ABSTRACT
The rising cancer incidence and mortality in sub-Saharan Africa (SSA) warrants an increased focus on adopting or developing approaches that can significantly increase access to treatment in the region. One such approach recommended by the recent Lancet Oncology Commission for sub-Saharan Africa is hypofractionated radiotherapy (HFRT), which can substantially increase access to radiotherapy by reducing the overall duration of time (in days) each person spends being treated. Here we highlight challenges in adopting such an approach identified during the implementation of the HypoAfrica clinical trial. The HypoAfrica clinical trial is a longitudinal, multicentre study exploring the feasibility of applying HFRT for prostate cancer in SSA. This study has presented an opportunity for a pragmatic assessment of potential barriers and facilitators to adopting HFRT. Our results highlight three key challenges: quality assurance, study harmonisation and machine maintenance. We describe solutions employed to resolve these challenges and opportunities for longer term solutions that can facilitate scaling-up use of HFRT in SSA in clinical care and multicentre clinical trials. This report provides a valuable reference for the utilisation of radiotherapy approaches that increase access to treatment and the conduct of high-quality large-scale/multi-centre clinical trials involving radiotherapy. Trial registration: Not available yet.
ABSTRACT
PURPOSE: This study aims to determine the mean and 75th percentile entrance skin dose (ESDcal) from anteroposterior (AP) chest X-rays using machine parameters (indirect method). Also, a comparison was made between the ESDcal and already determined thermoluminescent dosimeter (TLD) measurements (ESDTLD) from a previous study from the same patients' data. In addition, the results were compared to similar articles, where the direct and indirect methods were used in estimating ESD to newborns. MATERIALS AND METHODS: The study determined the digital radiography (DR) X-ray machine output using a calibrated XR Multidetector (silicon photodiode). X-ray machine milliampere-seconds (mAs), peak kilovoltage (kVp), focus to detector distance (FDD) and focus to skin distance (FSD) were used from a previous study. The mean kVp and mAs were 56.63 (52-60) and 5.7 (5-6.3) and the patient thickness was 9.5 (8-11.5) cm. RESULTS: The mean ESDs of the newborn between 0 and 28 days were 0.67 ± 0.09 mGy, and the 75th percentile was 0.75 mGy. The effective dose (E) for the 40 patients was 0.19 mSv and the estimated prenatal cancer risk ranged from (5-24.7) 10-6 Sv-1. The variation between the indirect and the direct methods for assessing ESD was 39.6 (33.7-45.1)%. CONCLUSION: The 75th percentile ESD was the highest compared to the American College of Radiology-American Association of Physicists in Medicine-Society for Pediatric Radiology (ACR-AAPM-SPR), European Commission (EC) and United Kingdom (UK) reports. Comparison of both methods for assessing ESD was within 40% as compared to other studies. Based on the above results, the indirect method can be implemented for clinical dose audit.
