IMRT Are we ready for it? SK Shrivastava Radiation Oncologist Tata Memorial Hospital, Mumbai, India
Diagnosis Death Diagnosis ? Curative Bereavement Treatment Palliative Treatment
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
Shrinagar ICB-25 Regional Cancer Centres Shimla Shimla Shimla Shimla Shimla Shimla Shimla Shimla Shimla Chandigarh Chandigarh Chandigarh Chandigarh Chandigarh Chandigarh Chandigarh Chandigarh Chandigarh Rohtak Rohtak Rohtak Rohtak Rohtak Rohtak Rohtak Rohtak Rohtak Delhi Delhi Delhi Delhi Delhi Delhi Delhi Delhi Delhi Lucknow Lucknow Lucknow Lucknow Lucknow Lucknow Lucknow Lucknow Lucknow Bikaner Bikaner Bikaner Bikaner Bikaner Bikaner Bikaner Bikaner Bikaner Guwahati Guwahati Guwahati Guwahati Guwahati Guwahati Guwahati Guwahati Guwahati Gwalior Gwalior Gwalior Gwalior Gwalior Gwalior Gwalior Gwalior Gwalior Allahabad Allahabad Allahabad Allahabad Allahabad Allahabad Allahabad Allahabad Allahabad Patna Patna Patna Patna Patna Patna Patna Patna Patna Imphal Imphal Ahmadabad Ahmadabad Ahmadabad Ahmadabad Ahmadabad Ahmadabad Ahmadabad Ahmadabad Ahmadabad Aizwal Aizwal Aizwal Aizwal Aizwal Aizwal Aizwal Aizwal Aizwal Kolkata Kolkata Kolkata Kolkata Kolkata Kolkata Kolkata Kolkata Kolkata Raipur Raipur Raipur Raipur Raipur Raipur Raipur Raipur Raipur Cuttak Cuttak Cuttak Cuttak Cuttak Cuttak Nagpur Nagpur Nagpur Cuttak Cuttak Cuttak Nagpur Nagpur Nagpur Nagpur Nagpur Nagpur Mumbai Mumbai Mumbai Mumbai Mumbai Mumbai Mumbai Mumbai Mumbai Hyderabad Hyderabad Hyderabad Hyderabad Hyderabad Hyderabad Hyderabad Hyderabad Hyderabad 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
Tele-density m ap of I ndia Distribution of Teletherapy Machines: India Distribution of Teletherapy Machines: India December 2005 December 2005 ☻ ☻ ۩ ۩ ۩ ۩ ☻ ☻ India: 0.33 units per million ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ۩۩ ۩۩ ۩ ۩۩ ۩ ۩ ۩ ۩ ☻ ☻ ☻ ☻ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ☻ ☻ ☻ ☻ ☻ ☻ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ☻ ☻ ☻ ☻ ☻ ☻ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ☻ ☻ ☻ ☻ ☻ ☻ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ۩ ۩ ۩ ۩ ☻ ☻ ۩ ۩ ۩۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ۩ ۩ ۩ ۩ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ۩ ۩ ۩ ۩ ۩۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ۩ ۩۩ ۩۩ ۩ ۩۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩۩ ۩۩ ۩۩ ۩ ۩۩ ۩۩ ۩۩ ۩ ۩ ۩ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ۩ ۩ ۩ ۩ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ۩ ۩ ۩ ۩ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ☻ ☻ ☻ ☻ ☻ ☻ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ < 0.2 machines / million population < 0.2 machines / million population ☻ ☻ ☻ ☻ 0.2 – 0.4 machines / million population 0.2 – 0.4 machines / million population ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ☻ ☻ ۩ ۩ ۩ ۩ ☻ ☻ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ☻ ☻ ☻ ☻ ۩۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ 0.4 – 0.6 machines / million population 0.4 – 0.6 machines / million population ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ۩۩ ۩۩ ۩۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ > 0.6 machines / million population > 0.6 machines / million population ☻ ☻ ☻ ☻ ☻ ☻ ۩ ۩ ۩۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ☻ ☻ ☻ ☻ ☻ ☻ ۩ ۩۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ۩ ☻ ☻ ☻ ☻ ۩ Linear Accelerators ۩ Linear Accelerators ☻ ☻ ۩ ۩ Linear Accelerators Linear Accelerators ۩ ۩ ۩ ۩ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ ☻ Telecobalt ☻ Telecobalt Telecobalt Telecobalt ☻ ☻ ۩۩ ۩۩ ۩۩ ۩۩ ۩۩ ۩۩ ۩ ۩ ۩ ۩ ۩ ۩ I nternational norm : 2 m achines/ m illion population
Hospital Based Cancer Registry: TMH Cancer Cases 1984-2004 30000 24444 25111 25635 25000 25062 25540 25000 24258 23275 23784 23851 22974 22447 22470 22337 21629 21894 Pecentage of patients 20991 20865 20921 20591 20000 19509 17163 16160 15719 16097 15946 15696 15123 15620 15658 15676 15345 15724 15591 15351 14715 15173 15000 14403 13346 11986 12447 10619 10000 9773 9613 9099 9032 8950 8880 8796 8778 8784 8814 8822 8724 8658 8646 8458 8320 8057 7476 7550 7061 7065 6939 6952 6996 6917 6883 6910 6838 6836 6769 6699 6529 6515 6555 6665 6395 6345 5870 5744 5457 5508 5000 4875 0 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 Year Dec08 Total registr. Cancer Cases Males Females
Hospital Cancer Registry: TMH 2004 Ten Leading Sites of Cancer Males (9099) No. % Females (7061) No. % Leukemia 801 8.3 Breast 2113 28.0 1 1 2 Lung 747 7.8 2 Cervix 1177 15.6 3 Buccal Mucosa 719 7.5 3 Ovary 416 5.5 Lymphoma 523 5.4 Leukemia 359 4.8 4 4 5 Oesophagus 483 5.0 5 Oesophagus 255 3.4 Pyriform 474 4.9 Lung 234 3.1 6 6 7 Tongue 338 3.5 7 Thyroid 233 3.1 8 Stomach 301 3.1 8 Gall Bladder 219 2.9 STS 270 2.8 Buccal Mucosa 213 2.8 9 9 10 Prostate 244 2.5 10 Lymphoma 204 2.7 Dec08
Hospital Based Cancer Registry: TMH 2004: Presentation 18000 16000 14000 12000 No. Patients 10000 8000 6000 4000 2000 0 All Head&Neck GIT Breast Gyne Lung GU All Males Females
Hospital Based Cancer Registry: TMH 2004: Presentation 9000 8000 7000 6000 No. Patients 5000 23 25 4000 78 3000 2000 69 45 59 17 33 1000 66 5 22 25 16 22 10 25 40 15 45 9 0 All Head&Neck GIT Breast Gyne Lung GU Local Regional Advanced
Radiation Therapy Units: Expansion 300 Total Teletherapy - 373 250 Co- 259 200 No. Units 150 100 LA - 117 50 0 1980 1985 1990 1995 2000 2005 2010 Year Co-60 LA Brachy. (R) Dec08
Status of Radiotherapy in India Radiotherapy Centres 257 Radiotherapy Centres 257 Teletherapy Units 373 Teletherapy Units 373 � 60 Co Teletherapy 259 � 60 Co Teletherapy 259 � Accelerator 117 ( IGRT-22) � Accelerator 117 ( IGRT-22) � Cs Teletherapy 08 � Cs Teletherapy 08 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 Brachytherapy facilities 163 Brachytherapy facilities 163 � Remote LDR 28 � Remote LDR 28 � Remote HDR 101 � Remote HDR 101 � Manual ICA (Co 13, Cs 77) 90 � Manual ICA (Co 13, Cs 77) 90 � Manual Interstitial (Ir192) 31 � Manual Interstitial (Ir192) 31 RP & AD : December 2008 HDR: mSelectron-78, GammMed-16, Flexitron-4, BeBig-3) HDR: mSelectron-78, GammMed-16, Flexitron-4, BeBig-3)
History made Misuse & Abuse Controversy & Suggestions Caution
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