Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India.
Department of Radiation Oncology, Apollo Proton Cancer Center, Chennai, India.
JCO Glob Oncol. 2024 Nov;10:e2400410. doi: 10.1200/GO-24-00410. Epub 2024 Nov 21.
The information on the practice of radiotherapy, including intensity-modulated radiotherapy (IMRT) use for rectal cancer in India, is lacking. This national survey was planned to understand the current status of knowledge, attitudes, and practice among radiation oncologists, specifically concerning the practice of IMRT for rectal cancers.
A national survey was sent to radiation oncologists through e-mail or a WhatsApp message, where feasible, with a request letter containing the link to the survey questionnaire. The survey questionnaire was adapted from the UK IMRT survey with permission from the authors. It explored rectal cancer management, IMRT use, reasons for nonadoption, total neoadjuvant therapy (TNT), dose fractionation schedules and radiotherapy processes like radiotherapy simulation, target volume/organ at risk definition, and treatment planning, evaluation, and verification. Descriptive statistics is used to present the results.
Over 300 radiation oncologists were approached, and 182 (60.6%) of the 153 institutes responded. Around 88% (160 of 182) indicated using IMRT or volumetric modulated arc therapy (VMAT) to treat rectal cancer, of whom 32% used exclusively IMRT/VMAT in all their patients. The reasons for not adopting IMRT were affordability/lack of insurance, resource constraints, and lack of guidelines. Long-course chemoradiation (capecitabine-based) followed by surgery was the most common neoadjuvant approach, with short course and TNT in less than a third of patients. Daily verification feasibility was reported by 60%. Seventy-three percent emphasized the need for a national IMRT guidance document.
This national survey from India indicates a scope of routine implementation of IMRT in rectal cancer, highlighting the urgent need for a national IMRT guidance document, which could significantly enhance the quality of care for patients with rectal cancer in India.
印度有关放疗实践的信息，包括直肠癌调强放疗（IMRT）的使用情况，尚不清楚。本项全国性调查旨在了解放疗医师在直肠癌方面的知识、态度和实践现状，特别是 IMRT 的应用情况。
通过电子邮件或 WhatsApp 消息向放疗医师发送全国性调查，在可行的情况下，随附一封附有调查问卷链接的请求信。调查问卷改编自英国的 IMRT 调查，并经作者许可使用。它探讨了直肠癌的管理、IMRT 的使用、不采用的原因、全直肠新辅助治疗（TNT）、剂量分割方案以及放疗模拟、靶区/危及器官定义和治疗计划的评估和验证等。结果以描述性统计数据呈现。
共向 300 多名放疗医师发出邀请，其中 153 家机构中的 182 家（60.6%）做出了回应。约 88%（160/182）的受访者表示使用 IMRT 或容积旋转调强放疗（VMAT）治疗直肠癌，其中 32%的患者完全采用 IMRT/VMAT 治疗。不采用 IMRT 的原因包括费用/缺乏保险、资源限制和缺乏指南。长程放化疗（卡培他滨为基础）后手术是最常见的新辅助治疗方法，短程和 TNT 不到三分之一的患者采用。60%的受访者报告了每日验证的可行性。73%的受访者强调需要制定国家 IMRT 指导文件。
印度的这项全国性调查表明，IMRT 在直肠癌中的常规应用范围较广，突出了制定国家 IMRT 指导文件的迫切需要，这将显著提高印度直肠癌患者的护理质量。
