Urgências em radioterapia: perfil de atendimentos no Instituto Nacional de Câncer

Abstract

Introduction: Emergencies in radiotherapy are a determinant approach to cancer patient care, there is no consensus on its optimal approach and therapeutic decisions remain subjective. Objectives: To perform an oncology care profile in radiotherapy emergency care in Radioncology department, at Brazilian National Cancer Institute (INCA). Methods: It was performed a retrospective survey during the years 2012 to 2016 considering number of urgent treatments; treated cancer site; total dose delivered, total treatment time, dose /fraction, beam energy used, field distribution and technique employed (2Dimension-2D x 3D-3D dimension), the days in which the treatments occurred. The data were accessed through an internal departmental datasheet from planning calculations of the Medical Physics section. Results: More than 13,600 patients were treated in our department during this period (2012-2016), with 2840 (20% of all treatments) classified as emergencies, which are the study sample. Approximately 2 daily emergency cases for treatment were sent on a weekday basis. Predominated treatments with 2D technique (88% -2516 cases) and higher fractionation than single doses (SD) in (63% -1890 cases). Metastases were the most frequent cause of treatments (34%-974 cases), in this order: cerebral and meningeal in 601 cases (21%), and bone in 361 (13%). The treated sites in decreasing frequency were: central nervous system (22,6%-643 cases); pulmonary (17,7%-504 cases), bone (15,4% - 440 cases), head and neck (13,9%-396 cases), gynecologic (5,9% - 170 cases), soft tissues (1,6% - 46 cases),breat (1,1% - 33 cases) and skin (less than 1% - 22 cases).The most frequently used dosage was 8Gy/SD (38.5%), followed by 30Gy/10fr (29.5%) and 20Gy/5fr (26.2%). The most frequently energy beam used was 1.25MV (68%). The treatments were more frequently referred in Mondays (24%) and Fridays ( 21%), corresponding to 45% of the treatments. Conclusion: Urgent treatments in radiotherapy are requent and respond to 1/5 of radiotherapy consultations in our department. Metastases are the major treatment causes, a fact possibly related to patients advanced stages. The treatment referral nearby weekends was more frequent. These situations can impact departmental management decisions and should be appreciated for a possible approach change.