Postal dose audits for radiotherapy centers in Latin America and the Caribbean: trends in 1969-2003

Since 1969 the International Atomic Energy Agency and the World Health Organisation (along with the Pan American Health Organization, working with countries in Latin America and the Caribbean) have operated postal dosimetry audits based on thermoluminescent dosimetry (TLD) for radiotherapy centres. The purpose of these audits is to provide and independent dosimetry check of radiation beams used to treat cancer patients. The success of radiotherapy treatment depends on accurate dosimetry. Over the period of 1969 through 2003 the calibration of approximately 5200 photon beams in over 1300 radiotherapy centres in 115 countries worldwide was checked. Of these audits, 36 percent were performed in Latin America and the Caribbean, with results improving grealtly over the years. Unfortunately, in several instances large TLD deviations have confirmed clinical observations of inadequate dosimetry practices in hospitals in various parts of the world or even accidents in radiotherapy, such as the one that occurred in Costa Rica in 1996. Hospitals or centres that operate radiotherapy services without qualified medical physicists or without dosimetry equipment have poorer results than do hospitals or centres that are properly staffed and equipped. When centres have poor TLD results, a follow-up program can help them improve their dosimetry status. However, to achieve audit results that are comparable to those for centers in industrialized countries, additional strengthening of the radiotherapy infrastructure in Latin America and the Caribbean is needed (AU)

Can acromegaly be cured? A twenty year review

A retrospective review was performed on 41 patients under going transphenoidal surgery for treatment of acromegaly between 1977 and 1997. The mean age was 16.9 years (range 8-67). There were 28 (68.3 percent) male subjects. The mean follow-up was 4.4 years (range 0-17 years). 14 (34.1 percent) patients underwent postoperative adjuvant treatment with radiotherapy, bromocriptine or both. Three (7.3 percent) patients required a second transphenoidal procedure for persistent disease. Postoperatively 27 (65.9 percent) patients (3 had unknown postoperative growth hormone levels) had normalisation of growth hormone (GH) levels (<5 ng/ml). Of these, 5(20.8 percent) of 24 patients (excluding 3 who were lost to follow-up) had biochemical recurrence of disease. This yields surgical cure in 22 (57.9 percent) of 38 patients (excluding the three who were lost to follow-up). Of the fourteen patients who underwent adjuvant treatment 6 (42.3 percent) attained GH levels <5 ng/ml. Considering all treatments combined, 26 (74.3 percent) of 35 patients (6 lost to follow-up) achieved biochemical cure. These results compare favourably with previously reported cure rates in the literature. Transphenoidal surgery is the initial treatment of choice for acromegaly. An overview of the management of this fascinating neuroendocrine disorder will be presented.(AU)

The role of radiotherapy in cancer management

A brief look at the aims of radiation therapy, interactions with other modalities and recent advances. Although an ideal radiation beam capable of destroying only the cancer cells has not yet been found, the author examines the existing beams and the specific types of treatment for which they are used

Cancer of the cervix in Trinidad and Tobago 1983-1987

This project presents data on the type of treatment available at the National Radiotherapy Centre, St. James as well as a statistical analysis on the patients' data of cancer of the cervix cases in Trinidad and Tobago over the five year period 1983 - 1987. Two types of radiation treatment are available at the centre, (i) external, which uses cobalt - 60 as its source; (ii) internal, in which radium ovoids are used. For best results a combination of external and internal therapy is given. Usually radiation is given daily, a total dose of between 4500 - 4999R is usually received by the patient, from the cobalt-60 source over a 4 - 5 week period; while a dose of 4000 - 4999R is delivered by the internal radium source over a 2 - 6 day period. Data for the statistical analysis were obtained from the Radiotherapy Centre and compiled using a statistical survey program. Most of the cancer of the cervix cases occur between the ages of 41 - 70 years and there was a decrease in the amount of cases registered over the five year period 1983 - 1987. The survival rate was over 90 percent. Regular Pap smears of women in the cancer age group is an important method for reducing the incidence of invasive carcinoma of the cervix. With detection and treatment at an early stage the chances of survival are greatly enhanced. (AU)