Lack of staff trained to use new technology in cancer clinics could prolonging waiting time for radiation treatment and exacerbate the disease of patients urgently needing treatment, a professor in radiation therapy warned today. (Wednesday 24 October)
Addressing the ECCO 11 - the European Cancer Society in Lisbon, Professor Peter Levendag quoted examples from his own department of technological advances that were of potential benefit to head and neck cancer patients - but which were not being properly exploited.
Professor Levendag, of the Dr. Daniel den Hoed Cancer Center, Department of Radiation-Oncology, Rotterdam, explained: "The increasing effort in implementing advanced technology, given the shortage of highly skilled personnel and linear accelerators, can raise the departmental workload and could ultimately lead to an increase in waiting time. This is a psychological burden to the patient and his or her relatives. It might even cause a further loss in tumor control and/ or higher morbidity - with, finally, a rise in health care costs".
The new advances include:
External beam intensity modulated radiotherapy (IMRT) has produced remarkable technological advances in radiation therapy in the treatment of particular tumours, eg, head and neck, prostate, breast, lung, rectum, and central nervous system. It reduces side effects associated with conventional radiation therapy by sparing normal surrounding tissue and can improve treatment outcome by raising the dose. IMRT uses computer-generated treatment plans to deliver more tightly focused radiation beams to tumors than is possible with conventional radiotherapy. By evaluating many possible beam arrangements; it works out the best strategy to maximize the radiation dose directed to the tumour, while minimising that delivered to neighbouring healthy tissue.
Stereotactic radiation therapy (SRT) relies on extremely focused high doses of radiation. A stereotactic frame is placed on the patient's head to hold it in position and limiting movement to allow precise targeting. The physician scans the patient to establish the exact position of the malignant (or benign) abnormalities. To precisely define the intracranial target, an MRI scan is made with the same stereotactic frame and fused with the CT-scan. The treatment plan is worked out with computers to determine the direction of the beam and time of radiation exposure.
Teleconferencing has been introduced to speed up the process of peer review of IMRT and SRT treatment plans. Creating a communication link between departments a few miles apart, it incorporates broadband technology that permits fast transmission with interactive means of modifying data.
Professor Levendag warned: "With shortage of resources, the potential increase in waiting times might even become prohibitive in introducing this type of sophistication in the treatment routine of a department".
These "sacred cows of high-technology" in radiation therapy seemed worth the effort, he argued, but would have to be monitored carefully. Patients in the Netherlands were already waiting on average for three or four weeks for radiation therapy to begin.
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