction or treatment adjustments. This study evaluated the mean radiation dose to individual teeth for head and neck cancer (HNC) patients receiving external beam RT at the South West Wales Cancer Centre (SWWCC), to guide pre-emptive tooth extraction.

A retrospective analysis was conducted on 158 HNC RT patients treated over a 2-year period. Patients with subsites containing ≤10 patients were excluded, and larynx cases were analysed separately before exclusion due to low ORN risk, leaving 107 patients in the final analysis. Teeth were outlined using MedCom ProSoma v4.2, and treatment plans were generated with Philips Pinnacle v16.2 using volumetric arc therapy (VMAT), without dental dose optimisation. Mean doses were reported per tooth and categorised by site, staging and tooth position, with mean and standard deviations calculated. ORN risk was defined as medium (≥40Gy) and high (≥50Gy).

Larynx patients received low mean doses (<25Gy), supporting their exclusion. Base of tongue (BoT) cases showed a dose ≥40Gy for lower ipsilateral molars in T4. Oral cavity diagnosis had the highest ORN risk, with most teeth ≥40Gy in T2+ cases and ≥50Gy in later cancer staging. The oropharynx showed some higher risk doses for T4-staging. T-tests confirmed significant dose differences between upper and lower teeth.

This study provides a site-specific indicative guide for pre-RT tooth extraction based on likely dose exposure, to guide pre-radiation dental management strategies and plan optimisation decisions to reduce ORN risk.

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.

This report discusses a 28-year-old male patient diagnosed with an intermediate-grade vascular neoplasm in the distal diaphysis of the right femur. The tumour was excised, irradiated extracorporeally and re-implanted, demonstrating the procedure’s feasibility and effectiveness of this approach.

A 28-year-old male patient presented with complaints of claudication. Magnetic resonance imaging revealed a lytic lesion measuring 65 × 40 × 91 mm in the distal diaphysis of the right femur. Positron emission tomography-computed tomography evaluation identified a malignant lytic lesion in the right femur without evidence of distant metastasis. Preoperative imaging suggested malignancy. The bone segment was excised, irradiated with 50 Gy in a single fraction and re-implanted. The patient underwent open reduction, internal fixation and deep soft tissue tumour excision. Histopathology confirmed intermediate-grade vascular neoplasm without angio invasion or perineural invasion. Immunohistochemistry was positive for Pansitokeratin, Vimentin, Cytokeratin-7, D2-40 and CD31 and negative for CD34.

Postoperatively, the bone segment was successfully re-implanted and fixed with metal hardware. Follow-up imaging over thirty months showed successful integration with no local recurrence or metastasis. The patient recovered well without significant complications.

Extracorporeal radiotherapy is a viable technique for treating intermediate-grade vascular bone neoplasms, providing effective tumour control and preserving limb function. This approach could be considered for broader clinical application.

Before COVID-19, breast cancer patients in the UK typically received 15 radiotherapy (RT) fractions over three weeks. During the pandemic, adoption of a 5-fraction treatment prescription and more advanced treatment techniques like surface-guided RT, meant a change in the duration and number of hospital visits for patients accessing treatment. This work sought to understand how breast cancer patients’ time in the RT department has changed, between 2018 and 2023.

Appointments for CT simulation, mould room, and RT, from January 2018 to December 2023, were extracted from the Mosaiq® Oncology Management System. Appointments lasting between 5 minutes and 5 hours were analysed. Total visit time was calculated from check-in to completion on the quality checklist.

In total, 29,523 attendances were analysed over 6 years. Average time spent in the department decreased during the pandemic but has since increased 12·4% above pre-COVID-19 levels. Early morning and late afternoon appointments resulted in the shortest visits, with early afternoon appointments leading to the longest visits. On average, patients spend the longest in the department on a Monday, and the least amount of time on a Friday. Friday was the least common day to start a 15-fraction treatment, whereas Tuesday and Friday were equally uncommon for the 5-fraction regime.

During the COVID-19 pandemic, the number of visits a patient makes for breast cancer RT and related services dropped, and remained lower post-COVID-19, due to fewer treatment fractions being prescribed. Average time spent in the department initially decreased but has since increased beyond pre-COVID-19 levels.

Dental management is critical prior to radiotherapy (RT) for head and neck cancer (HNC) but cumbersome and time intensive. This qualitative study investigates dentists’ evaluative processes to identify areas for improvement.

Semi-structured interviews were conducted with dentists involved in the care of HNC patients. The interviews were guided by the Consolidated Framework for Implementation Research and the Theoretical Domains Framework to identify factors influencing pre-RT dental management.

Five dentists were participated in the interviews. Key themes were identified through qualitative and quantitative evaluation and are as follows: Coordination among care providers, knowledge of the RT plan, visual depictions of dose distribution and understanding of the patient’s dental history.

This study demonstrates the complexity of pre-RT management and identifies key elements. Knowledge of the RT plan and improved interdisciplinary coordination represents opportunities for improvement. Visual dose prediction methods may expedite and improve pre-RT management.

Oral mucositis (OM) emerged in the late 1980s to describe the adverse effects of radiation therapy (RT) on the oral mucosa. OM is the most common and clinically significant acute adverse effect of radiotherapy for head and neck cancer. Symptoms of OM vary from pain and discomfort to an inability to tolerate food or fluids, and it may affect the quality of life, breaks in treatment, hospitalisation, and therefore cancer treatment and outcome. This study aimed to evaluate the pomegranate flower’s efficacy in preventing and treating radiation-induced mucositis due to antioxidant, anti-inflammatory and anti-cancer effects.

This phase II clinical trial was conducted on 50 patients (case and control) with head and neck malignancy. Patients in the case groups were instructed to rinse their mouths with 5 mg Pomegranate powder with 15 cc of sterile water three times a day. The patients in the control group rinsed their mouths with normal saline mouthwash, which is the most relatively accepted preventive and supportive care in this setting. The onset and degree of radiation-induced mucositis were graded during treatment, with ‘WHO mucositis grading’ and the ‘quality of life questionnaire’ (QLQ-OES18).

Forty-eight patients were analysed. There was a significant difference between the two groups on onset and severity of mucositis in the two groups. There were longer intervals for the incidence of different grades of mucositis in the case group, in comparison with the control groups (P value < 0·05). Also, Complaints of dysphagia in the case groups were lower than in the control.

Pomegranate flower seems to be effective at the time of onset, and the severity of oral mucositis during head and neck radiation. It could be a simple, potent, and inexpensive agent, which is easily available.