IMRT Are we ready for it? SK Shrivastava Radiation Oncologist - - PowerPoint PPT Presentation

IMRT

Are we ready for it?

SK Shrivastava Radiation Oncologist Tata Memorial Hospital, Mumbai, India

Diagnosis Death

Curative Treatment

Palliative Treatment

Bereavement

Diagnosis ?

Guiding principles

• Cancer Control in the Community
• Needs to address the entire spectrum from IEC,

awareness, early detection, referral and palliative care

– Involvement of

• State health systems
• NGOs, civil society and private sector
• RCCs and Medical Colleges

– Diagnostic support – Reduce delay in referrals – Ensure prompt treatment of actively detected cases

• Usual practice is to conduct camp/do pap smear and

refer!

– Palliative care, home care, hospice

Allahabad Allahabad Allahabad Allahabad Allahabad Allahabad Allahabad Allahabad Allahabad Lucknow Lucknow Lucknow Lucknow Lucknow Lucknow Lucknow Lucknow Lucknow Gwalior Gwalior Gwalior Gwalior Gwalior Gwalior Gwalior Gwalior Gwalior Delhi Delhi Delhi Delhi Delhi Delhi Delhi Delhi Delhi Chandigarh Chandigarh Chandigarh Chandigarh Chandigarh Chandigarh Chandigarh Chandigarh Chandigarh Rohtak Rohtak Rohtak Rohtak Rohtak Rohtak Rohtak Rohtak Rohtak Shimla Shimla Shimla Shimla Shimla Shimla Shimla Shimla Shimla Shrinagar Aizwal Aizwal Aizwal Aizwal Aizwal Aizwal Aizwal Aizwal Aizwal Bikaner Bikaner Bikaner Bikaner Bikaner Bikaner Bikaner Bikaner Bikaner Hyderabad Hyderabad Hyderabad Hyderabad Hyderabad Hyderabad Hyderabad Hyderabad Hyderabad Raipur Raipur Raipur Raipur Raipur Raipur Raipur Raipur Raipur Nagpur Nagpur Nagpur Nagpur Nagpur Nagpur Nagpur Nagpur Nagpur Cuttak Cuttak Cuttak Cuttak Cuttak Cuttak Cuttak Cuttak Cuttak Bangalore Bangalore Bangalore Bangalore Bangalore Bangalore Bangalore Bangalore Bangalore Chennai Chennai Chennai Chennai Chennai Chennai Chennai Chennai Chennai Kanchipuram Pondicherry Pondicherry Pondicherry Pondicherry Pondicherry Pondicherry Pondicherry Pondicherry Pondicherry Thiruvananthapuram Thiruvananthapuram Thiruvananthapuram Thiruvananthapuram Thiruvananthapuram Thiruvananthapuram Thiruvananthapuram Thiruvananthapuram Thiruvananthapuram Mumbai Mumbai Mumbai Mumbai Mumbai Mumbai Mumbai Mumbai Mumbai Kolkata Kolkata Kolkata Kolkata Kolkata Kolkata Kolkata Kolkata Kolkata Guwahati Guwahati Guwahati Guwahati Guwahati Guwahati Guwahati Guwahati Guwahati Patna Patna Patna Patna Patna Patna Patna Patna Patna Ahmadabad Ahmadabad Ahmadabad Ahmadabad Ahmadabad Ahmadabad Ahmadabad Ahmadabad Ahmadabad Imphal Imphal

ICB-25 Regional Cancer Centres

< 0.2 machines / million population 0.2 – 0.4 machines / million population 0.4 – 0.6 machines / million population > 0.6 machines / million population

۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩۩ ۩۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩۩ ۩۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩۩ ۩ ۩ ۩ ۩ ۩ Linear Accelerators Linear Accelerators

Distribution of Teletherapy Machines: India

December 2005

☻ Telecobalt Telecobalt ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻

< 0.2 machines / million population 0.2 – 0.4 machines / million population 0.4 – 0.6 machines / million population > 0.6 machines / million population

۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩۩ ۩ ۩ ۩۩ ۩ ۩ ۩۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩۩ ۩۩ ۩ ۩ ۩۩ ۩۩ ۩ ۩ ۩ ۩ ۩۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩۩ ۩ ۩ ۩ ۩ ۩۩ ۩۩ ۩ ۩ ۩۩ ۩۩ ۩ ۩ ۩ ۩ ۩۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩۩ ۩ ۩ ۩۩ ۩ ۩ ۩۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩۩ ۩ ۩ ۩ ۩ ۩ Linear Accelerators Linear Accelerators

Distribution of Teletherapy Machines: India

December 2005

☻ Telecobalt Telecobalt ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻

Tele-density m ap of I ndia

I nternational norm : 2 m achines/ m illion population

India: 0.33 units per million

Hospital Based Cancer Registry: TMH Cancer Cases 1984-2004

19509 20921 22337 23275 23784 23851 25062 25540 24444 25111 25635 25000 24258 22974 22447 21629 21894 20991 20865 22470 10619 11986 12447 13346 14715 15173 15696 15123 15620 15658 14403 15676 15345 15724 15591 16097 15946 17163 5744 6529 6939 7476 8320 8658 8796 8880 8778 8458 8784 9773 8057 8724 8646 8814 8822 9099 9032 8950 9613 4875 5457 5508 5870 6395 6515 6555 6838 6917 6665 6836 6883 6345 6952 6699 6910 6769 7061 7065 6996 7550 20591 15351 16160 15719

5000 10000 15000 20000 25000 30000 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005

Year

Pecentage of patients Total registr. Cancer Cases Males Females

Dec08

Hospital Cancer Registry: TMH 2004 Ten Leading Sites of Cancer

Males (9099) No. %

1

Leukemia 801 8.3

2

Lung 747 7.8

3

Buccal Mucosa 719 7.5

4

Lymphoma 523 5.4

5

Oesophagus 483 5.0

6

Pyriform 474 4.9

7

Tongue 338 3.5

8

Stomach 301 3.1

9

STS 270 2.8

10

Prostate 244 2.5 Females (7061) No. %

1

Breast 2113 28.0

2

Cervix 1177 15.6

3

Ovary 416 5.5

4

Leukemia 359 4.8

5

Oesophagus 255 3.4

6

Lung 234 3.1

7

Thyroid 233 3.1

8

Gall Bladder 219 2.9

9

Buccal Mucosa 213 2.8

10

Lymphoma 204 2.7

Dec08

2000 4000 6000 8000 10000 12000 14000 16000 18000

• No. Patients

All Head&Neck GIT Breast Gyne Lung GU

Hospital Based Cancer Registry: TMH 2004: Presentation

All Males Females

1000 2000 3000 4000 5000 6000 7000 8000 9000

• No. Patients

All Head&Neck GIT Breast Gyne Lung GU

Hospital Based Cancer Registry: TMH 2004: Presentation

Local Regional Advanced

23 25 17 5 22 45 78 33 25 59 16 22 69 10 9 25 66 40 15 45

Radiation Therapy Units: Expansion

50 100 150 200 250 300 1980 1985 1990 1995 2000 2005 2010 Year

• No. Units

Co-60 LA

• Brachy. (R)

Dec08

Total Teletherapy - 373 Co- 259 LA - 117

Radiotherapy Centres 257 Radiotherapy Centres 257

Teletherapy Units 373

• 60Co Teletherapy

259

• Accelerator

117 (IGRT-22)

• Cs Teletherapy

08

Teletherapy Units 373

• 60Co Teletherapy

259

• Accelerator

117 (IGRT-22)

• Cs Teletherapy

08

Brachytherapy facilities 163

• Remote LDR

28

• Remote HDR

101

• Manual ICA (Co 13, Cs 77)

90

• Manual Interstitial (Ir192)

31

HDR: mSelectron-78, GammMed-16, Flexitron-4, BeBig-3)

Brachytherapy facilities 163

• Remote LDR

28

• Remote HDR

101

• Manual ICA (Co 13, Cs 77)

90

• Manual Interstitial (Ir192)

31

HDR: mSelectron-78, GammMed-16, Flexitron-4, BeBig-3)

Status of Radiotherapy in India

RP & AD : December 2008

Mevatron-7, Primus-41, Oncor-11, Artiste-2 SL-1, Precise-18, Synergy-3 Clinac-23, Trilogy-3, Novalis-2 Siddharth-1, Mitsubishi-1, Tomotherapy-2, Cyberknife-2

History made Caution Misuse & Abuse Controversy & Suggestions