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AIM: Describe the results of the first national census of radiotherapy in Mexico in order to make a situational diagnosis of radiotherapy availability, offer more accurate information to radiation oncologists, and promote an adequate scientific based investment for the country. BACKGROUND: According to the Organisation for Economic Co-operation and Development (OECD), the density of radiotherapy (RT) machines per million habitants in Mexico is approximately 1.7-1.8. Other international organizations such as DIRAC-IAEA report 1.15 per million habitants. National organizations collect data indirectly and previous surveys had a low accrual rate (32.5%). Therefore, a precise census is required. MATERIAL AND METHODS: The Mexican Radiation Oncology Certification Board (CMRO for its acronym in Spanish) conducted a nationwide census from January through November 2019. Gathered information was combined with CMRO database for sociodemographic information and human resources. RESULTS: The study included 103 RT centers [95.1% answered the survey], with a median of 2 centers by state (ranging from 0 in Tlaxcala to 20 in Mexico City) and with a report of only 1 center in 11 states (34.4%). Fifty-six (54.3%) of the centers are public. Fourteen centers (13.6%) have residency-training programs. The total number of RT machines is 162 [141 clinical and linear accelerators (87%) and 21 radionuclide units (13%)] with a median of 3 machines by state (0 in Tlaxcala to 46 in Mexico City) and with ≤3 machines in 18 states (56.25%). The overall calculated density of RT machines per million habitants is 1.32, varying from 0 in Tlaxcala to 5.16 in Mexico City. The density of linear and clinical accelerators per million population is 1.19. The total number of brachytherapy units is 66, with a median of 1 center with brachytherapy unit per state and 29 states with ≤3 centers with a brachytherapy unit (90.6%). Thirty-seven brachytherapy units (56.1%) have automated afterload high-dose rate. The overall rate of brachytherapy units per million inhabitants is 0.55, varying from 0 in 5 states (15.6%), 0.1-0.49 in 8 states (25%), 0.5-0.99 in 13 states (40.6%), 1-1.49 in 5 states (15.6%) and 1.5-1.99 in Mexico City (3.1%). The Mexican CMRO has 368 radiation oncologists certified (99 women and 269 men), of whom only 346 remain as an active part of Mexico's workforce. CONCLUSIONS: This is the first time the CMRO conducts a national census for a radiotherapy diagnostic situation in Mexico. The country currently holds a density of clinical and linear accelerators of 1.19 per million habitants. Brachytherapy density is 0.55 devices per million habitants, and 57% of radiotherapy centers have brachytherapy units.
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BACKGROUND: In laryngeal cancer, multidisciplinary treatment improves the patient's quality of life and the possibility of preserving the larynx. Most cases occur in a locally advanced stage. The aim is to present the results according to the stage. METHOD: A retrospective study which analyzed the clinical stage, type of primary treatment, outcomes, and survival were analyzed. RESULTS: 451 patients were included. The median age was 66 years. The majority of the tumors presented in advanced stage (72%) and the most affected subsite was the glottis (84.5%). In the early stage the most frequent treatment was radiotherapy as the only treatment modality. In stages III and IVA, 65% were resectable. In stage IVB the management was non-surgical, with control in 26% of the cases. Survival at 10 years was related to the clinical stage: 81.7% for stage I and 0% for stages IVB and IVC. CONCLUSIONS: Patients with laryngeal cancer should be treated according to the clinical stage, through a multidisciplinary approach. Long-term follow-up showed a worse prognosis for advanced clinical stages.
ANTECEDENTES: En cáncer de laringe, el tratamiento multidisciplinario mejora la calidad de vida del paciente y la posibilidad de preservar la laringe. La mayor parte de estos cánceres se presentan localmente avanzados. El objetivo es presentar los resultados de acuerdo con la etapa. MÉTODO: Estudio retrospectivo en el que se analizaron la etapa clínica, el tipo de tratamiento primario, los resultados y la sobrevida. RESULTADOS: Se incluyeron 451 pacientes. La mediana de edad fue de 66 años. El mayor porcentaje de los tumores se presentó en etapa avanzada (72%) y el sitio más afectado fue la glotis (84.5%). En etapa temprana, el tratamiento más frecuente fue la radioterapia. En las etapas III y IVA, el 65% fueron operables. En la etapa IVB el manejo fue no quirúrgico, con control en el 26% de los casos. La supervivencias a 10 años se relacionaron con la etapa clínica: 81.7% para la etapa I y 0% para las etapas IVB y IVC. CONCLUSIONES: Los pacientes con cáncer de laringe deben ser tratados de acuerdo con la etapa clínica y mediante un abordaje multidisciplinario. El seguimiento a largo plazo demostró un peor pronóstico para las etapas clínicas avanzadas.
