240MO - Disparities in the radiotherapy management of cervical carcinoma across the globe-DOES THE INCIDENCE PATTERN MATCH THE INFRASTRUCTURE AVAILABILITY?

Background

Majority of patients with cervical cancer in the high incidence regions present at an advanced stage,warranting definitive treatment with chemoradiation.Studies have shown that dose escalation to a biological equivalent dose (BED) of 90Gy or above is necessary for optimal locoregional control ,making brachytherapy(BT) boost an integral component in the radiotherapy(RT) management of cervical carcinoma.However , not all External Beam Radiation(EBRT) centres has inhouse brachytherapy.A reflection of this deficit could be the high mortality to incidence ratio found in low and middle income countries.Our study aims at estimating this deficit across 6 countries –With high and low incidence.

Methods

The incidence of cervical carcinoma was obtained from the global cancer observatory update 2018.The RT centre ,EBRT units and BT units availabe in each country was obtained from the IAEA radiation directory.Percentage requiring definitive or adjuvant radiation in each country was obtained from literature. Based on above data following calculations were made,

1) TOTAL NUMBER OF BT APPLICATIONS PER YEAR:

No.of new case * % requiring RT * 3 to 4 (optimal no. of BT fraction-3 or 4)

2) REQUIRED NO. OF APPLICATION PER DAY PER BT UNIT BASED ON EXISTING NO. OF BT UNIT:

Total BT applications per year /Total BT units /No. of working days (12monthx4weekx5days)

3) REQUIRED NO. OF APPLICATION PER DAY PER UNIT IF ALL CENTRES HAD INHOUSE BT UNIT:

Total BT applications per year/Total RT centres/No. of working days

Results

Conclusions

The high incidence of cervical cancer in certain regions could be attributed to the varying outreach of screening programs and HPV vaccination,however,high mortality due to cervical cancer,although multifactorial appears to be linked to the deficient infrastructure for optimal radiotherapy management .We suggest that by housing all EBRT centres with BT units ,especially in the high incidence countries, treatment quality can be improvised ,eventually leading to lower mortality rates due to cervical cancer .

Clinical trial identification

Editorial acknowledgement