1
|
Ali N, Amare E, Fekadu A, Awol M, Kayode O, Gebresenbet M, Nasir K, Dresser SA, Schriebmann E, Seife E, Esiashvili N. Establishment of Twinning Partnership to Improve Pediatric Radiotherapy Outcomes Globally. JCO Glob Oncol 2024; 10:e2300345. [PMID: 38359372 PMCID: PMC10881094 DOI: 10.1200/go.23.00345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 11/05/2023] [Accepted: 12/05/2023] [Indexed: 02/17/2024] Open
Abstract
PURPOSE Pediatric radiotherapy is a necessary and challenging component of oncologic care for children in low- and middle-income countries (LMICs). Collaboration between institutions in LMICs and high-income countries (HICs) has been shown to be effective in improving oncologic treatment outcomes; however, literature regarding pediatric radiotherapy twinning partnerships is limited. METHODS Emory University has a long-standing twinning collaboration with Tikur Anbessa Specialized Hospital (TASH) for certain medical specialties. After securing institutional funding, a faculty member and a resident from the Emory University Department of Radiation Oncology set out to establish a twinning program with TASH for pediatric radiotherapy. RESULTS Emory and TASH faculty and residents established initial communications virtually via email and video correspondence. TASH residents and faculty completed surveys regarding pediatric radiotherapy institutional and educational needs to outline goals of collaboration. Five lectures and case-based practicums were identified focused on Wilms tumor, medulloblastoma, rhabdomyosarcoma, Hodgkin lymphoma, and palliative radiotherapy. The Emory team then conducted a visit to TASH during which lectures and practicums were delivered. The Emory team directly observed and guided simulation and treatment planning procedures. TASH residents practiced decision making, simulation, contouring, and field placement for Wilms tumor cases on the basis of didactics and feedback provided by the Emory team. Additionally, a needs assessment regarding pediatric oncologic resources was completed. Clinical care pathways and standard operating procedures were drafted by collaborators. Virtual peer-review sessions were established to continue collaborations abroad and plan for next in-person visit. CONCLUSION Collaborative efforts by global experts have helped to establish and improve treatment protocols for childhood cancer. The presented twinning experience may serve as a model for other LMIC and HIC centers for establishing similar partnerships.
Collapse
Affiliation(s)
- Naba Ali
- Winship Cancer Institute of Emory University, Atlanta, GA
| | - Elias Amare
- Tikur Anbessa Specialized Hospital, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Adugna Fekadu
- Tikur Anbessa Specialized Hospital, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Munir Awol
- Tikur Anbessa Specialized Hospital, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Molalgn Gebresenbet
- Tikur Anbessa Specialized Hospital, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Keyru Nasir
- Tikur Anbessa Specialized Hospital, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | | | | | - Edom Seife
- Tikur Anbessa Specialized Hospital, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | | |
Collapse
|
2
|
Joseph A, Akinsete AM, Lasebikan NN, Adeneye S, Awofeso OM, Oladipo AT, Ajose AO, Ojo O, Merrell K, Ngwa W, Puthoff DS, Onitilo AA. The Landscape of Pediatric Radiation Oncology in Nigeria. JCO Glob Oncol 2024; 10:e2300219. [PMID: 38207247 DOI: 10.1200/go.23.00219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 09/11/2023] [Accepted: 10/23/2023] [Indexed: 01/13/2024] Open
Abstract
Radiation therapy (RT) is an essential part of the multidisciplinary treatment of pediatric cancer. Over the past five decades, significant advances have been made in the delivery of RT, with better dose delivery to disease targets while minimizing exposure to nearby organs at risk. These advances have led to improved treatment outcomes, increased survival, and reduced treatment-related toxicities. Advanced treatment techniques, however, require significant investment in infrastructural and personnel resources. This review documents what is currently available regarding expertise and infrastructure for pediatric radiation oncology practice in Nigeria. It was performed to serve as a foundation for the creation and design of tailored solutions (initiatives and policies) to increase pediatric radiation availability, accessibility, and equity in Nigeria and ultimately improve pediatric cancer treatment outcomes in the region.
Collapse
Affiliation(s)
- Adedayo Joseph
- NSIA-LUTH Cancer Centre, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Adeseye M Akinsete
- Hematology & Oncology Unit, Department of Pediatrics, College of Medicine University of Lagos, Lagos, Nigeria
| | | | - Samuel Adeneye
- NSIA-LUTH Cancer Centre, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Opeyemi M Awofeso
- Psychosocial Oncology & Palliative Care, Dana Farber Cancer Institute, Boston, MA
| | - Aishat T Oladipo
- NSIA-LUTH Cancer Centre, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Azeezat O Ajose
- NSIA-LUTH Cancer Centre, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Oluwatimileyin Ojo
- Long Island Jewish Medical Center and North Shore University Hospital, New Hyde Park, NY
| | - Kenneth Merrell
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN
| | | | - David S Puthoff
- Marshfield Clinic Research Institute, Marshfield Clinic Health System, Marshfield, WI
| | - Adedayo A Onitilo
- Marshfield Clinic Research Institute, Marshfield Clinic Health System, Marshfield, WI
| |
Collapse
|
3
|
Aruah SC, Chidebe RC, Orjiakor TC, Uba F, Shagaya UN, Ugwanyi C, Umar AA, Ige T, Asogwa OC, Ahmadu OT, Ali-Gombe M, Adewumi A, Okwor VC, Mutiu JA, Bello B, Eriba LO, Ahmed YA, Bisalla A, Itanyi U, Balogun RA, Alabi S, Pistenmaa D, Coleman CN, Manjit D. Status of Government-Funded Radiotherapy Services in Nigeria. JCO Glob Oncol 2023; 9:e2200406. [PMID: 37348033 PMCID: PMC10497276 DOI: 10.1200/go.22.00406] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 02/20/2023] [Accepted: 04/18/2023] [Indexed: 06/24/2023] Open
Abstract
PURPOSE Access to radiotherapy (RT) is now one of the stark examples of global cancer inequities. More than 800,000 new cancer cases require potentially curative or palliative RT services in Africa, arguably <15% of these patients currently have access to this important service. For a population of more than 206 million, Nigeria requires a minimum of 280 RT machines for the increasing number of cancer cases. Painfully, the country has only eight Government-funded RT machines. This study aimed to evaluate the status of the eight Government-funded RT services in Nigeria and their ability to deliver effective RT to their patients. METHODS A survey addressing 10 critical areas was used to assess the eight Government-funded RT services in Nigeria. RESULTS Unfortunately, six of the eight centers (75%) surveyed have not treated patients with RT because they do not have functioning teletherapy machines in 2021. Only two RT centers have the capability of treating patients using advanced RT techniques. There is no positron emission tomography-computed tomography scan in any of the Government-funded RT centers. The workforce capacity and infrastructure across the eight centers are limited. All of the centers lack residency training programs for medical physicists and radiation therapy technologists resulting in very few well-trained staff. CONCLUSION As the Nigerian Government plans for the new National Cancer Control Plan, there is an urgent need to scale up access to RT by upgrading the RT equipment, workforce, and infrastructure to meet the current needs of Nigerian patients with cancer. Although the shortfall is apparent from a variety of RT-capacity databases, this detailed analysis provides essential information for an implementation plan involving solutions from within Nigeria and with global partners.
Collapse
Affiliation(s)
- Simeon C. Aruah
- Radiation Oncology Department, National Hospital Abuja, Abuja, Nigeria
- College of Medicine, University of Abuja, Gwagwalada, Abuja, Nigeria
| | - Runcie C.W. Chidebe
- Project PINK BLUE—Health & Psychological Trust Centre, Abuja, Nigeria
- Department of Sociology & Gerontology, Miami University, Oxford, OH
- Scripps Gerontology Center, Miami University, Oxford, OH
| | - Tochukwu C. Orjiakor
- Project PINK BLUE—Health & Psychological Trust Centre, Abuja, Nigeria
- Department of Psychology, University of Nigeria Nsukka, Enugu, Nigeria
| | - Fatima Uba
- Radiation and Clinical Oncology Department, National Hospital Abuja, Abuja, Nigeria
| | | | - Charles Ugwanyi
- Neurosurgery Department, National Hospital Abuja, Abuja, Nigeria
| | - Aisha A. Umar
- Department of Radiology, National Hospital Abuja, Abuja, Nigeria
| | - Taofeeq Ige
- Medical Physics Department, National Hospital Abuja, Abuja, Nigeria
| | - Obinna C. Asogwa
- Medical Physics Department, National Hospital Abuja, Abuja, Nigeria
- Radiotherapy Department, Asi Ukpo Comprehensive Cancer Center, Calabar, Nigeria
| | - Oiza T. Ahmadu
- Radiation Oncology Department, Ahmadu Bello University Teaching Hospital (ABUTH), Zaria, Nigeria
| | - Musa Ali-Gombe
- Radiology Department, Gombe State University, Gombe, Nigeria
- Department of Radiotherapy and Oncology, Federal Teaching Hospital Gombe, Gombe, Nigeria
| | - Alabi Adewumi
- Radiation Oncology Department, Nigeria Sovereign Investment Authority-Lagos University Teaching Hospital (NSIA-LUTH), Lagos, Nigeria
| | - Vitalis C. Okwor
- Radiation Oncology Department, University of Nigeria Teaching Hospital (UNTH), Ituku Ozalla, Enugu, Nigeria
| | - Jimoh A. Mutiu
- University of Ibadan/University College Hospital Ibadan, Ibadan, Nigeria
| | - Basheer Bello
- Radiation Oncology Department, Usman Danfodio University Teaching Hospital (UDUTH), Sokoto, Nigeria
| | - Lucy O. Eriba
- Radiation Oncology Department, University of Benin Teaching Hospital (UBTH), Edo State, Nigeria
| | - Yusuf A. Ahmed
- Centre for Energy Research and Training, Ahmadu Bello University, Zaria, Nigeria
- Nigeria Atomic Energy Commission (NAEC), Abuja, Nigeria
| | - Awwal Bisalla
- Nigeria Atomic Energy Commission (NAEC), Abuja, Nigeria
| | - Ukamaka Itanyi
- Radiology Department, University of Abuja Teaching Hospital (UATH), Gwagwalada, Abuja, Nigeria
| | | | - Suleiman Alabi
- Radiation and Clinical Oncology Department, National Hospital Abuja, Abuja, Nigeria
| | - David Pistenmaa
- International Cancer Expert Corps (ICEC) Inc, Washington, DC
| | | | - Dosanjh Manjit
- University of Oxford, Oxford, United Kingdom
- European Centre for Nuclear Research (CERN), Geneva, Switzerland
| |
Collapse
|
4
|
Bokun J, Popović-Vuković M, Stanić D, Grujičić D, Pekmezović T, Janić D, Paripović L, Ilić V, Pudrlja Slović M, Sarić M, Mišković I, Nidžović B, Gavrilović N, Milinčić M, Nikitović M. Clinical Profile and Outcome of 806 Pediatric Oncology Patients Treated With Radiotherapy at the Serbian National Cancer Center. J Pediatr Hematol Oncol 2023; 45:116-122. [PMID: 36730662 DOI: 10.1097/mph.0000000000002589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 10/10/2022] [Indexed: 02/04/2023]
Abstract
Radiotherapy plays an important role in the multimodal treatment of childhood cancer. Our objective was to provide an analysis of pediatric oncology patients treated with radiotherapy in a national referral institution in Serbia. A retrospective chart review of children treated with radiotherapy between January 2007 and July 2018 was conducted. Of the 806 patients who were identified, 767 formed the basis of this study. CNS tumors (31.2%) were the most common tumors followed by leukemias (17.3%) and bone tumors (14.3%). The most common indication for radiotherapy was in adjuvant setting (69.1%). Anesthesia or sedation was performed on 115 patients. The 5-year and 10-year overall survival rates were 65.7% and 62.1%, respectively. A significant difference in survival in relation to tumor type was seen. The best survival rates were obtained in patients with retinoblastoma, followed by lymphomas and nephroblastoma, while patients with bone sarcomas had the worst survival. The intent of radiotherapy treatment was also a parameter associated with survival. Patients treated with palliative and definitive intent lived shorter than patients treated with prophylactic and adjuvant intent. Our study showed that good treatment outcomes can be achieved in specialized centers with an experienced team of professionals who are dedicated to pediatric oncology.
Collapse
Affiliation(s)
- Jelena Bokun
- University of Belgrade
- Pediatric Radiation Oncology Department
| | | | - Dragana Stanić
- University of Belgrade
- Pediatric Radiation Oncology Department
| | - Danica Grujičić
- University of Belgrade
- Pediatric Oncology Department
- Neuro-Oncology Department, Clinic of Neurosurgery, University Clinical Center of Serbia, Belgrade, Serbia
| | - Tatjana Pekmezović
- University of Belgrade
- Institute of Epidemiology, University of Belgrade, Faculty of Medicine
| | | | | | | | | | - Milan Sarić
- Department of Medical Physics, Institute of Oncology and Radiology of Serbia
| | - Ivana Mišković
- Department of Medical Physics, Institute of Oncology and Radiology of Serbia
| | - Borko Nidžović
- Department of Medical Physics, Institute of Oncology and Radiology of Serbia
| | | | | | | |
Collapse
|
5
|
Balakrishnan A, Jah A, Lesurtel M, Andersson B, Gibbs P, Harper SJF, Huguet EL, Kosmoliaptsis V, Liau SS, Praseedom RK, Ramia JM, Branes A, Lendoire J, Maithel S, Serrablo A, Achalandabaso M, Adham M, Ahmet A, Al-Sarireh B, Albiol Quer M, Alconchel F, Alejandro R, Alsammani M, Alseidi A, Anand A, Anselmo A, Antonakis P, Arabadzhieva E, de Aretxabala X, Aroori S, Ashley S, Ausania F, Banerjee A, Barabino M, Bartlett A, Bartsch F, Belli A, Beristain-Hernandez J, Berrevoet F, Bhatti A, Bhojwani R, Bjornsson B, Blaz T, Byrne M, Calvo M, Castellanos J, Castro M, Cavallucci D, Chang D, Christodoulis G, Ciacio O, Clavien P, Coker A, Conde-Rodriguez M, D'Amico F, D'Hondt M, Daams F, Dasari B, De Beillis M, de Meijer V, Dede K, Deiro G, Delgado F, Desai G, Di Gioia A, Di Martino M, Dixon M, Dorovinis P, Dumitrascu T, Ebata T, Eilard M, Erdmann J, Erkan M, Famularo S, Felli E, Fergadi M, Fernandez G, Fox A, Galodha S, Galun D, Ganandha S, Garcia R, Gemenetzis G, Giannone F, Gil L, Giorgakis E, Giovinazzo F, Giuffrida M, Giuliani T, Giuliante F, Gkekas I, Goel M, Goh B, Gomes A, Gruenberger T, Guevara O, Gulla A, Gupta A, Gupta R, Hakeem A, Hamid H, Heinrich S, Helton S, Heumann A, Higuchi R, Hughes D, Inarejos B, Ivanecz A, Iwao Y, Iype S, Jaen I, Jie M, Jones R, Kacirek K, Kalayarasan R, Kaldarov A, Kaman L, Kanhere H, Kapoor V, Karanicolas P, Karayiannakis A, Kausar A, Khan Z, Kim DS, Klose J, Knowles B, Koh P, Kolodziejczyk P, Komorowski A, Koong J, Kozyrin I, Krishna A, Kron P, Kumar N, van Laarhoven S, Lakhey P, Lanari J, Laurenzi A, Leow V, Limbu Y, Liu YB, Lob S, Lolis E, Lopez-Lopez V, Lozano R, Lundgren L, Machairas M, Magouliotis D, Mahamid A, Malde D, Malek A, Malik H, Malleo G, Marino M, Mayo S, Mazzola M, Memeo R, Menon K, Menzulin R, Mohan R, Morgul H, Moris D, Mulita F, Muttillo E, Nahm C, Nandasena M, Nashidengo P, Nickkholgh A, Nikov A, Noel C, O'Reilly D, O'Rourke T, Ohtsuka M, Omoshoro-Jones J, Pandanaboyana S, Pararas N, Patel R, Patkar S, Peng J, Perfecto A, Perinel J, Perivoliotis K, Perra T, Phan M, Piccolo G, Porcu A, Primavesi F, Primrose J, Pueyo-Periz E, Radenkovic D, Rammohan A, Rowcroft A, Sakata J, Saladino E, Schena C, Scholer A, Schwarz C, Serrano P, Silva M, Soreide K, Sparrelid E, Stattner S, Sturesson C, Sugiura T, Sumo M, Sutcliffe R, Teh C, Teo J, Tepetes K, Thapa P, Thepbunchonchai A, Torres J, Torres O, Torzili G, Tovikkai C, Troncoso A, Tsoulfas G, Tuzuher A, Tzimas G, Umar G, Urbani L, Vanagas T, Varga, Velayutham V, Vigano L, Wakai T, Yang Z, Yip V, Zacharoulis D, Zakharov E, Zimmitti G. Heterogeneity of management practices surrounding operable gallbladder cancer - results of the OMEGA-S international HPB surgical survey. HPB (Oxford) 2022; 24:2006-2012. [PMID: 35922277 DOI: 10.1016/j.hpb.2022.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 06/22/2022] [Accepted: 06/28/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Gallbladder cancer (GBC) is an aggressive, uncommon malignancy, with variation in operative approaches adopted across centres and few large-scale studies to guide practice. We aimed to identify the extent of heterogeneity in GBC internationally to better inform the need for future multicentre studies. METHODS A 34-question online survey was disseminated to members of the European-African Hepatopancreatobiliary Association (EAHPBA), American Hepatopancreatobiliary Association (AHPBA) and Asia-Pacific Hepatopancreatobiliary Association (A-PHPBA) regarding practices around diagnostic workup, operative approach, utilization of neoadjuvant and adjuvant therapies and surveillance strategies. RESULTS Two hundred and three surgeons responded from 51 countries. High liver resection volume units (>50 resections/year) organised HPB multidisciplinary team discussion of GBCs more commonly than those with low volumes (p < 0.0001). Management practices exhibited areas of heterogeneity, particularly around operative extent. Contrary to consensus guidelines, anatomical liver resections were favoured over non-anatomical resections for T3 tumours and above, lymphadenectomy extent was lower than recommended, and a minority of respondents still routinely excised the common bile duct or port sites. CONCLUSION Our findings suggest some similarities in the management of GBC internationally, but also specific areas of practice which differed from published guidelines. Transcontinental collaborative studies on GBC are necessary to establish evidence-based practice to minimise variation and optimise outcomes.
Collapse
Affiliation(s)
- Anita Balakrishnan
- Department of HPB Surgery, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, United Kingdom.
| | - Asif Jah
- Department of HPB Surgery, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - Mickael Lesurtel
- Department of HPB Surgery and Liver Transplantation, Beaujon Hospital, University of Paris Cité, 100 Bd du Général Leclerc, 92110, Clichy, France
| | - Bodil Andersson
- Department of Surgery, Lund University, Skane University Hospital, Lund, Sweden
| | - Paul Gibbs
- Department of HPB Surgery, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - Simon J F Harper
- Department of HPB Surgery, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - Emmanuel L Huguet
- Department of HPB Surgery, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - Vasilis Kosmoliaptsis
- Department of HPB Surgery, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - Siong S Liau
- Department of HPB Surgery, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - Raaj K Praseedom
- Department of HPB Surgery, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, United Kingdom
| | - Jose M Ramia
- Department of Surgery, Hospital General Universitario de Alicante, Avenida Pintor Baeza, 12 03010 Alicante, Spain
| | - Alejandro Branes
- Department of HPB Surgery, Hospital Sotero del Rio, Av. Concha y Toro 3459, Puente Alto, Región Metropolitana, Chile
| | - Javier Lendoire
- Department of Surgery, University of Buenos Aires, Hospital Dr Cosme Argerich, Buenos Aires, Argentina
| | - Shishir Maithel
- Department of Surgery, Emory University School of Medicine, Atlanta, GA, 30322 USA
| | - Alejandro Serrablo
- Department of HPB Surgery, Miguel Servet University Hospital, Zaragoza, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
6
|
Agrawal R, Goel V, Anand A, Arora RS. Deviation from delivery of radiation therapy to childhood cancer patients: A retrospective audit. Pediatr Blood Cancer 2022; 69:e29462. [PMID: 34842336 DOI: 10.1002/pbc.29462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 10/22/2021] [Indexed: 11/05/2022]
Abstract
BACKGROUND Planning and coordination of the delivery of radiation therapy (RT) can be challenging in resource-limited settings. In this retrospective study, we describe the profile of children undergoing radiation and analyze deviation from some accepted norms. PROCEDURE Data on all children (<18 years of age) with cancer who completed RT from January 2009 to December 2019 were retrieved. Diagnostic groups with more than five patients were included in the analysis for deviations in RT (time to start [TTS]; total dose delivered [TDD] in gray; and time to complete [TTC]). We investigated reasons for deviation. RESULTS Two hundred seven children received RT as front-line treatment (68% Indian, 59% male). Most common diagnoses were brain tumors (44%), lymphomas (13%), leukemias, and soft tissue sarcomas (10% each). TTS deviation was seen in 23.6%, TTD in 6.0%, and TTC in 24.7%, while 43.4% had at least one deviation in any of these three parameters. Deviation in TTS varied significantly by location of preceding treatment and by cancer (greatest deviation in sarcomas), with issues around access to health care being the most common reason. Deviation in TTC varied significantly by cancer (greatest deviation in sarcomas and medulloblastoma), with myelotoxicity being the most common reason. CONCLUSIONS Our study adds to the limited literature on RT quality for children with cancer in resource-limited settings. Certain cancers (sarcomas and medulloblastomas) and patient groups (preceding treatment outside our institute) had the maximum deviation. Barriers to accessing care and myelotoxicity were the two main reasons for this deviation.
Collapse
Affiliation(s)
- Rashi Agrawal
- Max Institute of Cancer Care, Max Super Speciality Hospital, Vaishali, Ghaziabad, Uttar Pradesh, India
| | - Vineeta Goel
- Max Institute of Cancer Care, Max Super Speciality Hospital, Shalimar Bagh, New Delhi, India
| | - Anil Anand
- Max Institute of Cancer Care, Max Super Speciality Hospital, Saket, New Delhi, India
| | - Ramandeep Singh Arora
- Max Institute of Cancer Care, Max Super Speciality Hospital, Saket, New Delhi, India
| |
Collapse
|