Mulago's new brachy therapy system improves cancer treatment

Uganda Cancer Institute in Kampala has improved treatment processes and shortened treatment time for cancer patients with the installation of an advanced new Flexitron® Cobalt-60 High Dose Rate brachy therapy system from Elekta.

The new system, installed as part of the hospital's two-year, US$49 million renovation, will allow oncology staff at the hospital to significantly shorten treatment times and treat more patients.

Brachytherapy, or internal radiotherapy, is commonly used to treat cervical, prostate, bladder, breast and skin cancer through the temporary or permanent placement of a short range radiation source close to the tumor inside the body, positioning the radioactive pellet through a technique known as afterloading.

Afterloading may be done manually by an operator, or remotely, using a controlled delivery treatment plan.

Flexitron's advanced remote afterloading platform helps the clinical team work safely and efficiently and ensures accuracy in treatment delivery, reducing the possibility of human error. Typically brachytherapy is associated with low toxicity rates and a favourable side effect profile.

Brachytherapy improves clinical outcomes by combining a boost with external beam radiation therapy,1, 2, 3, 4 and can also be effective as a monotherapy modality.5

Mulago Hospital, the largest hospital in Uganda and site of Uganda's only Cancer Institute and radiotherapy Department, had been using an ageing Low Dose Rate caesium afterloader model, which required up to 10-14hours per treatment to deliver 20-30 Gyand meant only one patient per day could be treated.

In a nation of over 40 million people, where cancer rates are on the increase, faster, more accurate treatment modalities are considered important factors.

Elekta's Flexitron brachytherapy system with Oncentra®Brachy allows for faster, more accurate treatment delivery and dose distribution.

"After the staff being trained at the beginning of March, the treatments of the first two patients with Flexitron were completed in only five hours - a significant improvement in treatment time," says Elekta application specialist Jeroen Singelenberg.

"In addition, the new system enables far more accurate dose distribution, with minimal impact on healthy tissue."

Dr. Kavuma Awusi, a medical physicist at the Uganda Cancer Institute comments: "By the second week after initiation, we were treating an average of five cervical patients per day. Cervical cancer is the most common cancer, accounting for 40% of the nearly 2000 new cancer patients seen in our department per year. The new unit will reduce their brachytherapy waiting time and improve both treatment response and survival rates."

While Elekta's Flexitron brachytherapy system typically uses advanced imaging to assist in treatment planning and dose placement, the Uganda Cancer Institute faced a challenge because it has no suitable imaging systems. "Due to budget constraints, the hospital currently has no MRI and CT scanners or a working radiotherapy simulator. Without imaging capabilities, there was a risk of delivering incorrect treatment, so our team created a solution using standardized plans for each applicator, which they use in conjunction with their fluoroscopy C-arm, to deliver accurate treatment," says Singelenberg.  

He says providing full support and a full solution such as this is very typical for Elekta: "As a company, we always strive to help and guide our customers in the best possible way. We have an obligation to ensure that when they buy our equipment that they can work with it. Here, we had to devise a solution to overcome a major challenge the hospital had."

The solution is proving successful, with the number of patients being treated in the brachytherapy unit increasing steadily.

Elekta's managing director, Erik Leksell, said: "Cancer is becoming a great challenge for Africa and I am pleased that Mulago Hospital has chosen our Flexitron brachytherapy solution.

Radiotherapy and especially brachytherapy is by far the most cost-effective option and fundamental pillar for both curative and palliative cancer care.

We are committed to support the clinicians at Mulago Hospital so they can provide the best clinical care going forward."