Establishment of Twinning Partnership to Improve Pediatric Radiotherapy Outcomes Globally.

PURPOSE: Pediatric radiotherapy is a necessary and challenging component of oncologic care for children in low- and middle-income countries (LMICs). Collaboration between institutions in LMICs and high-income countries (HICs) has been shown to be effective in improving oncologic treatment outcomes; however, literature regarding pediatric radiotherapy twinning partnerships is limited. METHODS: Emory University has a long-standing twinning collaboration with Tikur Anbessa Specialized Hospital (TASH) for certain medical specialties. After securing institutional funding, a faculty member and a resident from the Emory University Department of Radiation Oncology set out to establish a twinning program with TASH for pediatric radiotherapy. RESULTS: Emory and TASH faculty and residents established initial communications virtually via email and video correspondence. TASH residents and faculty completed surveys regarding pediatric radiotherapy institutional and educational needs to outline goals of collaboration. Five lectures and case-based practicums were identified focused on Wilms tumor, medulloblastoma, rhabdomyosarcoma, Hodgkin lymphoma, and palliative radiotherapy. The Emory team then conducted a visit to TASH during which lectures and practicums were delivered. The Emory team directly observed and guided simulation and treatment planning procedures. TASH residents practiced decision making, simulation, contouring, and field placement for Wilms tumor cases on the basis of didactics and feedback provided by the Emory team. Additionally, a needs assessment regarding pediatric oncologic resources was completed. Clinical care pathways and standard operating procedures were drafted by collaborators. Virtual peer-review sessions were established to continue collaborations abroad and plan for next in-person visit. CONCLUSION: Collaborative efforts by global experts have helped to establish and improve treatment protocols for childhood cancer. The presented twinning experience may serve as a model for other LMIC and HIC centers for establishing similar partnerships.

Clinicopathology and Treatment Patterns of Head and Neck Cancers in Ethiopia.

PURPOSE: Head and neck cancers are the third most common cancers treated with radiation in Ethiopia. There is, however, a lack of published data on clinical and pathological characteristics and treatment patterns of head and neck cancers in the country. The objective of the study was to assess clinical and pathological characteristics and treatment patterns of head and neck cancers at Tikur Anbessa Specialized Hospital, which housed the only radiotherapy facility in Ethiopia during the study period. MATERIALS AND METHODS: A retrospective cross-sectional study design with a simple random sampling of histologically confirmed head and neck cancers treated from 2014 to 2017 with analysis of descriptive data. RESULTS: Three hundred twenty-one patient charts were analyzed in this study from a total population of 1,377 from the department cancer registry. The male to female ratio was 2:1. The median age was 45 years (interquartile range, 26-59). The most common primary site of head and neck cancers was nasopharynx (128 of 321, 40%), and the major histologic type was squamous cell carcinoma (285 of 321, 89%). Majority of the cases had advanced disease (stage III-IVC, 221 of 251, 88%), but 92% had potentially curable disease (231 of 321). Cobalt radiotherapy was used for 67% of all patients receiving treatment (184 of 273). Induction chemotherapy followed by radiotherapy was frequently used for curative intent patients (75 of 231, 32%). There was long duration between diagnosis and initiation of treatment, with 56% (148 of 264) waiting longer than 3 months. CONCLUSION: Majority of patients with head and neck cancers seen in Ethiopia presented at advanced stage of disease, received cobalt radiotherapy, and had protracted treatment initiation. These findings underscore the need for additional investments to improve research capacity and increase the availability of high-quality radiotherapy and supportive services to deliver optimal care for patients with head and neck cancer and other cancer patients in the country.