Locally advanced non-small cell lung cancer (NSCLC) encompasses a heterogeneous collection of tumour and nodal stages. Despite recent advances, the overall survival for this group remains poor. Radical radiotherapy remains the mainstay of treatment. The complexities involved in the delivery of radical radiotherapy to the lung pertain to tumour volume definition, intra- and inter-fraction motion (namely tumour motion caused by respiration and GTV migration during treatment) and the proximity of organs at risk to the high-dose region. Here we discuss a selection of strategies to manage these complexities. Motion management can be addressed by 4D CT planning, radiotherapy gating and on-board imaging, including cone beam CT. Advanced planning methods such as intensity modulated radiotherapy may potentially allow dose escalation and sparing of normal tissue toxicity. Functional imaging has already improved our ability to stage tumours and more carefully select appropriate candidates for radical treatment. Better imaging also improves GTV definition. However, the complexities of image acquisition and interpretation need to be accounted for and agreed consensus protocols have yet to be defined. Novel imaging methods such as 4D PET-CT and 4D MRI may also yield improvements for the future and these are briefly discussed.

Objective: To explore the association between socialsupport and stress levels in preclinical and clinical dentalstudents in Malaysia. Method: A cross sectional surveyof dental undergraduate students was conducted at theFaculty of Dentistry, University of Malaya, UniversitiKebangsaan Malaysia and Universiti Sains Malaysia.Stress was measured using the Dental Environment Stress(DES) questionnaire. A DES-32 item was used to measurestress for the clinical students and DES-16 item for thepreclinical students. Four questions were used to measuresocial support. The total stress scores were standardizedfor comparison purposes. Results: A total of 357 (79.7%)preclinical and 417 (71.8%) clinical undergraduate dentalstudents responded to the questionnaires. The clinicalstudents experienced higher stress [mean standardizedDES score = 72.63, SD = 10.64] than preclinical students[mean standardized DES score = 70.19, SD=12.01]. Thetwo most stressful items reported by preclinical studentswere “fear of failing” and “examination and grades”.Among clinical students, the two most stressful items relatedto academic were “completing course requirement” and“fear of failing course” and items related to clinical sessionwere “fear of being barred due to the clinical schedule”and “patients late or absent”. Multiple regression analysesrevealed that low stress levels among preclinical studentswere significantly associated to a lot of contact withstudents of the same course. Conclusion: To some extent,social support does play a role in explaining differences inperceived stress, in particular among preclinical students.