Complete haematological response to Imatinib in chronic myeloid leukaemia patients attending the Ocean Road Cancer Institute in Tanzania

Background: There is limited information on clinical characteristics, diagnosis and response to therapy of patients with chronic myeloid leukaemia (CML) in Tanzania. This hospital-based retrospective and cross-sectional study was conducted to describe the clinical and laboratory characteristics, time to diagnosis and response to first line therapy with imatinib in Philadelphia chromosome positive CML.Methods: The study was conducted at the Ocean Road Cancer Institute in Dar es Salaam, Tanzania. Participants were sequentially recruited from the outpatient clinic where a structured questionnaire was employed seeking details socio-clinical features of the disease. Haematology indices at baseline and at three months of treatment was obtained from patient’s medical records. Haematological response was determined at three months of imatinib use using leukaemia net definition.Results: Of 127 study participants, 63% were males. The mean (±standard deviation) age at diagnosis was 40 (±16) years, majority being in the third decade of life. Abdominal distention (88%) and symptoms of anaemia (84%) were the most frequent complaints. Splenomegaly (92%) and pallor (82.7%) were the common physical findings. The mean duration from consultation to diagnosis was 3(±0) weeks and mean duration from diagnosis to imatinib therapy initiation was 3 (±0.9) weeks. A total of 116 (91.3%) of patients had complete haematological response to imatinib therapy three months after therapy. There was significant decline in total white blood cell counts, basophils count, platelets and increase in haemoglobin at three months after imatinib therapy initiation.Conclusion: Majority of patients were young with clinical and laboratory findings of severe disease. Patients presented late to hospital and there was a considerable long time to reach a final diagnosis and yet haematological response was still achieved in majority of these patients with imatinib therapy. The elucidated clinical and laboratory findings should advocate early CML diagnosis and immediate referral to a tertiary hospital

Clinician’s awareness and knowledge on the management of differentiated thyroid cancer and the use of radioactive iodine in Tanzania

Introduction: Thyroid cancer is the most common endocrine malignancy worldwide with better outcome if timely and properly managed. Surgery followed by radioactive iodine (RAI) ablation remains the mainstay in the management of differentiated thyroid cancer (DTC). In Tanzania however, few patients with DTC receive RAI ablation post-surgery, and most of these present late, with advanced disease resulting in poor treatment outcome. The objective of this study was to determine the course for late referral by assessing clinician’s awareness and knowledge on the management of DTC and the use of RAI in Tanzania.Methods: This descriptive cross sectional study was carried out in referral hospitals in Tanzania. Data collection used a standardized self-administered questionnaire. Information sought included awareness, knowledge and practices of clinicians on the management and the use of RAI on patients with DTC was explored.Results: Majority of clinicians managing DTC patients were males (86%), in-training surgeons (54%), and attended less than ten DTC patients per year (62%). About 44% of in-training surgeons never heard of nuclear medicine (p=0.04), and 20% were not aware of the role of RAI in the management of DTC (p=0.031). Only 7.3% of surgeons were aware of the role of thyroxine therapy, or RAI ablation post-surgery. Of all DTC patients managed surgically, only 16% had total thyroidectomy with lymphadenectomy (p=0.05).Conclusion: The findings of this study indicate there is insufficient knowledge on proper management and use of RAI on patients with DTC among clinicians in Tanzania

Comparison of Prescribed from Delivered Dose to Cancer of Cervix Patients Treated by Theratron Equinox 80 cm Source-to-Axis Distance (SAD) Technique at Ocean Road Cancer Institute in Tanzania

The aim of the present study was to investigate deviations between prescribed from delivered dose for cervical cancer patients treated at Ocean Road Cancer Institute using Equinox 80 Tele-cobalt machine. In this work, anterior-posterior (AP) and posterior anterior (PA) fields using Source-to-Axis Distance (SAD) technique was used. Measurements of entrance doses were taken using calibrated diode detector in three groups of patients. In group 1, only 15 patients out of 31 curative intent patients received doses lower than ± 5% of 2 Gy as compared to the prescribed dose. In group 2, 1 measurement was done for 9 patients who received palliative single dose of 10 Gy and 2 patients out of 9 received doses within the range of ± 5% of the prescribed dose. In group 3, 1 daily measurement was done for 12 patients who were prescribed a curative dose of 50 Gy in 25 fractions. The maximum observed deviation was + 25.08%, while that of minimum was – 0.59%. Since significant deviations between prescribed and delivered doses exist, there is a need to conduct another study using both patient and machine related factors to refine the problem of high dose deviations among the patients. Keywords: Tele-cobalt machine; in-vivo dosimetry; measured and delivered dose; cervical cancer; diode detecto

Advantages of 3D-CT Based Conformal Radiotherapy Treatment Planning Over 2D Conventional Tera Six Planning for Cervical Cancer Treatment at Ocean Road Cancer Institute

Although External Beam Radiation Therapy (EBRT) is essential tool for the radiation therapy of cervical cancer; only one cancer institute in Tanzania performs 3-Dimensional Conformal Radiation Therapy (3DCRT) Computed Tomography (CT)-based planning. To identify benefits and advantages of 3D-CRT over 2D- conventional radiation therapy (2D-CRT), dosimetric parameters for tumor targets and organs at risk (OARs) were compared between these modalities for 23 cervical cancer patients. 11 cervical cancer patients were CT scanned after proper positioning and immobilization and transferred to Eclipse Treatment Planning System (TPS) for dose planning. The remaining 12 curative intent patients were planned using 2D-CRT system and treatment times were calculated for each patient. From the CT based planning, the minimum dose (D min), maximum dose (D max) and mean dose (D mean) to Planning Target Volume (PTV) and organs at risk (OAR), were compared for each plan. On average, the optimized maximum doses for bladder, rectum, femoral heads, PTV and Gross Tumor Volume (GTV) were 46.56 Gy, 42.65 Gy, 28.76 Gy, 48.56 Gy and 48.53 Gy. For 2D-concentional planning, the dose rate was 75.75 cGy/min and the average treatment time was 1.6075 minutes. This study confirms that 3D CT-based planning is a good choice in the treatment protocol for carcinoma cervix as it delivered a highly homogeneous and conformal plan with superior dose coverage to PTV and better OARs sparing

A consensual approach to domain-partitioning of a cancer data sample space : lessons from Tanzania

Interest in the patterns and predictability of various types of cancer has been steadily growing over the years (e.g. Steliarova-Foucher et al. 2004). However, comparative studies on geo-ethnic grounds (particularly Africa-specific) have been quite limited. Further, the influence of commonly known predisposing factors on various types of cancer has mainly been studied using conventional statistical analysis approaches which, typically, make assumptions about the underlying data distributions. We critically examine the common methods used in studying cancer predisposing factors and propose a novel triangular approach to detecting patterns in data samples. Three samples of cervix cancer, conjunctival cancer and Kaposi's sarcoma, collected from various regions in the United Republic of Tanzania, are subjected to techniques for graphical visualisation (GDV), association rules (AR) and dimensional reduction (DR). We uncover interesting patterns in the distribution of the three cancer types hinging on Tanzania's basic cultural attributes and geographical diversity. The results are analysed in a multi-disciplinary context - presenting an unprecedented approach to addressing cancer-related research issues. Our findings show that the triangular approach is capable of uncovering subtle cultural-driven relationships among data attributes. The findings present a rigorous basis for assessing and evaluating the impact of predisposing factors on the three types of cancer hence providing some useful guidelines into informed intervention, prevention and treatment of the diseases. On the basis of the results from the analysis, the paper makes recommendations as to how to structure future cancer studies in areas of similar geo-ethnic features. The triangular approach to extracting knowledge from data provides good insights into avoiding knowledge masking effects and highlights the need for formulating and designing a prototype model for updatable cancer-related data sources and storages aimed at connecting cancer registries across the African continent and beyond

Hospital Based Cancer Statistics as an Initial Step towards Establishment of Effective Cancer Intervention in Tanzania

There is an increasing public awareness that cancer in terms of increasing incidence rates and low curability become a serious problem in Tanzania. Due to limited human and physical resources in Tanzania, cancer interventions that address high incidences, curability and socio-economic impact must be given top priority. This information is often obtained in Population Based Cancer Registry (PBCR) which is not only lacking in Tanzania but its production requires relatively long period of follow-up and high cost of registration. Since establishment of effective cancer intervention is urgent, the desired information needed to accord this priority has been obtained from Hospital Based Cancer Statistics at Ocean Road Cancer Institute (ORCI). From this study, it was found that interventions of cancer of the cervix, breast, kaposi sarcoma, esophageal and head and neck has to be given high priority. It was also observed that treatment outcome for cervical cancer patients of all stages ranged between 34.2 % and 39.1% in the year 2010 and 2015 respectively. Using incidence, curability and socio-economic indices, the cancer type which require effective intervention are cancer of the cervix, breast and kaposi sarcoma. Implicitly, in the low cure rate of each detected cervical cancer in Tanzania compared to high cure rate reported in developed countries, early detection interventions and dose delivery accuracy should be improved

Verification of Depth Dose Curves Derived on Beeswax, Paraffin and Water Phantoms Using FLUKA Monte Carlo Code

This study aimed on the investigation of depth dose curves from beeswax, water and paraffinphantoms using FLUKA Monte Carlo code. In order to test the validity of FLUKA code,computational values of depth doses in water, beeswax and paraffin have been obtained using thiscode. The relative average coefficient of variation of percentage depth dose was observed to beless than 0.38% between beeswax and water, below 0.2% between water and paraffin and 0.98%between beeswax and British Journal of Radiology supplement 25 data. The deviations ofpercentage depth doses within the beeswax phantom material were also calculated and it wasconcluded that, among the treatment fields, the average coefficient of variation was about 0.74%for 7 × 7 cm2 and 1.23% for 20 × 20 cm2. The minor deviation in percentage depth dose obtainedin this work demonstrates that beeswax phantom has a potential to provide a better alternativematerial for dose calculations, and hence can be used as substitute material for in-vivo dosimetry inexternal beam radiation therapy using Theratron Equinox 80 Cobalt-60 unit. Keywords: FLUKA; Monte Carlo code; beeswax; percentage depth dose; phantom

Radiation therapists' perceptions of thermoplastic mask use for head and neck cancer patients undergoing radiotherapy at Ocean Road Cancer Institute in Tanzania: A qualitative study.

IntroductionA thermoplastic mask is the most widely used immobilization device for head and neck cancer patients undergoing radiotherapy. The radiation therapist is the staff responsible to prepare these masks and set-up the patients for treatment, a procedure that requires time, patience, and precision. An understanding of Radiation therapists' perceptions regarding thermoplastic mask use will help design interventions to address challenges encountered in its use. This study explored Radiation therapists' perceptions of thermoplastic mask use for head and neck cancer patients undergoing radiotherapy at Ocean Road Cancer Institute in Tanzania.Material and methodsAn exploratory qualitative study design was used to explore thermoplastic mask use for head and neck cancer patients undergoing radiotherapy. Semi-structured in-depth interviews were conducted, involving fifteen Radiation therapists from Ocean Road Cancer Institute in Tanzania between March and May 2021. A thematic analysis method was used to identify themes from data scripts.ResultsFour themes emerged that reflected radiation therapists' perceptions of thermoplastic mask use for head and neck cancer immobilization among patients undergoing radiotherapy. Emerged themes were (1) Perceived benefits and limitations of thermoplastic mask use, (2) Refresher training and supervision requirements for effective use, (3) Proper storage for quality maintenance, and (4) Increased financial support and proper budgeting.ConclusionParticipants perceived better patient immobilization with a thermoplastic mask use. However, too often recycling of thermoplastic masks and the long waiting time between thermoplastic mask preparation and treatment delivery limits their effective use. For efficient use of thermoplastic masks, there is a need for Radiation therapists' refresher training and proper supervision, improving the storage system and increasing financial support for procuring new thermoplastic masks

Radiation therapists’ perceptions of thermoplastic mask use for head and neck cancer patients undergoing radiotherapy at Ocean Road Cancer Institute in Tanzania: A qualitative study

Introduction A thermoplastic mask is the most widely used immobilization device for head and neck cancer patients undergoing radiotherapy. The radiation therapist is the staff responsible to prepare these masks and set-up the patients for treatment, a procedure that requires time, patience, and precision. An understanding of Radiation therapists’ perceptions regarding thermoplastic mask use will help design interventions to address challenges encountered in its use. This study explored Radiation therapists’ perceptions of thermoplastic mask use for head and neck cancer patients undergoing radiotherapy at Ocean Road Cancer Institute in Tanzania. Material and methods An exploratory qualitative study design was used to explore thermoplastic mask use for head and neck cancer patients undergoing radiotherapy. Semi-structured in-depth interviews were conducted, involving fifteen Radiation therapists from Ocean Road Cancer Institute in Tanzania between March and May 2021. A thematic analysis method was used to identify themes from data scripts. Results Four themes emerged that reflected radiation therapists’ perceptions of thermoplastic mask use for head and neck cancer immobilization among patients undergoing radiotherapy. Emerged themes were (1) Perceived benefits and limitations of thermoplastic mask use, (2) Refresher training and supervision requirements for effective use, (3) Proper storage for quality maintenance, and (4) Increased financial support and proper budgeting. Conclusion Participants perceived better patient immobilization with a thermoplastic mask use. However, too often recycling of thermoplastic masks and the long waiting time between thermoplastic mask preparation and treatment delivery limits their effective use. For efficient use of thermoplastic masks, there is a need for Radiation therapists’ refresher training and proper supervision, improving the storage system and increasing financial support for procuring new thermoplastic masks