In Regard to Gajjar et al
2018; Elsevier BV; Volume: 102; Issue: 5 Linguagem: Inglês
10.1016/j.ijrobp.2018.08.044
ISSN1879-355X
AutoresNicolas Leduc, Patrick Escarmant, Vincent Vinh‐Hung, Clarisse Joachim, Jacqueline Véronique-Baudin,
Tópico(s)Advances in Oncology and Radiotherapy
ResumoTo the Editor: We read with interest the report about the situation of radiation oncology in the Dominican Republic written by Gajjar et al ( 1 Gajjar S.R. Melton E.A. Castaneda S.A. et al. Assessment of the radiation therapy model in the Dominican Republic and its impact on the Caribbean Islands. Int J Radiat Oncol Biol Phys. 2018; 101: 503-509 Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar ). We share their concern about the current lack of proficient radiation oncology wards in low-income countries all across the Caribbean archipelago. Population is scattered in a number of small islands and almost as many countries that fail to muster the necessary resources to develop technologically advanced medical expertise. However, some islands—a legacy of a complicated history—remain the dominion of European nations and harbor state-of-the-art radiation oncology wards. In this regard, data used in Table 3 seem severely outdated. Martinique and Guadeloupe (which are not even mentioned in Table 3) are 2 French islands with 400,000 to 500,000 inhabitants each. Both islands harbor university hospitals, including radiation oncology wards. For instance, our department routinely delivers intensity modulated radiation therapy/volumetric modulated arc therapy–based treatment and stereotactic body radiation therapy with linear accelerator, Tomotherapy, and Novalis/Truebeam equipment. Currently, 80% of our patients are treated with intensity modulated, volumetric, image guided radiation therapy—100 patients daily. Brachytherapy for prostate cancer is also available ( 2 Atallah V. Leduc N. Creoff M. et al. Curative brachytherapy for prostate cancer in African-Caribbean patients: A retrospective analysis of 370 consecutive cases. Brachytherapy. 2017; 16: 342-347 Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar ). Moreover, our universal health care system allows our patients to get access to all drugs available to French patients. We regularly participate in clinical trials and publish treatment results in Afro-Caribbean populations ( 3 Escarmant P. Zimmermann S. Amar A. et al. The treatment of 783 keloid scars by iridium 192 interstitial irradiation after surgical excision. Int J Radiat Oncol Biol Phys. 1993; 26: 245-251 Abstract Full Text PDF PubMed Scopus (114) Google Scholar , 4 Leduc N. Ahomadegbe C. Agossou M. et al. Incidence of lung adenocarcinoma biomarker in a Caribbean and African Caribbean population. J Thorac Oncol. 2016; 11: 769-773 Abstract Full Text Full Text PDF PubMed Scopus (10) Google Scholar ). Most importantly, several agreements with neighboring English-speaking islands, such as Saint Lucia and Dominica, allow insured patients to consult our physicians and be treated in Martinique with specific housing conditions. Extraterritorial missions for consulting oncologists are organized on a regular basis in Saint Lucia. Patients from the French area of Saint Martin island are referred to Guadeloupe, and patients from the Dutch counterpart are usually treated in Curaçao. Our position as physicians referring to French and European guidelines and quality standards is unique in this area, and the confrontation with the US standards followed in Puerto Rico and the Dominican Republic is always fruitful. Declaring the Dominican Republic to be the only country providing advanced radiation therapy in the Caribbean may be an overstatement. Assessment of the Radiation Therapy Model in the Dominican Republic and Its Impact on the Caribbean IslandsInternational Journal of Radiation Oncology, Biology, PhysicsVol. 101Issue 3PreviewThe Dominican Republic (DR) is an upper-middle-income country that has taken several strides to address cancer care at the national level (1). The International Atomic Energy Agency (IAEA) performed an analysis of the radiation therapy resources in 2004 and noted 3 radiation therapy centers with deficiencies in equipment as there were only 3 cobalt (60Co) teletherapy units and 1 linear accelerator (2). Afterward, an effort was undertaken to characterize the resources available for cancer care by the Fundación Plenitud, though only the resources of 2 radiation therapy centers were analyzed (3). Full-Text PDF In Reply to Leduc et alInternational Journal of Radiation Oncology, Biology, PhysicsVol. 102Issue 5PreviewTo the Editor: We appreciate the thoughtful comments on our article, “Assessment of the Radiation Therapy Model in the Dominican Republic and Its Impact on the Caribbean Islands”(1-3). The successful development of radiation oncology programs in Martinique and Guadeloupe appear to have many similarities with the development of radiation oncology programs in the Dominican Republic. We acknowledge that radiation therapy resources are constantly in flux and are influenced by many different factors, including healthcare schemas, economic changes, and sociopolitical influences. Full-Text PDF
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