2125 - Does the Implementation of Last Generation Radiation Therapy Equipments Impact in the Interval between the First Clinical Visit to the First Treatment Fraction in a Public Health Scenario?

J. Regis Neto¹, T. Y. T. De Souza², and M. A. Regis³; ¹Assistential Foundation from Paraiba, Campina Grande, Brazil, ²McGill University Health Centre, Montreal, QC, Canada, ³Sao Paulo University, Sao Paulo, Brazil

Purpose/Objective(s): Waiting times for radiation therapy (RT) should be as short as reasonably achievable for great majorities of cancer cases, as demonstrated by many trials how it may impact negatively in relapses rates or even in the patients psychological effects. Unfortunately, the Brazilian public health system remains with a great deficit of Linear Accelerators (LINACs), leading to substantial waiting times for the beginning of RT. State of art equipments, which can perform advanced techniques of RT are even more scarce. We assessed if the implementation of a state of art LINAC in a Brazilian public health facility impacts the waiting time between the first clinical visit to the first fraction of RT treatment. Materials/

Methods: Data from prostate cancer (PCa) patients before and after the implementation of a LINAC with Intensity modulated Radiation Therapy (IMRT) and Image guided Radiation Therapy (IGRT) technology in a public health RT facility in Brazil was collected. Time intervals from the first clinical visit to the first fraction of RT were calculated assessing institutional clinical records from a same frametime of sequential years. All the clinical protocols remained inalterable in terms of number of fractions by cancer site/stage for the analyzed period, except the prostate cancer protocol, in which moderated hypofractionated regimen was adopted to the vast majority of cases.There was also no changes in the numbers of RT technicians team or in the LINACs operation shifts. Moreover, comparison was performed including all PCa patients, not only the ones who received hypofractionated treatments.
Results: A total of 155 PCa patients, mean age 71,8 years old were included in the analysis. For the 83 patients treated before the IMRT/IGRT adoption, the meantime from the first clinical visit to the first RT fraction was 87,1 days. For the 72 patients treated after the upgrade, 74% of whom received hypofractionated treatments, the mean interval was 35,9 days, leading to a statistically significant mean reduction of nearly 50 days ( 57% ) ( P <0,001).Similar rates of acute toxicity were demonstrated in both groups, leading to no statistically significant difference of interruption rates during the RT.
Conclusion: The implementation of state of art equipment and, consequently, more advanced RT treatments may provide a significant shortage of the interval between the first clinical visit to the first RT fraction in a public health scenario, congregating clinical and cost-effectiveness advantages.