Starting the Stereotactic Radiosurgery Facility in Bangladesh: An Initial Experience

Abstract

Radiotherapy is an integral part of a well-defined cancer management program. Bangladesh is a fast-growing East Asian country with 161 million population, and approximately 2 lakh cancer patients are diagnosed newly ever year. Though there are several modern treatment facilities to deliver radiotherapy, only limited facilities were available to deliver stereotactic radiotherapy (SRS) programs for needy patients. Evercare Hospitals Dhaka has recently started SRS and stereotactic therapy (SRT) with a dedicated team of trained people. The hospital is equipped with modern linear accelerator capable of delivering high dose rate mode and micro multileaf collimators with 2.45-mm thickness at isocenter to deliver larger doses of radiation precisely. This paper summarizes patient selection criteria and workflow for the SRS/SRT treatment established, including patient preparation, image data acquisition, target and organ at risk delineation on CT (computed tomography) and MRI (magnetic resonance imaging) images, treatment planning process, and quality assurance. Each stage of the process is explained in detail, with specific emphasis on certain areas to achieve a higher degree of accuracy. This article also highlights the need for dedicated timeout procedures to be followed to avoid drastic errors in treatment delivery. We also summarized demographics data of patients treated in the first 6 months, including diagnosis, sizes of lesions, and dose fraction. The dosimetric and setup uncertainties encountered during SRS/SRT treatment delivery are also described. Though, initially, we faced challenges, SRS/SRT treatment was successfully implemented and more than 35 patients were treated, with appreciable clinical outcomes.