Status of radiotherapy resources in Africa: an International Atomic Energy Agency analysis

Abdel‐Wahab, May; Bourque, Jean‐Marc; Pynda, Yaroslav; Iżewska, J.; Merwe, D. van der; Zubizarreta, Eduardo; Rosenblatt, Eduardo

doi:10.1016/s1470-2045(12)70532-6

Cited by 249 publications

(169 citation statements)

References 13 publications

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“…Less than one-fourth of these cases will receive appropriate and safe surgery. Though many women present with advanced cervical cancer requiring chemoradiation therapy in LMICs, many resource-limited areas in Southeast Asia, Western Pacific Asia, Africa, and Latin America lack adequate radiotherapy and chemotherapy capabilities and therefore surgery may continue to play an important role in cervical cancer management (Abdel-Wahab et al, 2013, Grover et al, 2015). In particular, surgical management may play a key role in patients with early cervical cancer or locally advanced cervical cancer after neoadjuvant chemotherapy (Chuang et al, 2016).…”

Section: Surgery and Clinical Trials In Lmicsmentioning

confidence: 99%

Clinical trials in low and middle-income countries — Successes and challenges

Grover

Jhingran

et al. 2017

Gynecologic Oncology Reports

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Gynecologic malignancies affect women in low and middle-income countries (LMICs) at equal or higher rates compared to high income countries (HICs), yet practice guidelines based on clinical trials performed in HICs do not routinely account for resource disparities between these regions. There is a need and growing interest for executing clinical trials in LMICs. This has led to the creation of multinational cooperative groups and the initiation of several ongoing clinical trials in Mexico, China, and Korea. In this article we describe the challenges involved in initiating clinical trials in LMICs, review current efforts within surgical, medical, and radiation oncology, and introduce high priority topics for future research.

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Section: Surgery and Clinical Trials In Lmicsmentioning

confidence: 99%

Clinical trials in low and middle-income countries — Successes and challenges

Grover

Jhingran

et al. 2017

Gynecologic Oncology Reports

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“…This is an important finding given the lack of radiotherapy treatment options in many parts of the world. 5,6,7,8 The gradient index results indicate that the dose fall-off is not as steep as that obtained with traditional radiosurgery techniques, as is expected from the larger penumbra obtained with the 5 mm MLC leaves relative to micromultileaf collimators or divergent cones. This results in a greater volume of tissue being included in the V10 Eq , thereby potentially increasing the risk of inducing radiation necrosis.…”

Section: Discussionmentioning

confidence: 83%

“…6 Over 60% of linacs in Africa are situated in South Africa and Egypt. 7 Even in South Africa, it is estimated that only 69.7% of the required number of linacs are installed, and that an additional 56 will be required by 2020. 6 Very few linacs in South Africa are modified for radiosurgery treatment.…”

Section: Methodsmentioning

confidence: 99%

Hypofractionated image-guided radiotherapy for the treatment of acoustic neuromas: A dosimetrically acceptable alternative to stereotactic radiosurgery in a resource-constrained environment

Burger¹,

Gregor²,

Balchin³

et al. 2017

S. Afr. j. oncol.

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Purpose: Treatment options for acoustic neuromas (ANs) are limited in low- and middle-income countries. The aim of this study was to investigate whether hypofractionated image-guided radiotherapy (IGRT) is a clinically acceptable treatment option for departments where no other radiosurgery options are available. Methods and materials: Fifteen dynamic conformal arc plans that had been clinically utilised were evaluated against the Radiation Therapy Oncology Group (RTOG) radiosurgery criteria and published indices. Analysis involved evaluating critical structure doses and the volume of normal tissue receiving 12 and 10 Gy single fraction equivalent dose (V12Eq and V10Eq). Results: Overall, there was only one RTOG protocol deviation in the whole patient group, where quality of coverage was compromised in order to achieve brainstem tolerance. Conformity indices were within clinically acceptable limits (CIPaddick ≥ 0.6) despite being inferior to the published Universitair Ziekenhuis Brussel (UZB) Gamma Knife and CyberKnife results (p < 0.0001). Homogeneity was superior to the Gamma Knife (p < 0.0001) and Novalis dynamic conformal arc (p = 0.0002) results. Gradient index results were inferior to all published techniques, but doses to the normal structures were well controlled with the exception of the cochlea. The V10Eq data showed increased sensitivity when compared with V12Eq. Conclusion: Dynamic arc IGRT allows for good coverage of AN lesions, but the dose fall-off is not as steep as that obtained with mainstream radiosurgery systems. Contouring and planning should include detailed critical structures analysis. For normal brain parenchyma analysis, V10Eq is a superior risk indicator when compared to V12Eq for this technique. Dynamic arc IGRT offers a dosimetrically acceptable treatment alternative for patients without serviceable hearing, in departments where there are no mainstream radiosurgery treatment options available.

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“…In contrast, in Romania a proposal on the expansion of radiotherapy services within the country was planned on the basis that 70% of the new cancer cases require radiation [32]. Although generalizing contexts must be done carefully, in the case of developing countries and having in mind that the IAEA reported that nearly 30 African and Asian countries have no radiotherapy services at all [26], and only 23 African countries are known to have teletherapy [33], it is important to generate information in constrained resources settings to support feasible solutions and to better assist national health planners in the decision making process.…”

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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Status of radiotherapy resources in Africa: an International Atomic Energy Agency analysis

Cited by 249 publications

References 13 publications

Clinical trials in low and middle-income countries — Successes and challenges

Clinical trials in low and middle-income countries — Successes and challenges

Hypofractionated image-guided radiotherapy for the treatment of acoustic neuromas: A dosimetrically acceptable alternative to stereotactic radiosurgery in a resource-constrained environment

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

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