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Sarria GR, Martinez DA, Li B, Castillo RD, Salgado A, Pinillos L, Felix A, Bobadilla I, Ferraris G, Castilho M, Carmona J, Leon B, Aviles L, Ricagni L, Isa N, Flores C, Giordano FA, Zubizarreta EH, Polo A, Sarria GJ. Leveling Up the Access to Radiation Therapy in Latin America: Economic Analysis of Investment, Equity, and Inclusion Opportunities Up to 2030. Int J Radiat Oncol Biol Phys 2022; 116:448-458. [PMID: 36549348 DOI: 10.1016/j.ijrobp.2022.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 11/30/2022] [Accepted: 12/06/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE Latin America faces a shortage in radiation therapy (RT) units and qualified personnel for timely and high-quality treatment of patients with cancer. Investing in equitable and inclusive access to RT over the next decade would prevent thousands of deaths. Measuring the investment gap and payoff is necessary for stakeholder discussions and capacity planning efforts. METHODS AND MATERIALS Data were collected from the International Atomic Energy Agency's Directory of Radiotherapy Centers, industry stakeholders, and individual surveys sent to national scientific societies. Nationwide data on available devices and personnel were compiled. The 10 most common cancers in 2020 with RT indication and their respective incidence rates were considered for gap calculations. The gross 2-year financial return on investment was calculated based on an average monthly salary across Latin America. A 10-year cost projection was calculated according to the estimated population dynamics for the period until 2030. RESULTS Eleven countries were included in the study, accounting for 557,213,447 people in 2020 and 561 RT facilities. Approximately 1,065,684 new cancer cases were diagnosed, and a mean density of 768,469 (standard deviation ±392,778) people per available unit was found. By projecting the currently available treatment fractions to determine those required in 2030, it was found that 62.3% and 130.8% increases in external beam RT and brachytherapy units are needed from the baseline, respectively. An overall regional investment of approximately United States (US) $349,650,480 in 2020 would have covered the existing demand. An investment of US $872,889,949 will be necessary by 2030, with the expectation of a 2-year posttreatment gross return on investment of more than US $2.1 billion from patients treated in 2030 only. CONCLUSIONS Investment in RT services is lagging in Latin America in terms of the population's needs. An accelerated outlay could save additional lives during the next decade, create a self-sustaining system, and reduce region-wide inequities in cancer care access. Cash flow analyses are warranted to tailor precise national-level intervention strategies.
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Affiliation(s)
- Gustavo R Sarria
- Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Bonn, Germany; Rayos Contra Cancer, Inc, Nashville, Tennessee.
| | - David A Martinez
- Rayos Contra Cancer, Inc, Nashville, Tennessee; Department of Radiation Oncology, Oncosalud-Auna, Lima, Peru
| | - Benjamin Li
- Rayos Contra Cancer, Inc, Nashville, Tennessee; Department of Radiation Oncology, University of California, San Francisco, California
| | | | - Apolo Salgado
- Department of Radiation Oncology, Instituto Nacional del Cancer, Santiago de Chile, Chile
| | - Luis Pinillos
- Department of Radiation Oncology, Oncosalud-Auna, Lima, Peru
| | - Armando Felix
- Department of Radiation Oncology, Hospital de Oncologia Centro Medico Nacional Siglo XXI - IMSS, Mexico City, Mexico
| | - Ivan Bobadilla
- Radiotherapy Unit, Luis Carlos Sarmiento Angulo Cancer Treatment and Research Center - CTIC, Bogota, Colombia
| | - Gustavo Ferraris
- Radiotherapy Unit, Centro de Radioterapia Dean Funes, Cordoba, Argentina
| | - Marcus Castilho
- Radiotherapy Center, Hospital Felicio Rocho, Belo Horizonte, Brazil
| | - Jorge Carmona
- Radiotherapy Unit, Oncoserv, Santiago de los Caballeros, Dominican Republic
| | - Barbara Leon
- Radiotherapy Technical Unit, Hospital Carlos Andrade Marín, Quito, Ecuador
| | | | - Leandro Ricagni
- Department of Radiation Oncology, Hospital de Clinicas, Montevideo, Uruguay
| | - Nicolas Isa
- Department of Radiation Oncology, Clinica IRAM, Santiago de Chile, Chile
| | - Claudio Flores
- Department of Epidemiology and Applied Research, Auna Ideas, Lima, Peru
| | - Frank A Giordano
- Department of Radiation Oncology, University Hospital Bonn, University of Bonn, Bonn, Germany
| | | | - Alfredo Polo
- Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Gustavo J Sarria
- Department of Radiation Oncology, Oncosalud-Auna, Lima, Peru; Department of Radiotherapy, Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru
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Sarria GR, Martinez DA, Del Castillo R, Salgado A, Pinillos L, Felix A, Bobadilla I, Ferraris G, Polo A, Sarria GJ. Radiotherapy and cancer status in Latin America: economic analysis of investment opportunities up to 2030. Lancet Oncol 2022. [DOI: 10.1016/s1470-2045(22)00404-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Colonio C, Lecman L, Pinto JA, Vallejos C, Pinillos L. Life expectancy and cancer survival in Oncosalud: outcomes over a 15-year period in a Peruvian private institution. Ecancermedicalscience 2022; 15:1336. [PMID: 35211205 PMCID: PMC8816511 DOI: 10.3332/ecancer.2021.1336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Indexed: 11/06/2022] Open
Abstract
Background There is a large gap in the data on cancer outcomes in Latin America, making it difficult to establish adequate cancer control policies in the region. The aim of our study was to describe the survival, life expectancy estimates and life expectancy changes over time for a large cohort of Peruvian patients insured with Oncosalud, a private healthcare system. Patients and methods We evaluated a retrospective cohort of patients diagnosed between 2000 and 2015 in Oncosalud (Lima-Peru). Cases included colon, rectum, stomach, bladder, breast, prostate and non-melanoma skin cancers. Survival was evaluated with the Kaplan–Meier methodology. The standard period life table was used to estimate the excess mortality risks of patients in our cohort compared to the population covered by the Peruvian Superintendence of Banks, Insurance Companies and Pension Funds (SBS). The years of life lost was estimated based on SBS population, matching patients by age and sex. Results A large cohort of 7,687 Peruvian cancer patients managed in a 15-year period was eligible. If patients survive 5 years after a cancer diagnosis, life expectancy tends to be close to that of a population without cancer. The number of years of life lost at diagnosis was higher at the youngest ages, steadily decreasing thereafter. During the first years after cancer diagnosis, young patients face a much higher loss in life expectancy than older ones. Patients suffering from colon, rectum, stomach and bladder cancer are the most affected by the years of life lost. Conclusion In cancer patients surviving ≥ 5 years, life expectancy becomes similar to that observed in a population with similar socioeconomic characteristics. The estimated survival rate in our cohort is higher than that reported by public cancer registries in Peru. This could be explained by the different socio-economic background and access to specialised cancer care.
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Affiliation(s)
| | | | - Joseph A Pinto
- Centro de Investigación Básica y Traslacional, AUNA Ideas, Lima 15036, Peru
| | - Carlos Vallejos
- Centro de Investigación Básica y Traslacional, AUNA Ideas, Lima 15036, Peru
| | - Luis Pinillos
- Departamento de Radioterapia, Oncosalud-AUNA, Lima 15036, Peru
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Posada-Arango AM, García-Madrigal J, Echeverri-Isaza S, Alberto-Castrillón G, Martínez D, Gómez AC, Pinto JA, Pinillos L. Thrombosis in abdominal vessels associated with COVID-19 Infection: A report of three cases. Radiol Case Rep 2021; 16:3044-3050. [PMID: 34306276 PMCID: PMC8286875 DOI: 10.1016/j.radcr.2021.07.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 07/07/2021] [Accepted: 07/10/2021] [Indexed: 01/08/2023] Open
Abstract
Hypercoagulability related to SARS-CoV-2 infection is one of the main extrapulmonary complications of COVID-19. We present three cases of intrabdominal thrombotic complications related to the state of hypercoagulability of COVID-19 and its tomographic features. Hypercoagulability state should be taking into account in the interpretation of radiological images in all infected patients with COVID-19.
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Affiliation(s)
- Ana María Posada-Arango
- Department of Radiology, Oncosalud- AUNA, Peru Ave. Guardia Civil N 227, San Borja, Lima, Peru
| | - Joaquín García-Madrigal
- Department of Radiology, Clinic Las Americas, Medellin, Colombia.,Department of Radiology, Clinic el Rosario, Medellin, Colombia
| | - Santiago Echeverri-Isaza
- Department of Radiology, Clinical Interventionist Las Americas and Hospital Pablo Tobon Uribe, Medellin, Colombia
| | | | - David Martínez
- Department of Radiooncology, Oncosalud- AUNA, Lima, Peru
| | - Andrea C Gómez
- Basic and Translational Research Center, AUNA Ideas, Lima, Peru
| | - Joseph A Pinto
- Basic and Translational Research Center, AUNA Ideas, Lima, Peru
| | - Luis Pinillos
- Department of Radiology, Oncosalud- AUNA, Peru Ave. Guardia Civil N 227, San Borja, Lima, Peru
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Del Castillo R, Martinez D, Salgado A, Sarria G, Uzuga F, Chumbimuni R, Veliz I, Pinillos L, Garcia B. PO-0246 Cost-effectiveness analysis of the use of blood patch as a pre-rectal spacer in brachytherapy. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)06405-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Montenegro P, Pinillos L, Young F, Aguilar A, Tirado-Hurtado I, Pinto JA, Vallejos C. Telemedicine and the current opportunities for the management of oncological patients in Peru in the context of COVID-19 pandemic. Crit Rev Oncol Hematol 2021; 157:103129. [PMID: 33227573 PMCID: PMC7581359 DOI: 10.1016/j.critrevonc.2020.103129] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 10/08/2020] [Accepted: 10/09/2020] [Indexed: 12/29/2022] Open
Abstract
COVID-19 pandemic is the more challenging public health emergency of the century, producing the collapse of health systems and unprecedented levels of morbidity and mortality around the world, especially in low resource settings. Patients with chronic diseases are the most affected, not only due to the high susceptibility to SARS-CoV-2 infection but also due to the decrease in opportunities for timely care. In this dark landscape, telemedicine, before limited to very specific scenarios, has become one of our main tools to manage cancer patients, particularly in Latin America where COVID-19 has had a strong impact on the public health. Telemedicine can provide rapid access to specialized cancer care in a scenario complicated, reducing the exposure of patients and healthcare personnel to the SARS-CoV-2. In this review, we would like to share our experience and our workflow using telemedicine at Oncosalud-AUNA, a private clinic in Peru.
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Affiliation(s)
| | | | | | | | | | - Joseph A Pinto
- Unidad de Investigación Básica y Traslacional, AUNA, Lima41, Peru
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Del Castillo R, Martinez D, Sarria GJ, Pinillos L, Garcia B, Castillo L, Carhuactocto A, Giordano FA, Sarria GR. Low-dose radiotherapy for COVID-19 pneumonia treatment: case report, procedure, and literature review. Strahlenther Onkol 2020; 196:1086-1093. [PMID: 32816059 PMCID: PMC7439803 DOI: 10.1007/s00066-020-01675-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 07/27/2020] [Indexed: 01/08/2023]
Abstract
Background The COVID-19 pandemic outbreak has set the emergency services in developing countries on major alert, as the installed response capacities are easily overwhelmed by the constantly increasing high demand. The deficit of intensive care unit beds and ventilators in countries like Peru is forcing practitioners to seek preventive or early interventional strategies to prevent saturating these chronically neglected facilities. Case presentation A 64-year-old patient is reported after presenting with COVID-19 pneumonia and rapidly progressing to deteriorated ventilatory function. Compassionate treatment with a single 1‑Gy dose to the bilateral whole-lung volume was administered, with gradual daily improvement of ventilatory function and decrease in serum inflammatory markers and oxygen support needs, including intubation. No treatment-related toxicity developed. Procedures of transport, disinfection, and treatment planning and delivery are described. Conclusion Whole-lung low-dose radiotherapy seems to be a promising approach for avoiding or delaying invasive respiratory support. Delivered low doses are far from meeting toxicity ranges. On-going prospective trials will elucidate the effectiveness of this approach.
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Affiliation(s)
| | - David Martinez
- Department of Radiation Oncology, Clinica Delgado-AUNA, Lima, Peru
| | - Gustavo J Sarria
- Department of Radiation Oncology, Clinica Delgado-AUNA, Lima, Peru
| | - Luis Pinillos
- Department of Radiation Oncology, Clinica Delgado-AUNA, Lima, Peru
| | - Bertha Garcia
- Department of Radiation Oncology, Clinica Delgado-AUNA, Lima, Peru
| | - Luis Castillo
- Department of Critical Care, Clinica Delgado-AUNA, Lima, Peru
| | | | - Frank A Giordano
- Department of Radiation Oncology, University Hospital Bonn, Universitätsklinikum Bonn, Venusberg Campus 1, Building 55, 53127, Bonn, Germany
| | - Gustavo R Sarria
- Department of Radiation Oncology, University Hospital Bonn, Universitätsklinikum Bonn, Venusberg Campus 1, Building 55, 53127, Bonn, Germany.
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Pinto JA, Pinillos L, Villarreal-Garza C, Morante Z, Villarán MV, Mejía G, Caglevic C, Aguilar A, Fajardo W, Usuga F, Carrasco M, Rebaza P, Posada AM, Tirado-Hurtado I, Flores C, Vallejos CS. Barriers in Latin America for the management of locally advanced breast cancer. Ecancermedicalscience 2019; 13:897. [PMID: 30792814 PMCID: PMC6372299 DOI: 10.3332/ecancer.2019.897] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Indexed: 01/21/2023] Open
Abstract
Breast cancer (BC) is a highly prevalent malignancy in Latin American women, most cases being diagnosed at locally advanced or metastatic stages when options for cancer care are limited. Despite its label as a public health problem in the region, Latin American BC patients face several barriers in accessing standard of care treatment when compared with patients from developed countries. In this review, we analyse the landscape of the four main identified barriers in the region: i) high burden of locally advanced/advanced BC; ii) inadequate access to medical resources; iii) deficient access to specialised cancer care and iv) insufficient BC research in Latin America. Unfortunately, these barriers represent the main factors associated with the BC poor outcomes seen in the region. Targeted actions should be conducted independently by each country and as a region to overcome these limitations and create an enhanced model of BC care.
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Affiliation(s)
- Joseph A Pinto
- Unidad de Investigación Básica y Traslacional, Oncosalud-AUNA, Lima 15036, Peru
| | - Luis Pinillos
- Departamento de Radioterapia, Oncosalud-AUNA, Lima 15036, Peru
| | - Cynthia Villarreal-Garza
- Departamento de Investigación y de Tumores Mamarios, Instituto Nacional de Cancerología, Mexico City 14080, Mexico
| | - Zaida Morante
- Departamento de Medicina Oncológica, Oncosalud-AUNA, Lima 15036, Peru.,Departamento de Oncología Médica, Instituto Nacional de Enfermedades Neoplásicas, Lima 15038, Peru
| | - Manuel V Villarán
- Unidad de Investigación Básica y Traslacional, Oncosalud-AUNA, Lima 15036, Peru
| | - Gerson Mejía
- Departamento de Oncología Médica, Hospital Clínico Viedma, Cochabamba 00725, Bolivia
| | - Christian Caglevic
- Medical Oncology Department, Clinica Alemana, Santiago 5951, Chile.,Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago 700, Chile
| | - Alfredo Aguilar
- Departamento de Medicina Oncológica, Oncosalud-AUNA, Lima 15036, Peru
| | - Williams Fajardo
- Departamento de Medicina Especializada, Hospital Nacional Dos de Mayo, Lima 15003, Peru
| | - Franz Usuga
- Grupo de Radioterapia Oncológica, Instituto Nacional de Cancerología, Bogotá 9-85, Colombia
| | - Marcia Carrasco
- Departamento de Oncología, Hospital Santa Rosa, Lima 95405, Peru.,Unidad de la Mama, Oncosalud-AUNA, Lima 15036, Peru
| | | | - Ana M Posada
- Unidad de la Mama, Oncosalud-AUNA, Lima 15036, Peru
| | | | - Claudio Flores
- Unidad de Investigación Básica y Traslacional, Oncosalud-AUNA, Lima 15036, Peru
| | - Carlos S Vallejos
- Departamento de Medicina Oncológica, Oncosalud-AUNA, Lima 15036, Peru
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Araujo JM, Prado A, Cardenas NK, Zaharia M, Dyer R, Doimi F, Bravo L, Pinillos L, Morante Z, Aguilar A, Mas LA, Gomez HL, Vallejos CS, Rolfo C, Pinto JA. Repeated observation of immune gene sets enrichment in women with non-small cell lung cancer. Oncotarget 2018; 7:20282-92. [PMID: 26958810 PMCID: PMC4991454 DOI: 10.18632/oncotarget.7943] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 02/11/2016] [Indexed: 12/26/2022] Open
Abstract
There are different biological and clinical patterns of lung cancer between genders indicating intrinsic differences leading to increased sensitivity to cigarette smoke-induced DNA damage, mutational patterns of KRAS and better clinical outcomes in women while differences between genders at gene-expression levels was not previously reported. Here we show an enrichment of immune genes in NSCLC in women compared to men. We found in a GSEA analysis (by biological processes annotated from Gene Ontology) of six public datasets a repeated observation of immune gene sets enrichment in women. "Immune system process", "immune response", "defense response", "cellular defense response" and "regulation of immune system process" were the gene sets most over-represented while APOBEC3G, APOBEC3F, LAT, CD1D and CCL5 represented the top-five core genes. Characterization of immune cell composition with the platform CIBERSORT showed no differences between genders; however, there were differences when tumor tissues were compared to normal tissues. Our results suggest different immune responses in NSCLC between genders that could be related with the different clinical outcome.
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Affiliation(s)
- Jhajaira M Araujo
- Unidad de Investigación Básica y Traslacional, Oncosalud-AUNA, San Borja, Lima 41, Peru
| | - Alexandra Prado
- Unidad de Investigación Básica y Traslacional, Oncosalud-AUNA, San Borja, Lima 41, Peru
| | - Nadezhda K Cardenas
- Escuela de Medicina Humana, Universidad Privada San Juan Bautista, Chorrillos, Lima 09, Peru
| | - Mayer Zaharia
- Unidad de Investigación Básica y Traslacional, Oncosalud-AUNA, San Borja, Lima 41, Peru
| | - Richard Dyer
- Departamento de Patología, Oncosalud-AUNA, San Borja, Lima 41, Peru
| | - Franco Doimi
- Departamento de Patología, Oncosalud-AUNA, San Borja, Lima 41, Peru
| | - Leny Bravo
- Escuela de Medicina Humana, Universidad Privada San Juan Bautista, Chorrillos, Lima 09, Peru
| | - Luis Pinillos
- Unidad de Investigación Básica y Traslacional, Oncosalud-AUNA, San Borja, Lima 41, Peru
| | - Zaida Morante
- Departamento de Medicina Oncológica, Instituto Nacional de Enfermedades Neoplásicas, Surquillo, Lima 41, Peru
| | - Alfredo Aguilar
- Unidad de Investigación Básica y Traslacional, Oncosalud-AUNA, San Borja, Lima 41, Peru
| | - Luis A Mas
- Unidad de Investigación Básica y Traslacional, Oncosalud-AUNA, San Borja, Lima 41, Peru
| | - Henry L Gomez
- Unidad de Investigación Básica y Traslacional, Oncosalud-AUNA, San Borja, Lima 41, Peru
| | - Carlos S Vallejos
- Unidad de Investigación Básica y Traslacional, Oncosalud-AUNA, San Borja, Lima 41, Peru
| | - Christian Rolfo
- Phase I - Early Clinical Trials Unit, Antwerp University Hospital, Antwerp, 2650 Edegem, Belgium
| | - Joseph A Pinto
- Unidad de Investigación Básica y Traslacional, Oncosalud-AUNA, San Borja, Lima 41, Peru
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Abstract
Radiotherapy was the first nonsurgical treatment for malignant tumours and represents one of the oldest disciplines of oncology. In Latin America, as in many parts of the world, the history of modern oncology begins with the implementation of radiation therapy facilities. The development of radiotherapy in Latin America was possible thanks to the seminal work of radiation oncologists in different countries. As a large territory, there is a need to implement modern facilities and equipment, but unfortunately there are disparities in the access and quality of radiotherapy services across Latin America and even within individual countries. In this review, we describe the history, challenges and success in the implementation of radiotherapy and the frustration caused by the lack of facilities in several Latin American countries.
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Affiliation(s)
- Luis Pinillos
- Departamento de Radioterapia, Oncosalud-AUNA, Av Paseo de la República 3650, San Isidro, Lima 15046, Peru
| | - Joseph A Pinto
- Unidad de Investigación Básica y Traslacional, Oncosalud-AUNA, Av Guardia Civil 571, San Borja, Lima 15036, Peru
| | - Gustavo Sarria
- Departamento de Radioterapia, Oncosalud-AUNA, Av Paseo de la República 3650, San Isidro, Lima 15046, Peru
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Aguilar A, Flores C, Mas L, Gutierrez JM, Pinillos L, Vallejos C. P1.01-050 Overall Survival in Advanced Lung Cancer Patients Treated at Oncosalud-AUNA. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2016.11.574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Aguilar A, Pinto JA, Araujo J, Fajardo W, Bravo L, Pinillos L, Vallejos C. Control of cervical cancer in Peru: Current barriers and challenges for the future. Mol Clin Oncol 2016; 5:241-245. [PMID: 27446557 PMCID: PMC4950606 DOI: 10.3892/mco.2016.926] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 05/09/2016] [Indexed: 11/16/2022] Open
Abstract
Cervical cancer is the leading malignant neoplasm in Peruvian women. This malignancy is a public health problem and several efforts were previously performed to develop cancer control plans. Geographical, cultural, structural, infrastructural and procedural barriers can limit the implementation of such strategies. Several previous studies have characterized human papilloma virus (HPV) epidemiology, where prevalence of high-risk HPV in adult females is ~12% and the prevalence in cervical cancer is 90–95%. The predominant barriers for the control of cervical cancer are lack of specialists in remote villages, education/cultural issues, loss of patients in follow-up, lack of access to HPV testing and lack of compliance for HPV vaccination. A good strategy for the prevention and early detection of high-risk HPV, pre-malignant neoplasms and cervical cancer, identified by interventional studies, is the self-sampling test, which assists with overcoming the cultural and geographic barriers. The current cancer control plan, termed ‘Plan Esperanza’, is performed with massive training of health professionals and social sensitization campaigns leading to filling the gaps regarding education and, in addition, it provides cancer care coverage for poorer individuals. In our experience at Oncosalud-AUNA, with a cohort of ~750,000 affiliates using a pre-paid system with annual screenings for cervical cancer for women, offered free-of-charge, a lower incidence of this malignancy (5.8/100,000) is now observed compared with the national incidence (32.7/100,000). As in other countries, the HPV vaccination can be a cost-utility strategy to reduce the high burdens of cervical cancer in Peru, a rapid and cheap HPV molecular sub-typification is rapidly required.
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Affiliation(s)
- Alfredo Aguilar
- Department of Medical Oncology, Oncosalud-AUNA, San Borja, Lima 41, Peru
| | - Joseph A Pinto
- Unit of Basic and Translational Research, Oncosalud-AUNA, San Borja, Lima 41, Peru
| | - Jhajaira Araujo
- Unit of Basic and Translational Research, Oncosalud-AUNA, San Borja, Lima 41, Peru
| | - Williams Fajardo
- School of Human Medicine, St. John's Private University, Chorrillos, Lima 09, Peru
| | - Leny Bravo
- School of Human Medicine, St. John's Private University, Chorrillos, Lima 09, Peru
| | - Luis Pinillos
- Department of Radiotherapy, Oncosalud-AUNA, San Borja, Lima 41, Peru
| | - Carlos Vallejos
- Department of Medical Oncology, Oncosalud-AUNA, San Borja, Lima 41, Peru
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Vallejos C, Flores C, Aguilar A, Vigil C, Sarria G, Pinillos L. 1000 Survival of cancer patients treated at Oncosalud-AUNA. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(15)30016-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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14
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Barriga LE, Zaharia M, Pinillos L, Moscol A, Heredia A, Sarria G, Marquina J, Barriga O, Picon C. Long-term follow-up of radiation accident patients in Peru: review of two cases. Radiat Prot Dosimetry 2012; 151:652-655. [PMID: 22914334 DOI: 10.1093/rpd/ncs175] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Overexposure to radioactive sources used in radiotherapy or industrial radiography may result in severe health consequences. This report assesses the initial clinical status and the medical and psychological long-term follow-up of two radiation accident patients from Peru during the mid-to-late 1990s: one patient exposed to a radiotherapy (60)Co source in Arequipa, the other patient to a (192)Ir source in Yanango. Commonalities and differences are described. The main causes in both accidents were human error and the failure to apply appropriate safety guidelines and standard operating procedures. Education and training of the personnel working with radiation sources are essential to prevent accidents. The experience gained from the medical management of the two patients is valuable for future treatment of such patients.
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Affiliation(s)
- L E Barriga
- Centro de Radioterapia de Lima, Calle 22 No 202, Urb. Corpac, San Borja, Lima, Perú.
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15
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Linares L, Poitevin A, De la Pena C, Britton KR, Ospino R, Lara R, Sarria G, Motta N, Rene N, Pinillos L, Novaes P. The prescription of oral anticancer drugs: Another perspective. Rep Pract Oncol Radiother 2012; 17:295-7. [PMID: 24377031 DOI: 10.1016/j.rpor.2012.10.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Affiliation(s)
- Luis Linares
- HOPE International Radiation Center, Guatemala, Guatemala
| | - Adela Poitevin
- Department of Radiation Oncology, Médica Sur, Mexico City, Mexico
| | | | - Keith R Britton
- Centro Internacional de Radiocirugía y Radioterapia Oncológica (CIRRO), Panamá, Panama
| | | | - Raul Lara
- Centro Salvadoreño de Radioterapia, San Salvador, El Salvador
| | - Gustavo Sarria
- Department of Radiation Oncology, National Institute for Neoplastic Diseases (INEN), Lima, Peru
| | - Neiro Motta
- Radioterapia, ISCMPA/UFCSPA, Porto Alegre, Brazil
| | | | | | - Paulo Novaes
- Radioterapia - ISO Hospital Dia Santos, São Paulo, Brazil
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16
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Guedea F, Ventura M, Londres B, Pinillos L, Poitevin A, Ospino R, Cordova A, Camacho R, Britton R, Sarria G, Sempere P, Delgado RL, Bulnes R, Ventura NC, Limbergen EV, Haie-Meder C, Kovacs G. Overview of brachytherapy resources in Latin America: a patterns-of-care survey. Brachytherapy 2011; 10:363-8. [PMID: 21296032 DOI: 10.1016/j.brachy.2010.12.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2010] [Revised: 11/30/2010] [Accepted: 12/06/2010] [Indexed: 11/16/2022]
Abstract
PURPOSE Relatively little is known about available resources and patterns of practice for brachytherapy (BT) in Latin America. To rectify this situation, we performed a patterns-of-care survey whose aim was to assess the human and material resources available for BT in Latin America and document current clinical practices. METHODS AND MATERIALS A total of 392 radiotherapy (RT) centers located in 17 Latin American countries were asked to complete an online survey that included detailed questions about BT practices, facilities, and staffing. The study was coordinated through central offices located in Spain and Peru. National coordinators were appointed to manage the survey in each individual country. RESULTS Overall, 77 of the 392 institutions (20%) completed the questionnaire. Of the 14 countries with at least one response, the participation rate was 35% (77 of 223 RT centers). The average number of patients (RT+BT) per center was 917. The mean number of BT patients per center increased by 46% (from 105 to 153 patients) from 2002 to 2007. Gynecologic localizations (endometrium, cervix, and vagina) accounted for 95% of treatments, and the uterine cervix was the most common tumor site (75% of all treatments). CONCLUSIONS In Latin America, BT is most commonly used to treat gynecologic tumors, particularly of the cervix. Relatively few interventions were performed for breast and prostate. This was the first study of its kind in this region and should be repeated periodically.
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Affiliation(s)
- Ferran Guedea
- Department of Radiation Oncology, Catalan Institute of Oncology, Hospitalet de Llobregat, Barcelona, Spain.
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17
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Van Der Giessen PH, Alert J, Badri C, Bistrovic M, Deshpande D, Kardamakis D, Van Der Merwe D, Da Motta N, Pinillos L, Sajjad R, Tian Y, Levin V. Multinational assessment of some operational costs of teletherapy. Radiother Oncol 2004; 71:347-55. [PMID: 15172152 DOI: 10.1016/j.radonc.2004.02.021] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2003] [Revised: 01/06/2004] [Accepted: 02/25/2004] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Decisions in planning radiotherapy facilities in countries with limited financial resources require information on economic factors to make provision for sustainability. This study aims at acquiring data on some of these factors involved in delivery of teletherapy in 11 countries of different economic status. PATIENTS AND METHODS Representatives of three European, one African, three Latin American and four Asian countries, were identified from radiation oncology institutions that operated both cobalt and linac teletherapy machines. Productivity data were prospectively collected for the year 2002. A detailed log was recorded for each machine over an arbitrary two-week period. Data on quality assurance (QA), maintenance, the capital costs of each machine, and the source replacement costs for the cobalt units were also recorded. RESULTS Both linear accelerators and cobalt machines treat more than 10,000 fractions per year per machine with 2.5 and 2.3 fields per fraction, respectively. The capital costs of the machines vary considerably, with a factor of more than 10 for linear accelerators. Cobalt sources show a huge variation in price. The median costs of QA and maintenance of a linac was US$ 41,000 compared to US$ 6000 for cobalt machines. This results for the economic factors considered in median costs per fraction of US$ 11.02 for linear accelerators and US$ 4.87 for cobalt machines. These figures do not include the costs for physicians. CONCLUSIONS The variation of the costs per fraction is more due to the result of differences in machine usage and costs of equipment than of national economic status. A treatment fraction on a linac with functionality comparable to cobalt, costs 50% more than cobalt therapy. This project shows that it is possible to collect data on economic factors prospectively as well as retrospectively.
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Nag S, Dally M, de la Torre M, Tatsuzaki H, Kizilbash N, Kurusun S, Pinillos L, Pokrajac B, Sur R, Levin V. Recommendations for implementation of high dose rate 192Ir brachytherapy in developing countries by the Advisory Group of International Atomic Energy Agency. Radiother Oncol 2002; 64:297-308. [PMID: 12242118 DOI: 10.1016/s0167-8140(02)00166-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
PURPOSE To provide recommendations for the implementation of high dose rate (HDR) 192Ir brachytherapy technology in developing countries. METHODS An Advisory Group Meeting of the International Atomic Energy Agency (IAEA) met to address the implementation of HDR 192Ir brachytherapy technology in developing countries. These recommendations reflect only the personal opinions of the authors and do not necessarily represent the opinion of the IAEA. RESULTS An HDR treatment system should be purchased as a complete unit that includes the 192Ir radioactive source, source loading unit, applicators, treatment planning system, and control console. Infrastructure support may require additional or improved buildings and procurement of or access to new imaging facilities. A supportive budget is needed for quarterly source replacement and the annual maintenance necessary to keep the system operational. The radiation oncologist, medical physicist, and technologist should be specially trained before HDR can be introduced. Training for the oncologist and medical physicist is an ongoing process as new techniques or sites of treatment are introduced. Procedures for quality assurance (QA) of patient treatment, and the planning system must be introduced. Emergency procedures with adequate training of all associated personnel must be in place. CONCLUSIONS The decision to select HDR in preference to alternate methods of brachytherapy is influenced by the ability of the machine to treat a wide variety of clinical sites. In departments with personnel and budgetary resources to support this equipment appropriately, economic advantage becomes evident only if large numbers of patients are treated. Intangible benefits of source safety, personnel safety, and easy adaptation to fluctuating demand for treatments also require consideration when evaluating the need to introduce this treatment system.
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Affiliation(s)
- Subir Nag
- Ohio State University, 300 W. Tenth Avenue, Columbus 43210, USA
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Abstract
The Instituto Nacional de Enfermedades Neoplásicas was established by the government of Peru as an institution for the treatment of cancer patients in 1939; it has existed under different names until the current title was adopted in 1952. Between 1980 and 1987, attendance increased by 70% and a new and larger facility came into use at the beginning of 1988. This institution has national responsibility for cancer prevention, detection, treatment, education, and research and is currently organizing satellite treatment centers in other parts of the country. More than 80% of the medical staff has been trained in the institute's residency program, the majority of whom received additional postgraduate training in the United States and Europe; 90% of the medical staff hold academic appointments in medical schools. In 1952 the Institute became the first hospital in Peru with a formal postgraduate training system for various medical disciplines, including surgical oncology and medical oncology. So far we have trained about 500 surgical oncologists who are working in all parts of Peru. The Maes-Heller Institute for Cancer Research forms part of the National Cancer Institute complex. Research will be directed mainly toward new diagnostic and therapeutic approaches, multidisciplinary tumor therapy, and large-scale cancer screening. The Institute focuses on early detection and prevention of cancer and is active in breast self-examination education and antismoking campaigns. It enjoys community support evidenced in the women's organization, Adainen, involved in fundraising; 460 women volunteers give at least 4 hr service per week to the Institute. The Institute has grown from 9,000 patients seen per year in its early days to 215,000 attendances in 1986.
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Affiliation(s)
- L Pinillos
- Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru
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20
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Zaharia M, Salem LE, Travezan R, Moscol A, Pinillos L, Farias C, Pinillos L. Postoperative radiotherapy in the management of cancer of the maxillary sinus. Int J Radiat Oncol Biol Phys 1989; 17:967-71. [PMID: 2808058 DOI: 10.1016/0360-3016(89)90143-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
This report comprises 149 patients with carcinoma of the maxillary sinus treated with radical surgery and postoperative radiotherapy (5500 to 6000 cGy in 6 weeks) between 1963 and 1980 at the Instituto Nacional de Enfermedades Neoplasicas of Lima. Permanent local control was observed in 67.1% of the cases with a 5-year actuarial survival of 36.2% and a corrected survival for death not due to cancer of 42.3%. The ultimate local and distant failures were 61%. Data were analyzed regarding stage of the disease, radiotherapeutic technique and its influence on local control, complications, and patterns of relapse. The data indicate that the stage of the tumor influences survival. Because of the natural history of this disease, local control is paramount.
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MESH Headings
- Adenocarcinoma/mortality
- Adenocarcinoma/pathology
- Adenocarcinoma/radiotherapy
- Adenocarcinoma/surgery
- Adult
- Aged
- Aged, 80 and over
- Carcinoma/mortality
- Carcinoma/pathology
- Carcinoma/radiotherapy
- Carcinoma/surgery
- Carcinoma, Squamous Cell/mortality
- Carcinoma, Squamous Cell/pathology
- Carcinoma, Squamous Cell/radiotherapy
- Carcinoma, Squamous Cell/surgery
- Carcinoma, Transitional Cell/mortality
- Carcinoma, Transitional Cell/pathology
- Carcinoma, Transitional Cell/radiotherapy
- Carcinoma, Transitional Cell/surgery
- Cause of Death
- Combined Modality Therapy
- Female
- Humans
- Lymphatic Metastasis
- Male
- Maxillary Sinus Neoplasms/mortality
- Maxillary Sinus Neoplasms/pathology
- Maxillary Sinus Neoplasms/radiotherapy
- Maxillary Sinus Neoplasms/surgery
- Middle Aged
- Neoplasm Recurrence, Local
- Neoplasm Staging
- Paranasal Sinus Neoplasms/radiotherapy
- Postoperative Period
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Affiliation(s)
- M Zaharia
- Department of Radiotherapy, Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru
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Abstract
A retrospective study of 484 patients with locally advanced cancer of the breast treated with irradiation alone revealed a partial or complete response in 64% of the patients, with a mean duration of 13 months. The 5-year survival was 21.9% for the entire group of patients; 32% for patients responding, and 5% for non-responding patients. The data suggests that the size of the tumor and the age of the patients influence the quality of response. The results indicate that radiotherapy adequately controls local disease in a significant number of patients but systemic treatment is needed for better disease control.
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