Abstract
Background : Globally incidence of cancer is on the increase and a significant rise in the number of cases is anticipated worldwide. 52% of cancer patients will need radiation therapy at least once either for cure or palliation. Evolution from 2D to 3D has improved treatment by reducing morbidity and mortality.
Aim : To highlight our experience with 3 Dimensional(3D) Radiotherapy in terms of cancer treatment, pattern of presentation and challenges with treatment.
Methodology: This is a retrospective study conducted at Lagos University Teaching Hospital in Nigeria from January 2009 - December 2013.
Results: A total of 422 patients were treated with 3D radiotherapy within the study period. 128 (30.3%) were males while 294 (69.7%) were females with M:F ratio of 1.2:3. The age range was 6-88years with a mean of 51.62 (SD 15.39) years. The commonest age group treated was 50-59 years (105(24.9%)). Common cancers treated include Breast 130 (30.7%), Cervix 105 (24.88%), Prostate 31(7.35%) and Nasopharynx 25(5.92%). Common sites treated were Abdomino-pelvic 165(39.1%) and Chest 132(31.3%) fields. 122 (28.9%) had Complete response (CR), 262(62.2%) had Partial response(PR), 38 (8.9%) had no response. Stages III & IV treated were 300(71.1%) while stages I & II were 122(28.9%). 232 (50%) had a DFS of 6months, 84 (20%) had 1 year DFS, 32 (75%) had 3 years and 74 (17.5%) were lost to follow up. Documentation of machine failures revealed minor faults with a frequency of 55 times lasting from one hour to twenty-four hours and major faults with a frequency of 15times and overall down time of over six months.
Conclusion: The use of the LINAC machine has been proven to be reliable in reducing tumour burden and treatment despite the incessant breakdowns. Lack of steady electricity power supply contributed to these breakdowns. Unavailability of spare parts and cost were also major challenges. Adequate provision should be made to train Engineers and technicians for indigenous machine maintenance.
Keywords: 3D radiotherapy, Linear accelerator, cancer treatment, breakdowns.
Résumé
Contexte: Universellement,l’incidence du cancer est à la hausse et une augmentation significative du nombre de cas est anticipée dans le monde entier. 52% des patients atteints du cancer aura besoin de la radiothérapie au moins une fois, soit pour guérir ou palliation. L’évolution de la 2D à la 3D a amélioré le traitement en réduisant la morbidité et de la mortalité.
Objectif: Pour mettre en valeur notre expérience avec la Radiothérapie 3 Dimensionnelles (3D) en termes de traitement du cancer, modèle de présentation et les défis avec le traitement.
Méthodologie: Cette étude rétrospective menée à l’Hôpital d’Enseignement Universitaire de Lagos, Nigeria, de Janvier 2009 à Décembre 2013.
Résultats: Un total de 422 patients ont été traités avec la radiothérapie 3D au sein de la période d’étude. 128 (30,3%) étaient des mâles tandis que 294 (69,7%) étaient des femelles avec un rapport M:F de 1,2: 3. La tranche d’âge était de 6 à 88 ans avec une moyenne de 51,62 (SD 15.39) ans. Le plus fréquent groupe d’âge traitéétait 50-59 ans (105 (24,9%)). Les cancers communs traités comprennent le Sein 130 (30,7%), Cervical 105 (24,88%), Prostate 31 (7,35%) et Nasopharynx 25 (5,92%). Les sites communs traités étaient les zonesde l’abdomino-pelvien 165 (39,1%) et de la poitrine132 (31,3%). 122 (28,9%) avaient une réponse complète (CR), 262 (62,2%) avaient une réponse partielle (PR), 38 (8,9%) n’ont pas eu de réponse. Les étapes III et IV traités étaient de 300 (71,1%), tandis que les stades I et II étaient 122 (28,9%). 232 (50%) avaient un DFS de 6 mois, 84 (20%) avaient un an DFS, 32 (75%) avaient 3 ans et 74 (17,5%) ont été perdus de suivi. La documentation des défaillances de la machine a révélé des défauts mineurs avec une fréquence de 55 fois durant d’une heure à vingt-quatre heures et défauts majeurs avec une fréquence de 15 fois et un temps entier d’arrêt de plus de six mois.
Conclusion: L’utilisation de lamachine LINAC a étéavéréed’être fiable dans la réduction de la chargetumorale et le traitement tumoral malgré les pannes incessantes. Le manque d’approvisionnement régulierd’électricité a contribué à ces pannes. L’indisponibilité des pièces de rechange et les coûts étaient aussi des défis majeurs. Des dispositions appropriées devraient être mises pour former des ingénieurs et techniciens pour l’entretien indigène de la machine.
Mots-clés: Radiothérapie 3D, Accélérateur linéaire, Traitement du cancer, Pannes
Correspondence: Dr. A.C. Sowunmi, Department of Radiology, College of Medicine, University of Lagos, Lagos, Nigeria. E-mail: asowumi@unilag.edu.ng; toniasow@yahoo.com
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