Palliative radiation therapy practice for advanced esophageal carcinoma in Africa

Abstract

While numerous surveys of pattern of practices of palliative radiotherapy (RT) in advanced esophageal cancers have been published in developed countries, there is no such survey in African countries. During and after a regional training course by the International Atomic Energy Agency (IAEA) in palliative cancer care, a questionnaire was distributed to African RT centers to gather information about infrastructure and human resources available, and the pattern of practice of palliative RT for esophageal cancers. Twenty-four of the 35 centers (60%) completed the questionnaire. Twenty out of 23 (87%) centers treat patients with esophageal cancer presenting with dysphagia using external beam RT (16 centers external beam RT alone and 4 centers also use brachytherapy as a boost). Twelve (60%) centers prescribe RT doses of 30 Gy in 10 fractions and 2 centers 20 Gy in 5 fractions. Eighteen centers (78%) have low dose rate (LDR) brachytherapy, and 9 (39%) centers have high dose rate (HDR) brachytherapy. One center only used HDR brachytherapy alone to a dose of 16 Gy in 2 fractions over 8 days. RT remains a major component of treatment of patients with esophageal cancers in African countries. Still, there is a great variety among centers in both indications for RT and its characteristics for a treatment indication.

Palliative Two-Dimensional Radiotherapy of Pancreatic Carcinoma: A Feasibility Study

“…The results showed that accelerated treatment at reduced doses (30 Gy) is feasible with all considered energies. Furthermore, it is interesting to note that using higher energies (6)(7)(8)(9)(10)(11)(12)(13)(14)(15) it is also possible to administer a higher dose with less hypofractionated fractionation (36 Gy, 2.4 Gy/fraction).…”

“…The standard treatment technique of pancreatic cancer is three-dimensional conformal radiotherapy 3 . However, the technique is not available in several centers, especially in developing countries, where the only available technique is standard two-dimensional (2D), often based on a cobalt unit (Co60) [4][5][6] . For the 2D technique, guidelines for adjuvant or radical treatments involving prophylactic nodal irradiation (PNI) are available 7 .…”

Definition of fields margins for palliative�radiotherapy of pancreatic carcinoma

“…The standard treatment technique of CAP is three-dimensional conformal radiotherapy (3D-CRT), intensity modulated radiotherapy, and stereotactic radiotherapy ( 3 ). These techniques however, are not available in several centers, especially in developing countries, where the only available technique is standard two-dimensional (2D) technique, often based on a cobalt unit ( 4 – 6 ). For 2D technique, guidelines for adjuvant or radical treatments involving the prophylactic irradiation of regional lymph nodes are available ( 7 ).…”