Introduction:

 

Radiotherapy plays a crucial role in the curative and palliative treatment of cancer. The state of the art radiotherapy department is technologically developed which is keeping the promise. The improvements can occur both in the delivery of treatment and cure.  

 

The department is most equipped radiation center in the country and thus, adding the excellence to the hospital. The team is highly efficient and dedicated. Everyday, 6-10 new patients are planned for external radiotherapy (Teletherapy); about the same number are replanned. Five to eight patients receive brachytherapy a day. Three Dimensional conformal radiotherapy (3D CRT) is the cutting edge technology at the department. About 20 new cases are treated by 3D CRT a month.

 

Delivering the radiation therapy:

 

Accurate localization of the target volume, i.e. the tumor and margin:

 

Varian Ximatron unit, an X-ray simulator, mimics all the movements of the treatment machine. The patients are simulated in this unit. Tumor localization and treatment planning is made. This unit is equipped with fluoroscopy. The portal imaging device provides data in real time so that the accuracy of alignment of each field used for radiation is ensured.

 

Effective patient immobilization:

 

Patient immobilization is an important aspect of successful treatment delivery in radiotherapy. This ensures the reproducibility of position both during planning and daily treatment.

 

Thermoplastic immobilizations are used for malignancies of brain, head and neck, thorax, pelvis, abdomen and breast. For immobilization, Vac-lock is also used. Theses immobilization devices have allowed more precise daily set-up reproducible. As the radiation portal marks are not made on skin surface, patients are having more comfort both cosmetically and hygienically.  

 

The department is also equipped with Sitting treatment chair to deliver radiation in sitting position for those patients who have difficulties in lying down.

 

The mould room is equipped with Styrofoam cutting machine for complex field designs like Mantle field radiation. Individualized cerrobend blocks are made for shielding purposes.

 

Correct delineation of the target volume:

 

The department has a state of the art computerized ECLIPSE treatment planning system (TPS). Digital Imaging and Communication in Medicine (DICOM) allows direct transfer of CT scan images from CT scan machine to the TPS. The treatment volumes and organs at risk are delineated from the CT scan image and the plan is computed. This assures accuracy in a multiple field arrangement for 3D CRT.

 

Delivery of the treatment:

 

Radiotherapy is usually delivered in 2 ways:-

 

Teletherapy – The Teletherapy machines of the department

 

·         One 2300 CD Linear accelerator with MLC, portal vision, Dual energy photon-6&20MV, various electron energies

·         One 600 CD Linear accelerator with 6MV photon energy

·         One Theratron Telecobalt unit

 

Brachytherapy – The brachytherapy is application of small sealed sources directly into the body either from within or from near the surface. Relatively high doses of radiation can be delivered by this method. We have one High Dose Rate (HDR) Varisource brachytherapy utilizing Iridium isotope as the radioactive source. These sources are stored in protected containers and move by remote control to propositioned applicators, a process called remote after loading. Intracavitory brachytherapy (for uterine cervical and endometrial cancers) is the most common service available here followed by intraluminal brachytherapy for esophageal cancers.

 

Dosimetry:

Absolute dose measurement is performed based on International Atomic Energy Agency (IAEA), TRS (Technical Report Series) 398 protocols. Wellhofer chambers, water phantom, 3D Blue phantom, solid phantom, electrometers, survey meters, HDR-Brachytherapy source measuring well chambers and dosimeters are available for dosimetry. All relevant chambers and dosimeters are calibrated from Secondary Standard Dosimetry Laboratory (SSDL) and Bhabha Atomic Research Centre (BARC), India. All staff in department use personnel monitoring TLD Badges.

 

Quality assurance:

Quality assurance refers to identifying the sources of error and preventing its occurrence and assuring that the machines and services are of high quality. Mechanical tests, machine's routine output checks, energy consistency, laser alignment, safety checks and survey are performed. IAEA / WHO postal dose quality audit for teletherapy beam are satisfactory. 

Services / activities offered by the Department:

 

Outpatient services – it is available on all working days from Sunday to Friday, three clinics: thoracic, gastro-intestinal, skin, & musculo-skeletal; head and neck, neurologic, & lymphoma / leukemia; gynecologic, genitor-urinary, & breast.

 

Computerized patient data system – cases are discussed in the department meeting, also in the joint clinic & tumor board as appropriate; local condition (of disease) and case report of all the patients are computerized and updated.

 

Radiotherapy and chemotherapy – patients are planned and offered therapy based on stage of the disease and the intent of treatment (curative / palliative) after taking consent from the patient / relatives.

 

Inpatient services – 16 bedded inpatient wing is available for the supportive / symptomatic care; investigations and work-up; and chemotherapy (anterior / concurrent / adjuvant).

 

Day care services – about 10 patients per day are served, mainly for short duration concurrent chemotherapy.

 

Academic activities – the department is affiliated with National Academy of Medical Sciences (NAMS) for conducting Post graduate training in MD Radiotherapy. Residents undergo extensive academic activities for one year (excluding two years at Bir Hospital) training here. The department is also affiliated with Tribhuvan University. Students of M Sc Physics conduct research activities in radiation physics. Besides, undergraduate and post graduate students from other academic institutions also attend the various training programs in the department.

 

Research activities – department encourages everyone for conducting research, writing scientific articles and participating oncologic conferences (& presenting papers). Department regularly organizes scientific sessions. A number of clinical studies are going on.

 

Visiting oncologists – department welcomes national and international oncologic faculties for sharing their experiences and skills.

 

Recreation – department believes in recreation for appetite, body and soul. Get together programs are enjoyed frequently for stronger bond among members of the department.

 

Future dedication – we are soon to offer Intensity Modulated RadioTherapy (IMRT) service at our department, human resources are being trained internationally.

 

 

Some of the recent activities:

 

Participation activities

 

·         Jha A K participated in RGCON-2010, 9^th International Conference, Rajib Gandhi Cancer Institute & Research Centre, Delhi, India

 

·         Jha A K, Acharya B, Karn A, Neupane P, Sharma S, Chaurasia PP, Chand SB, Adhikari MP  participated in Multidisciplinary Cancer Management Course & 2nd National Oncology Conference, Kathmandu and Bharatpur, Nepal, jointly organized by American Society of Clinical Oncology (ASCO), SAARC Federation of Oncology – Nepal (SFO-N)  & B P Koirala Memorial Cancer Hospital (BPKMCH), 5^th – 8^th March 2010

 

·         Karn A, Acharya B participated in 2nd Asian Breast Cancer Congress, Bangalore, India, 6^th – 7^th February 2010

 

·         Karn A, Acharya B, Bhandari RB, Neupane P, Sharma S participated in Workshop on Protocol Development for Central Nervous System (CNS) Tumors, Bharatpur, Nepal,  jointly organized by BPKMCH & WHO, 23^rd – 24^th October 2009

 

·         Karn A, Acharya B, Bhandari RB participated in RGCON-2009, 8^th International Conference, Rajib Gandhi Cancer Institute & Research Centre, Delhi, India, 27^th – 29^th March 2009

 

•  Jha AK, Acharya B participated in Association of Radiation Oncologists of India conference (AROICON), Mumbai, India, December 2008 
• karn A participated in Continuing Medical Education, SAARC Federation of Oncologists – Nepal. Kathmandu, Nepal, 26^th September 2008  
• Chand SB participated in Annual Scientific Meeting and attended Short term training in Medical Physics. Canadian Organization of Medical Physicists. Quebec, Toronto, and Ottawa, Canada, 25^th June – 11^th July 2008 
• Chand SB attended in ESTRO training course on Image–Guided Radiotherapy in Clinical Practice. International Organization for Medical Physics. Brussels, Belgium, 7^th December – 11^th December 2008

 

Publication activities

 

·         Karn A, Manandhar T, Jha AK. Effect of Radiotherapy and Concurrent Gemcitabine in Non-small cell Lung Cancer. PMJN 2009; 8: 8-12

 

·         Acharya B, Jha AK, Shrestha S, Karn A, Paudel S. Atypical Carcinoid Tumor of Larynx. PMJN 2009; 8: 123-126

·         Acharya B, Jha AK, Shrestha S, Karn A, Paudel S, Bhandari RB, Chaurasia PP. Orbital Rhabdomyosarcoma: Treatment modalities. PMJN 2009; 9: 44-48

 

·         Jha AK. Radiotherapy for benign disease. JNMA  2008; 47(171)

 

Paper Presentation activities

 

Chand SB. A Study on Dosimetry of Gynecological Cancer and Quality Assurance of HDR Brachytherapy in B P K M Cancer Hospital, Nepal. Asia Europe Physics Summit. Tsukuba, Japan. 24^th – 26^th March 2010

 

·         Karn A. Changes in the 7^th edition of TNM Classification for Lung Cancer: How and What?  Multidisciplinary Cancer Management Course & 2nd National Oncology Conference, Kathmandu and Bharatpur, Nepal, jointly organized by ASCO, SFO-N & BPKMCH, 5^th – 8^th March 2010

 

·         Chaurasia PP, Jha AK, Chand SB, Adhikari MP,  Pandey P. Quality Assurance (QA) in Linear Accelerators in B P Koirala Memorial Cancer Hospital (BPKMCH).  Multidisciplinary Cancer Management Course & 2nd National Oncology Conference, Kathmandu, Nepal, jointly organized by ASCO, SFO-N & BPKMCH, 5^th – 8^th March 2010

 

·         Chand SB,  Jha AK, Chaurasia PP, Adhikari MP, Shrestha S. A study on Dosimetry of Gynaecological Cancer and Quality Assurrance of HDR Brachytherapy in BPKMCH, Nepal. Multidisciplinary Cancer Management Course & 2nd National Oncology Conference, Kathmandu, Nepal, jointly organized by ASCO, SFO-N & BPKMCH, 5^th – 8^th March 2010

 

·         Adhikari MP, Jha AK, Chaurasia PP, Chand SB, Shrestha S, Acharya B, Karn A, Poudel S, Bhandari RB, Sharma S, Neupane P. A study of variation of dose in Bladder and Rectum and its contributors in High Dose Rate (HDR) Intracavitary Brachytherapy. Multidisciplinary Cancer Management Course & 2nd National Oncology Conference, Kathmandu, Nepal, jointly organized by ASCO, SFO-N & BPKMCH, 5^th – 8^th March 2010

 

·         Jha AK. Radiotherapy in management of Carcinoma Cervix.  24^th All Nepal Medical Conference of Nepal Medical Association (ANEMECON). Kathmandu, Nepal. 15^th – 17^th April 2009

 

·         Chaurasia PP, Jha AK, Karn A, et al. The Status of Brachytherapy in B P Koirala Memorial Cancer Hospital, Bharatpur Nepal. 24^th All Nepal Medical Conference of Nepal Medical Association (ANEMECON). Kathmandu, Nepal. 15^th – 17^th April 2009

 

·         Adhikari MP. 3D Conformal radiotherapy, an approach to accurate treatment of Cancer. 24^th All Nepal Medical Conference of Nepal Medical Association (ANEMECON), Kathmandu, 15-17^th April 2009.

 

·         Chaurasia PP.  A scenario of Radiotherapy in BPKMCH, Bharatpur, Nepal. International conference on Medical Physics, Radiation Protection & Radiobiology. Jaipur, India.  11^th – 13^th February 2009

·         Chaurasia PP. Prostate cancer: 3D Conformal radiotherapy in BPKMCH. 4th NAST Conference, Kathmandu, 2008

 

·         Karn A. 3 Dimensional Conformal Radiotherapy in Lung Cancer: BPKMCH Experience. SAARC Federation of Oncologists – Nepal. Kathmandu, Nepal. 26^th September 2008

 

·         Karn A. Definitive Radiotherapy in Pediatric Pontine Glioma: A Case Presentation. Updates in Radiation Oncology in BPKMCH. Bharatpur, Nepal. 12^th – 13^th Sep 2008