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As we mark 150 years since the birth of Marie Curie, we reflect on the global advances made in radiation oncology and the current status of radiation therapy (RT) research. Large-scale international RT clinical trials have been fundamental in driving evidence-based change and have served to improve cancer management and to reduce side effects. Radiation therapy trials have also improved practice by increasing quality assurance and consistency in treatment protocols across multiple centres. This review summarises some of the key RT practice-changing clinical trials over the last two decades, in four common cancer sites for which RT is a crucial component of curative treatment: breast, lung, urological and lower gastro-intestinal cancer. We highlight the global inequality in access to RT, and the work of international organisations, such as the International Atomic Energy Agency (IAEA), the European SocieTy for Radiotherapy and Oncology (ESTRO), and the United Kingdom National Cancer Research Institute Clinical and Translational Radiotherapy Research Working Group (CTRad), that aim to improve access to RT and facilitate radiation research. We discuss some emerging RT technologies including proton beam therapy and magnetic resonance linear accelerators and predict likely future directions in clinical RT research.

Spurred on by a BMJ Careers article on Balint groups, 1 and recognising rising stress in our peers, we started a monthly debrief group for oncology registrars in our centre, facilitated by a medically qualified chaplain (SLH). [...]to Lemaire and Wallace's suggestion that juniors adopt seniors' maladaptive behaviours, 2 this reflective peer support group has become embedded in our department, presaging redefinition of the \"hidden curriculum\"-a consultants' group has now been started, tackling challenges unique to this grade.

Given the potential for masking the competing differential diagnosis of lymphoma, steroids should be used with caution in the acute management of SVC obstruction unless the diagnosis is established. Tumour markers may not be elevated in seminomas, and diagnosis requires pathological and immunohistochemical analysis Three cycles of BEP (bleomycin, etoposide and cisplatin) chemotherapy is the accepted standard of care for primary mediastinal seminomas and, given the exquisite sensitivity of seminomas to platinum-based chemotherapy, they carry a favourable prognosis. The 5-year overall survival is ~90%, which compares favourably with the 40%–45% 5-year overall survival rate for non-seminomatous GCTs.1 3 Contributors MKT and DML wrote the case history and GJD wrote the case discussion and context.

Over a 2-year period, we brainstormed ideas, scoped the literature, obtained funding for dedicated pilot research that provided new data, and produced this Commission report to reduce the effects that breast cancer has on society. Costs and suffering can be financial, physical, psychological, emotional, and social, they affect children, families, local communities, and wider society, can occur at all stages of breast cancer, and are evident even within health-care services that are free at the point of delivery. Equitable access to early diagnosis and treatment is a fundamental need for all individuals to improve their breast cancer survival and quality of life. In collaboration with the WHO Global Breast Cancer Initiative, we call for action to deliver stage-shifting, as a sustained decline in breast cancer mortality rates is achieved by diagnosing at least 60% of invasive cancers at stages I–II.