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LILIAN Faroni
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P12 - Health Services Research/Health Economics - Health Policy (ID 124)
- Event: WCLC 2020
- Type: Posters
- Track: Health Services Research/Health Economics
- Presentations: 1
- Moderators:
- Coordinates: 1/28/2021, 00:00 - 00:00, ePoster Hall
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P12.04 - Access of Lung Cancer to High Technology Radiation Therapy in Brazil (ID 3742)
00:00 - 00:00 | Presenting Author(s): LILIAN Faroni
- Abstract
Introduction
Lung Cancer is a Global health problem, with more than 220.000 new cases more than 150.000 deaths per year in USA. Likewise in Brazil, lung cancer is the most lethal cancer in women and men with 30.200 new cases expected in 2020. Radiation treatment represent an important approach for lung cancer, since 60 – 70% of the patients will receive this modality of treatment during the course of their disease. Access to Radiation therapy is a social problem in Brazil; about 100.000 patients/year die without receiving Radiotherapy. The objective of this article is provide an overview of the status of the availability of high technology radiation therapy in Brazil.
Methods
2019 Brazilian Radiotherapy Census - public and private databases
Results
Brazil has still 20 cobalt machines working and about 363 linacs, but 122 linacs (34%) are outdated by manufacters, and in 2022 these numbers will rise to 162(45%) if they are not replaced. Most of this machines are in a public health facilities. Regarding high technology, we offer IMRT in 53.7%(130) and VMAT in 28.5%(69) but only 13.2%(48) of them have IGRT (Imaging Guided Radiation Therapy) with CBCT (Cone Beam Computed Tomography), extremely important for sophisticated treatments like IMRT/VMAT (Intensity Modulated Radiotherapy) and Lung SBRT (Stereotatic Body Radiation Treatment). In public scenario, number became worst, with 40.1%(65) offering IMRT, 21%(34) VMAT and 6.6% (24) having CBCT. Because of these, only 12% of Radiation Departments offer SBRT. Specifically for lack of radiation therapy for lung cancer, if all lung cancer patients could be treated, we would have prevented about 1689 dies. Any lung patient, independently if will receive conventional treatment or SBRT will cost in a public health (SUS) 3.563,00 reais (792 dolars), and in a private scenario 15.000 reais (3.334 dolars), with a medium machine cost of 1.5 million dolar. Although public hospitals take longer to pay for equipment (medium 10 years), new machines are able to treat almost 40% more patient that old machines, because of capacity of offer higher doses and hypofractionated patients. If we expand the analysis to number of PET-CT devices (mandatory exam for lung cancer patients), Brazil has approximately 135 machines, witch represent 50% of ideal according to the WHO (World Health Organization).
Conclusion
The contemporary approach to radiotherapy in lung cancer implicates in the use of high technology, both to address better clinical results and also to reach a lower expectancy of side effects, particulary pneumonitis. Brazil is the largest Latin American country accounting for almost half of the radiotherapy machines in the area. Despite the better numbers comparing its neighbours, the machines are usually old and do not carry high technology onboard. In the last years the quality improved with more available CBCT, most of them in larger cities and in more developed areas. There is still a big need for technical education but some are already delivering the best care.
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P19 - Locoregional and Oligometastatic Disease - Oligometastatic Disease (ID 129)
- Event: WCLC 2020
- Type: Posters
- Track: Locoregional and Oligometastatic Disease
- Presentations: 1
- Moderators:
- Coordinates: 1/28/2021, 00:00 - 00:00, ePoster Hall
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P19.09 - Lung Stereotatic Body Radiation Therapy: Outcomes from a Brazilian Cohort (ID 3747)
00:00 - 00:00 | Presenting Author(s): LILIAN Faroni
- Abstract
Introduction
Stereotactic body radiation therapy (SBRT) has emerged as an excellent treatment option for patients with primary non-small-cell lung cancer (NSCLC), with initial stages and oligometastatic disease. There are few reports in the literature describing “real world” data in a Latin America cohort. Here in we report SBRT lung cancer experience of a single institution in Brazil.
Methods
This is a retrospective analysis of patients that received lung SBRT between 2016 and 2019, in a single Brazilian institution. All patients received SBRT treatment with VMAT (Volumetric Modulated Arc Therapy), with 4d-CBCT (Cone Bean CT - Simetry®). We report local control (LC) per SBRT target, regional or distant failure-free survival, and overall survival (OS) per patient, using Kaplan-Meier estimates.
Results
This report comprises 271 patients with a median follow up of 18 months (range, 6 to 96 months), 74% of patients were men (n=200), median age 62 years (range, 37 - 98); Primary lesions (n = 136) were histology Adenocarcinoma (n = 85; 63%), Squamous Carcinoma (n = 43; 32%) and Neuroendocrine (n = 6; 5%); For secondary lesions (n = 135), 63% (n = 84) were Lung Cancer, 11% (n = 15) Gastro Intestinal Tumors, 10% (n = 13) Breast Cancer and 16% (n = 24) Other types. A median of five fractions (range, 3 to 10 fractions) and a total median dose of 59 Gy (range, 54 to 62 Gy) per lesion were prescribed for primary tumors. For secondary lesions, a median of five fractions (range, 3 to 10) and a total median dose of 45 Gy (range 30 to 62Gy). The 3 – Year Local Control for all patients was 89.14%, 93.48 (Primary) and 76.8% (Secondary) The 2-year rates of overal survival, for all patients was 67%, 88.2% (Primary) and 48.8% (Secondary), respectively. Grade 3 to 4 toxicities were observed in seven patients (3.8%): grade 3 pneumonitis (n = 5), grade 3 esophagitis (n = 1), and fatal hemoptysis (n = 1).
Conclusion
SBRT is effective and provide good local control, overall survival and low toxicity results in a real world scenario in Latin America. The results are in line with data published elsewhere.
