Rectal neuroendocrine tumor with uncommon metastatic spread: A case report and review of literature.

Neuroendocrine tumors of the gastrointestinal tract are rare neoplasms. Rectal neuroendocrine tumors consist approximately the 5%-14% of all neuroendocrine neoplasms in Europe. These tumors are diagnosed in relatively young patients, with a mean age at diagnosis of 56 years. Distant metastases from rectal neuroendocrine tumors are not very common. Herein we describe a case of a rectal neuroendocrine tumor which metastasized to the lung, mediastinum and orbit. This case underscores the importance of early identification and optimal management to improve patient's prognosis. Therefore, the clinical significance of this case is the necessity of physicians' awareness and education regarding neuroendocrine tumors' diagnosis and management.

Quality assurance in Health Services: the paradigm of radiotherapy.

INTRODUCTION: In radiotherapy, a team of highly specialised professionals co-operate in planning and delivery of treatment and are responsible for the effectiveness and safety of the service. The aim of this article was to present the necessity and features of a quality assurance (QA) program in radiotherapy through literature review. METHODS: A search was carried out in Scirus, Medline/ PubMed databases using the keywords "clinical oncology", "radiation oncology", "radiotherapy", "oncology practice", "quality assurance" and "quality of care". Twenty-nine articles were chosen covering the period 1995-2007. Further information was obtained from the Royal College of Radiologists' UK website. RESULTS: QA was relevant to three aspects of radiotherapy: 1) clinical, involving resources (staffing and equipment), procedures (treatment planning, follow up) and results (tumor control, toxicity); 2) medical physics, involving the measurements necessary for the safety and precision of equipment; and 3) technical, involving the accurate plan implementation and the smooth function of treatment machines. International guidelines defined best practice in diagnosis and treatment of cancer patients. Moreover, the principles of quality management provided the tools not only for a reasonable use of limited resources but also for continuous improvement of organisations towards patient- centred services. CONCLUSION: Quality in radiotherapy is a dynamic concept that needs to be measured and re-evaluated using scientific methods and feedback by the users. Successful implementation of a QA program in radiotherapy requires expertise, training and co-ordination in an environment of teamwork.