Role of radiotherapy in cancer control in low-income and middle-income countries

Bartoň, Michael; Frommer, Michael; Shafiq, Jesmin

doi:10.1016/s1470-2045(06)70759-8

Cited by 259 publications

(171 citation statements)

References 23 publications

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“…Approximately 50% of cancer patients can benefit from radiation therapy in the management of their diseases 1, 2, 3. The accuracy of radiation therapy depends on the conformal deposition of ionizing radiation to the target volume and the efforts to spare its neighboring healthy tissues 4, 5.…”

Section: Introductionmentioning

confidence: 99%

Optimizing the target detectability of cone beam CT performed in image‐guided radiation therapy for patients of different body sizes

Yang

Ruan

et al. 2018

J Applied Clin Med Phys

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PurposeThe target detectability of cone beam computed tomography (CBCT) performed in image‐guided radiation therapy (IGRT) was investigated to achieve sufficient image quality for patient positioning over a course of treatment session while maintaining radiation exposure from CBCT imaging as low as reasonably achievable (ALARA).MethodsBody CBCT scans operated in half‐fan mode were acquired with three different protocols: CBCTlowD, CBCTmidD, and CBCThighD, which resulted in weighted CT dose index (CTDIw) of 0.36, 1.43, and 2.78 cGy, respectively. An electron density phantom that is 18 cm in diameter was covered by four layers of 2.5‐cm‐thick bolus to simulate patients of different body sizes. Multivariate analysis was used to examine the impact of body size, radiation exposure, and tissue type on the target detectability of CBCT imaging, quantified as contrast‐to‐noise ratio (CNR).ResultsCBCTmidD allows sufficient target detection of adipose, breast, muscle, liver in a background of water for normal‐weight adults with cross‐sectional diameter less than 28 cm, while CBCThighD is suitable for adult patients with larger body sizes or body mass index over 25 kg/m2. Once the cross‐sectional diameter of adult patients is larger than 35 cm, the CTDIw of CBCT scans should be higher than 2.78 cGy to achieve required CNR. As for pediatric and adolescent patients with cross‐sectional diameter less than 25 cm, CBCTlowD is able to produce images with sufficient target detection.ConclusionThe target detectability of soft tissues in default CBCT scans may not be sufficient for overweight or obese adults. Contrary, pediatric and adolescent patients would receive unnecessarily high radiation exposure from default CBCT scans. Therefore, the selection of acquisition parameters for CBCT scans optimized according to patient body size was proposed to ensure sufficient image quality for daily patient positioning in radiation therapy while achieving the ALARA principle.

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Section: Introductionmentioning

confidence: 99%

Optimizing the target detectability of cone beam CT performed in image‐guided radiation therapy for patients of different body sizes

Yang

Ruan

et al. 2018

J Applied Clin Med Phys

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“…Another report on Indian HNC patients showed stage III -IV presentation in 80-90% (Rao et al, 1998). Between 50-80% of breast and cervical cancers in the low and middle income countries present in stage III and higher, compared to less than 20% in the western countries (Barton et al, 2006).…”

Section: Discussionmentioning

confidence: 95%

“…India has a very low density of radiotherapy services, approximately 0.3 megavoltage high-energy machine per 100,000 population compared to the western standards of one or more machine per million (Barton et al,2006). A survey by Murthy et al (2008) has shown a wide gap in the availability and access of radiotherapy facilities in most parts of India, mainly in the public-funded hospitals.…”

Section: Discussionmentioning

confidence: 99%

Clinical Audit in Radiation Oncology: Results from One Academic Centre in Delhi, India

Kaur

Mohanti²,

Muzumder³

2013

Asian Pacific Journal of Cancer Prevention

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The objective was to analyze the radiotherapy (RT) practice at the cancer centre of a tertiary academic medical institution in Delhi. This audit from an Indian public institution covered patient care processes related to cancer diagnosis, integration of RT with other anti-cancer modalities, waiting time, overall treatment time, and compliance with RT. Over a period of one year, all consecutively registered patients in radiotherapy were analyzed for the audit cycle. Analysis of 1,030 patients showed median age of 49.6 years, with presentation as stage I and II in 14.2%, stage III and IV in 71.2% and unknown stage in 14.6%. A total of 974 (95%) were advised for RT appointment; 669 (68.6%) for curative intent and 31.4% for palliation. Mean times for diagnostic workup and from registration at cancer centre to radiotherapy referral were 33 and 31 days respectively. Median waiting time to start of RT course was 41 days. Overall RT compliance was 75% and overall duration for a curative RT course ranged from 50 days to 61 days. Non-completion and interruption of RT course were observed in 12% and 13% respectively. Radiotherapy machine burden in a public cancer hospital in India increases the waiting time and 25% of advised patients do not comply with the prescribed treatment. Infrastructure, machine and manpower constraints lead to more patients being treated on cobalt (74%) and by two-dimensional (78%) techniques.

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“…Similar to the Italian survey, this model was applied in the African population and suggested that 55% of the new cancer cases in that continent have an indication of radiotherapy [28]. This utilization rate relied on estimates taken from Globocan 2002, so no information on the staging of the disease was available.…”

Section: Discussionmentioning

confidence: 99%

Prescription of Cancer Treatment Modalities in Developing Countries: Results from a Multi-Centre Observational Study

Camacho¹,

Neves²,

Piñeros³

et al. 2014

JCT

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Background: Treatment is an important component of a comprehensive cancer control approach and its outcomes strongly depend on infrastructure, equipment, human and financial resources available. Therefore it is imperative to generate evidence-based tools to assist health policy makers from low resourced countries in planning efficient and equitable treatment services for a defined population based on what it is feasible to these settings. Methods: The intended cancer specific treatment planned and written in the patients' medical record (treatment prescription) of untreated adult cancer cases (≥18 years of age), excluding non-melanoma skin cancer, was recorded in a chronological way from 1 January 2012 onwards in a group of eight comprehensive cancer centres located in middle income countries and offering the main modalities of cancer * Affiliations are as of 1 March 2014. # Corresponding author. R. Camacho et al.990 treatment (surgery, medical oncology and radiotherapy). Results: A total of 17,713 medical records were reviewed, of which 7106 (54.2%) met the eligibility criteria. Prescription of main cancer treatment modalities were distributed as follows: 57.6% for chemotherapy (n = 4093), 56.8% for surgery (n = 4038), and 46.8% for radiotherapy (n = 3327). There was a predominance of plans consisting of combined treatment modalities over monotherapy (55.2% versus 44.8%). At the time of diagnosis 54.3% of the cancer cases had disease that had spread beyond the primary site, 41.2% were considered as having local disease and in 4.5% of the cases the information on disease extension was unknown. Conclusions: The results obtained should be seen as an approximation of cancer treatment service demand based on what it is currently practiced and therefore feasible in developing countries, particularly in middle income countries.

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Role of radiotherapy in cancer control in low-income and middle-income countries

Cited by 259 publications

References 23 publications

Optimizing the target detectability of cone beam CT performed in image‐guided radiation therapy for patients of different body sizes

Optimizing the target detectability of cone beam CT performed in image‐guided radiation therapy for patients of different body sizes

Clinical Audit in Radiation Oncology: Results from One Academic Centre in Delhi, India

Prescription of Cancer Treatment Modalities in Developing Countries: Results from a Multi-Centre Observational Study

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