Multinational assessment of some operational costs of teletherapy.

BACKGROUND AND PURPOSE: Decisions in planning radiotherapy facilities in countries with limited financial resources require information on economic factors to make provision for sustainability. This study aims at acquiring data on some of these factors involved in delivery of teletherapy in 11 countries of different economic status. PATIENTS AND METHODS: Representatives of three European, one African, three Latin American and four Asian countries, were identified from radiation oncology institutions that operated both cobalt and linac teletherapy machines. Productivity data were prospectively collected for the year 2002. A detailed log was recorded for each machine over an arbitrary two-week period. Data on quality assurance (QA), maintenance, the capital costs of each machine, and the source replacement costs for the cobalt units were also recorded. RESULTS: Both linear accelerators and cobalt machines treat more than 10,000 fractions per year per machine with 2.5 and 2.3 fields per fraction, respectively. The capital costs of the machines vary considerably, with a factor of more than 10 for linear accelerators. Cobalt sources show a huge variation in price. The median costs of QA and maintenance of a linac was US$ 41,000 compared to US$ 6000 for cobalt machines. This results for the economic factors considered in median costs per fraction of US$ 11.02 for linear accelerators and US$ 4.87 for cobalt machines. These figures do not include the costs for physicians. CONCLUSIONS: The variation of the costs per fraction is more due to the result of differences in machine usage and costs of equipment than of national economic status. A treatment fraction on a linac with functionality comparable to cobalt, costs 50% more than cobalt therapy. This project shows that it is possible to collect data on economic factors prospectively as well as retrospectively.

Radiotherapy of stage IEA primary breast lymphoma: case report.

A 47-year-old woman was referred for the treatment to our Hospital because of a palpable nodule in the upper medial quadrant of her right breast. After tumor excision, pathohistological examination showed a follicular center cell lymphoma grade 2, B-cell type (CD20+, bc16+, CD10+, bcl2+). The final diagnosis was stage IEA primary extranodal non-Hodgkin s breast lymphoma. The involved breast was irradiated isocentrically with two opposite 6-megavolt (MeV) photon beams delivered from the linear accelerator (tangential fields) using asymmetric collimator opening. Radiation volume, inclinations of the medial and lateral field, and the part of the underlying chest wall and lung parenchyma were determined during the radiotherapy simulation process. The total irradiation dose was 44 Gy delivered in single daily doses of 2 Grays (Gy). After breast photon irradiation, a boost to the tumor bed was performed by a direct 12 MeV electron beam, with a total dose of 6 Gy delivered over three days. Since primary non-Hodgkin lymphoma of the breast is rather rare, there has been no uniform approach to its treatment. The advantage of applying the asymmetric collimator jaw opening in breast radiotherapy is the instant reduction of the dose at margin fields, resulting in both the protection of neighboring lung parenchyma and the good coverage of planned target volume.