Aims: Cancer remains a leading cause of death in children and adolescents in the developed world. Despite advances in oncological management, rates of primary treatment failure remain significant. Radiation of recurrent or metastatic disease improves survival in adults but there is little data to support clinical decision making in the paediatric/teenage and young adult population. Materials and methods: We present a retrospective case series of 14 patients treated with stereotactic ablative body radiotherapy or stereotactic radiosurgery at The Royal Marsden Hospital from September 2011 to December 2015. Eligible patients were aged <25 years, with Lansky/Karnofsky performance status 60 with confirmed relapsed or metastatic tumour in fewer than three sites. Follow-up was in accordance with standard clinical care and included regular outpatient review and radiological surveillance. Local control, progression-free survival and overall survival are presented. Results: Data for 14 patients with 18 treated lesions were included. The median patient age was 15 years (range 5e20 years). Nine patients were treated for local recurrence and five for metastatic lesions. All patients had already undergone multiple previous treatments. Eleven patients had undergone previous radiotherapy. The median interval between the completion of initial radiotherapy and reirradiation was 29.0 months (range 0.2e49.5 months). The median follow-up was 3.4 years (range 0.28e6.4 years). The 1-year local control rate was 78.6% and the 2-year local control rate was 57.1%. Overall median survival was 58.4 months (95% confidence interval 33.8e82.9 months). Cumulative biologically effective doses (BED) over 200 Gy were associated with late toxicity (P ¼ 0.04). Conclusion: Radical doses of short-course hypofractionated radiotherapy can achieve excellent local control and may contribute to the prolongation of overall survival. There is a need for prospective trials exploring the use of ablative radiotherapy in metastatic disease in paediatric/teenage and young adult patients in order to establish safe and effective treatment schedules.

The dysphagia encountered by patients with neurological disorders can be both distressing and life threatening because of the associated problems of aspiration. Decisions regarding management are often difficult because the exact nature of the underlying disorder varies from patient to patient and is frequently complex. A new approach to the assessment and evaluation of acquired neurological dysphagia is presented. Management of the first 50 patients assessed by this method is described. The advantages of a joint dysphagia clinic comprising neurology, speech therapy, ENT and radiology departments are discussed.

One thousand one hundred and sixty-one cases of carcinoma of the cervix presenting over a 20-year period to 1982 were considered: 326 (28%) of these women developed urological problems, of whom 82 (7%) had major complications. Fistula formation occurred in 46 cases (4%), and was associated with active malignant disease in 33. Significant progressive ureteric obstruction occurred in 15 patients, 11 of whom had active malignancy. Overall, 35 (43%) of 82 patients with major urological problems had no evidence of active disease. Urinary diversion by ileal conduit proved to be a relatively simple and effective way of dealing with the serious problems, especially for patients with fistula formation and progressive ureteric obstruction, 67% and 73% of whom, respectively, underwent this procedure. More complex reconstructive surgery proved successful in a small number of selected patients, in whom there was no evidence of active tumour. Attempts to compromise with less definitive or over-ambitious procedures resulted in further complications and prolonged hospitalisation.

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