PURPOSE Guatemala has the highest mortality and incidence of liver cancer in Central and South America. The aim of this study is to describe the extent of liver cancer in the country from 2012 to 2016 and the associated risk factors. METHODS A secondary analysis was performed using liver cancer mortality and morbidity data and data on risk factors, such as hepatitis B virus infection, cirrhosis, and alcoholism. RESULTS Analysis revealed that liver cancer causes approximately 20% of cancer deaths in the country, is more frequent in the population older than age 65 years old, and is increasing in those age 30 to 44 years. More than 25% of deaths occurred in the North and West regions. The incidence of major risk factors for development of liver cancer has decreased. CONCLUSION The high mortality of liver cancer compared with its incidence indicates that most patients are diagnosed at late stages. To reduce the burden of liver cancer, creation of strategies for earlier detection is needed.
The not-for-profit organization La LIGA Nacional Contra el Cáncer, with its hospital Instituto de Cancerología (INCAN), is responsible for cancer treatment of much of the indigent population in Guatemala, a country with a population of 16 million. Annually, approximately 70% of patients at INCAN are seen in late stages of cancer, which places a great strain on the hospital's limited resources. Private clinics account for 75% of radiation therapy centers in Guatemala and have considerable resources. However, private facilities are fee-based, which creates a barrier for low-income patients; this is an especially significant problem in Guatemala, which has the highest income inequalities and poverty rates in Latin America. This article describes a project on the transition from cobalt to a Halcyon radiation therapy system at INCAN through a partnership with
Implementation of a modern radiotherapy unit involves many critical steps to put the machine in clinical mode. Guatemala is a lower-middle income country (LMIC), where for many years treatments were with old Cobalt-60 units. In 2014, the LINAC technology use started in the national referral cancer hospital. In 2019 a modern ring gantry LINAC was installed and commissioned in Guatemala City for a more precise treatment of cancer with high treatment efficiency. The aim of this work is to describe the entire collaboration process among institutes in the US and in Guatemala with focus on clinical commissioning and implementation undertaken by the department of medical physics in the establishment of full clinical application of a modern radiotherapy unit. Materials/Methods: Weekly management calls between the US and Guatemalan partners were held for approximately twelve months during project planning, construction, and installation of the equipment. ICRP 151 protocol was followed to establish the new shielding. Staff were trained to use the new LINAC. Modification of the old LINACs license was defined with the National Regulatory Authority. A commercial distributor organized the removal of the cobalt-60 sources to a warehouse onsite and the US National Nuclear Safety Administration is helping coordinate the removal from the hospital. Motorized 3D water phantom, compact 1D water phantom and cylindrical ionization chambers were used for the beam data verification and machine calibration. An end-to-end test was also made to evaluate the dose of an IMRT plan. Results: The first three months of the project were focused on the bunker modification and LINAC purchase. Weekly conference calls started in October 2018. Regulatory importation approvals took eight months. Two cobalt-60 machines were decommissioned. The equipment arrived in July 2019, and was installed in three days, with acceptance testing performed in two days. A survey measurement was conducted to evaluate the integrity of the vault obtained between 1.41 to 122 % of the maximum of region limit. Staff personnel received training for two weeks in the US, three weeks in Brazil and five weeks on site, from April-November 2019. The commissioning of the machine was done in September 2019, all tests were in the acceptable tolerance. In November 2019, we received the permit for the new LINAC to start treating patients and an onsite inspection was conducted by the National Authority (Direccion General de Energía e DGE). Conclusion: The commissioning of a modern LINAC was successful thanks to the multi-partner cooperation with an academic institution in the US, hospital in Guatemala, a commercial US company and the government of the US, making possible advanced techniques as VMAT and IMRT to target better coverage and OAR sparing to benefit patients with cancer.
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