title: Incidence of hospitalization in patients receiving short course palliative cranial radiotherapy on outpatient basis in a limited resource setting - Experience from a regional cancer center in India.
abstract: OBJECTIVE
  To investigate incidence of toxicity and related hospitalization among patients treated at our institute by a short course of palliative cranial radiotherapy against a longer, widely established schedule.
  
  
  BACKGROUND
  Shorter schedule palliative cranial radiotherapy is more convenient for patients and reduce waiting times. Although many studies have established safety of short schedules, the need for hospitalization due to acute treatment toxicity remains under-explored. Hospital admissions are an economic burden both for the patient and healthcare system in a limited resource setting. Delivery of treatment on an outpatient basis and within shorter times is preferred by patients, caregivers and healthcare staff.
  
  
  METHODS
  This was a prospective study on 68 patients treated with palliative whole brain radiotherapy between November 2010 and October 2012. One group received 20 Gy in 5 fractions over 1 week and the other group, 30 Gy in 10 fractions over 2 weeks. Treatment toxicity due to cranial radiotherapy was assessed as per RTOG acute and late toxicity criteria. Need for hospitalization owing to acute toxicity was also noted. Significant differences in the study parameters between the two groups were calculated by Fisher's t-test.
  
  
  RESULTS
  Requirement for hospital stay due to acute toxicity was not significantly different between the two groups. Patients in both groups experienced similar toxicity both during and after treatment.
  
  
  CONCLUSIONS
  The shorter course entailed no significant increase in toxicity related admissions, suitable for limited resource settings where patient transport is difficult, there are financial constraints, and the healthcare system is overburdened.
authors.affiliation: Dept. of Radiation Oncology, Chittaranjan National Cancer Institute, Kolkata, India.
authors.forename: Aparna
authors.initials: A
authors.lastname: Gangopadhyay
authors.affiliation: Dept. of Radiation Oncology, Chittaranjan National Cancer Institute, Kolkata, India.
authors.forename: Joydeep
authors.initials: J
authors.lastname: Das
authors.affiliation: Dept. of Medical Oncology, Chittaranjan National Cancer Institute, Kolkata, India.
authors.forename: Partha
authors.initials: P
authors.lastname: Nath
authors.affiliation: Dept. of Radiation Oncology, Chittaranjan National Cancer Institute, Kolkata, India.
authors.forename: Tapas
authors.initials: T
authors.lastname: Maji
authors.affiliation: Dept. of Medical Oncology, Chittaranjan National Cancer Institute, Kolkata, India.
authors.forename: Jaydip
authors.initials: J
authors.lastname: Biswas
keywords: In-hospital care for brain metastases; Palliative cranial radiation; Radiation toxicity and patient care