title: Patterns of practice in palliative radiotherapy in Africa - case revisited.
abstract: OBJECTIVE
  To investigate patterns of practice in palliative radiotherapy in Africa.
  
  
  METHODS
  Fifteen centres in Africa provided detailed information about radiotherapy in both metastatic and locally advanced disease via a questionnaire. Information included general information (institution status, equipment, staff, patient number), radiotherapy and other treatment characteristics in bone metastasis, brain metastasis, metastatic spinal cord compression, lung and liver metastasis, as well as locally advanced tumours.
  
  
  RESULTS
  The number of patients annually seen/treated ranged from 285 to 5000. Breast, cervix, head and neck, gastrointestinal and prostate cancer were the top five cancers overall. Eight (53%) institutions were without linear accelerators, four (27%) had a single one, whereas one institution each had two, three and four linear accelerators. The number of cobalt machines ranged from 0 to 2 (median 1). Most centres still prefer to use fractionated radiotherapy regimens over single-fraction regimens in bone metastasis, although most centres are now using single-fraction radiotherapy in retreatments. Radiotherapy in brain metastasis and metastatic spinal cord compression mostly conform to worldwide standards. Lung and liver metastases are rarely irradiated, largely as a consequence of the lack of modern radiotherapy technology. Locally advanced disease in various tumour sites was mostly palliated, in agreement with current evidence-based practices.
  
  
  CONCLUSIONS
  African countries still lack adequate staffing and equipment to adequately address their clinical burden, being palliative in most cases. Emphasis should also be made on more rationally using existing capacities by using more of the single-fraction radiotherapy regimens, especially in bone metastasis.
authors.affiliation: Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa. Electronic address: bjeremic@sun.ac.za.
authors.forename: B
authors.initials: B
authors.lastname: Jeremic
authors.affiliation: National Center for Radiotherapy, Accra, Ghana.
authors.forename: V
authors.initials: V
authors.lastname: Vanderpuye
authors.affiliation: Ain Shams University, Cairo, Egypt.
authors.forename: S
authors.initials: S
authors.lastname: Abdel-Wahab
authors.affiliation: Institut de Curie, Dakar, Senegal.
authors.forename: P
authors.initials: P
authors.lastname: Gaye
authors.affiliation: Salah Aziz Institute of Cancer, Tunis, Tunisia.
authors.forename: L
authors.initials: L
authors.lastname: Kochbati
authors.affiliation: Ocean Road Cancer Institute, Dar es Sala'am, Tanzania.
authors.forename: M
authors.initials: M
authors.lastname: Diwani
authors.affiliation: Windhoek Central Hospital, Windhoek, Namibia.
authors.forename: P
authors.initials: P
authors.lastname: Emwula
authors.affiliation: Radiotherapy Centre, Parirenyatwa Group of Hospitals, Harare, Zimbabwe.
authors.forename: B
authors.initials: B
authors.lastname: Oro
authors.affiliation: Cancer Diseases Hospital, Lusaka, Zambia.
authors.forename: K
authors.initials: K
authors.lastname: Lishimpi
authors.affiliation: Mulago Hospital, Makerere University, Kampala, Uganda.
authors.forename: J
authors.initials: J
authors.lastname: Kigula-Mugambe
authors.affiliation: A B University Teaching Hospital, Zaria, Nigeria.
authors.forename: D
authors.initials: D
authors.lastname: Dawotola
authors.affiliation: Addis Ababa University, Addis Ababa, Ethiopia.
authors.forename: T
authors.initials: T
authors.lastname: Wondemagegnehu
authors.affiliation: Kenyatta National Hospital, Nairobi, Kenya.
authors.forename: C
authors.initials: C
authors.lastname: Nyongesa
authors.affiliation: Centre National d'Oncologie, Mauritania.
authors.forename: N
authors.initials: N
authors.lastname: Oumar
authors.affiliation: Mohammed VI University Hospital, Marrakech, Morocco.
authors.forename: A
authors.initials: A
authors.lastname: El-Omrani
authors.affiliation: National Cancer Institute, Cairo, Egypt.
authors.forename: T
authors.initials: T
authors.lastname: Shuman
authors.affiliation: Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa.
authors.forename: L
authors.initials: L
authors.lastname: Langenhoven
authors.affiliation: Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa.
authors.forename: L
authors.initials: L
authors.lastname: Fourie
mesh_terms: D000349:Africa; D003906:Developing Countries; D019583:Dose Fractionation, Radiation; D005260:Female; D006801:Humans; D008297:Male; D009362:Neoplasm Metastasis / Q000532:radiotherapy*; D009369:Neoplasms / Q000532:radiotherapy*; D010166:Palliative Care / Q000379:methods / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires
keywords: Africa; developing countries; locally advanced disease; metastatic disease; palliation; radiotherapy