1
RADIATION ONCOLOGY
GROOTE SCHUUR HOSPITAL & UNIVERSITY OF CAPE TOWN
AUDIT OF ACTIVITIES 2012
SUMMARY
New Patients
Follow up visits
Patient Chemotherapy Administrations
New Patients treated with external beam irradiation
Patient attendees for irradiation
Number of radiation fields
Patients planned for irradiation (computer plans)
Total Procedures in planning
Radio-active implants – largely for the eye
Gynaecological sealed radio-active procedures
Radioactive iodine administrations for cancer
Registrars qualified as specialists
Scientific Presentations
Scientific Publications
CONTENTS
A.
B.
C.
D.
E.
F.
G.
H.
VISION STATMENTS
KEY EVENTS
CLINICAL SERVICES
STAFF
TRAINING
ACADEMIC ACTIVITIES
PROFESSIONAL ORGANIZATIONAL ACTIVITIES
STRATEGIC PLAN FOR 2012
2011
2879
39879
7897
1478
18538
54184
2044
32361
65
419
32
4
22
6
2012
2922
36407
8071
1427
16388
55793
2173
30542
41
354
24
6
22
11
2
A. VISION AND VALUE STATEMENTS
To Care
Clinical Excellence
To serve patients with cancer
Academic Activities
To grow through training, and research
Relationships
To flourish as a community
Environment
To uplift us all
-
- -
Our Path to Care
Positive Assumption
About all people and what we can jointly achieve.
Accomplishments
Which reflect our aims and professionalism
Teamwork
That is built on openness, responsiveness and fidelity.
Higher Values
Which come from a sense of purpose and our common humanity
3
B. KEY EVENTS
1. Clinical Service
Radiation Oncology maintains an Oncology service to cancer patients in the
Western Cape. The service is organized around 23 multidisciplinary clinics.
The Department provided support for patients from the George region; a
Public Private Initiative was successfully introduced so that State patients in
the George region could receive their treatment in George, instead of having
to travel to Cape Town. Activities are reviewed by teleconference every 3
months.
One of the departments Linear accelerators was condemned in August 2012
and will be replaced by a sophisticated new unit in a refurbished bunker. The
therapy radiographers organized themselves into late night shifts to continue
to provide a service to patients. The number of radiation fields delivered and
new patients treated by radiation was maintained compared to 2011, largely
due to their efforts.
Departmental protocols (approximately 80), teaching programmes and
educational resources have been placed on-line on the UCT intranet.
An Electronic Patient Registry (EPR) is running which provides a synopsis of
all patients seen at the clinics. This currently has 60 000 records.
2. Academic Activities
The revised SA College of Radiation Oncology syllabus has been successfully
implemented. It is now a unified national exam. This places emphasis on the
candidates demonstrating their practical abilities through formalised case
reports and clinical audits.
The Department hosted a 5-day teaching course on behalf of the American
Society of Therapeutic Radiology and Oncology (ASTRO)at the University of
Cape Town. There were 6 USA Faculty members in attendance. The course
was fully subscribed. The course was also supported by the SA Society of
Clinical Radiation Oncology.
Dr. Alistair Hunter ran a weekend Radiobiology course with approximately 30
attendees from all parts of South Africa.
A Departmental Oncology Research Group was established to support
Departmental research and increase research output.
4
3. Relationships
A Strategic planning meeting was held in October 2011 with an outside
facilitator. The Strategic Plan for 2012 was determined as described in this
document.
An empowerment event for our patients, their caregivers and staff was hosted
at Groote Schuur Hospital. A multi-disciplinary team led by the Social
Workers initiated and planned this outstanding event. The primary focus was
to inform persons living with cancer of the resources available to them in the
community, thereby ensuring that they make informed decisions about their
care. The event was oversubscribed.
The support group for persons living with cancer meets twice a week. Many
of the patients report on how the group has successfully instilled hope in them
and also helped them to deal with news of poor prognosis. Relationships have
been established with CANSA and People Living with Cancer (PLWC).
4. Environment & Facilities
A new linear accelerator was installed at the end of 2012 and will be
commissioned in early 2013. At the same time, major new developments in
technology will be introduced in 2013.
The upgrading of the Department included: the creation of a Seminar Room
and Rehabilitation Centre in G7 and G8.
A liaison room for coordination of radiation treatment is planned for 2013.
5
C. CLINICAL SERVICES
1) Weekly Multidisciplinary Combined Oncology Clinics
Clinics
New Patients
Other Clinic Visits
Sarcoma
Melanoma
Lymphoma
Haematology
ENT
Head and Neck
Ocular Tumour
Skin
Kaposi Sarcoma
Miscellaneous LE32
Breast Clinic
Gynae
Neuro
Pituitary
Paediatric neurononcology
Paediatric oncology
Miscellaneous LE33
Bronchus
Urology
Thyroid
Thyrotoxicosis
Oesophagus
GIT
Unknown Primary
Miscellaneous LE34
Clinic includes Radiation Oncology +
other departments as in list below
Orthopaedics, General Surgery
Plastic Surgery
Haematology, Radiology, Pathology,
Haematopathology, Nuclear Medicine
Haematology, Radiology, Pathology,
Haematopathology, Nuclear Medicine
ENT Surgery, Radiology, Speech
Therapy, Dietetics
ENT Surgery, Plastic Surgery, Oral &
Dental Surgery, Radiology, Dietetics
Ophthalmology, Medical Physics
Plastic Surgery, Dermatology
Surgery, Plastic Surgery, Pathology,
Radiology
Gynaecological oncology & Pathology
Neurosurgery, Neuro-radiology,
pathology, Neurology
Neurosurgery, Endocrine
Paediatric oncology, paediatric
endocrine, paediatric neurosurgery
Coordinated at Red Cross Hospital
Respiratory Medicine, Radiology,
Thoracic Surgery
Urology, Radiology, Private Sector
General Surgery, Nuclear medicine,
Endocrinology, pathology
Thoracic surgery, dietician
Surgery, Radiology
-
2011
2012
2879*
2924
39879 36405
72
57
30
32
154
134
14
102
97
136
185
51
130
128
83
464
43
109
111
17
504
287
76
309
75
15
24
30
37
N/A
50
295
16
332
206
21
174
30
*
135
213
170
37
104
244
180
90
These figures are from Clinicom.
N/A = these patients are registered under Misc for Admin logistical reasons
6
2) Outpatient Clinics Attendances - E Floor
New Patients
2011
2012
Clinic Follow Ups
2011
Radiotherapy
Treatment checks
2011
2012
2012
LE 32
979
908
9089
9070
933
932
LE 33
823
862
16069
14256
1957
1716
LE 34
1077
1154
11368
10049
463
382
Total
2879
2924
36526
33375
3353
3030
3) Ward Statistics
Total beds = 41
No of pt.
Admissions
Discharges
Bed Occupancy*
WARD G7
2011
2012
6481
6264
998
913
921
818
86%
77.5%
WARD G8
2011
2012
5946
5939
873
974
758
878
80%
73.4%
* This includes as vacancy the weekends..
There is a Weekly Continuing Care Ward Round (CCWR) with involvement of
Occupational therapy, Dietetics, Social Work, nursing staff, St Luke’s Hospice,
Radiation Oncology and medical students. This is in addition to the Oncology care
rounds.
4) Radiotherapy Planning
2011
Total Patients
2023
New Patients
1524
Repeat Patients
466
Planning CT scans
446
Diagnostic CT
90
Simulated Patients
1683
No. Field Simulations
2927
Total Procedures*
32361
* Includes other procedures e.g. computer plans.
2012
2123
1608
515
519
78
1545
2723
30542
7
5) External Beam Radiotherapy Administration
New Patients /
Retreatments
Attendances
Fields
2011
2012
2011
2012
2011
2012
Linac.2
331
142
5399
1756
15728
4459
Linac.3
417
519
8355
10314
28341
42318
Theratron 2
11
258
45
1479
83
3084
Theratron 3
702
504
4601
2805
9735
5830
Med.
Voltage
17
4
138
34
297
102
1478
1427
18538
16388
54184
55793
-See
comment
TOTAL
Comments: Linac 2 - Condemned August 2012.
Linac 3 - Extended hours Jan – Dec 2012.
Ther 2 - Operational mid-August 2012 – Dec 2012.
Ther 3 - Operational Jan 2012 – August 2012 only due to renovation.
Medium Voltage - Condemned June 2012.
8
6) Radioactive Implants
I-125 Seeds
2011
Eye plaques (I-125) 35
2012
20
I-125 Claws / eye
applicator
2
Sr-90 applicator:
11
I-125 Orbits implant
7
9
Patients
Other / oral cavity
implants
Other (keloids)
9
3
5
5
Insertions
TOTAL all implants
65
41
Beta Plaque
2011
15
2012
21
48
40
7) Intracavitary Administrations
GYNAE CT/ RECORDS C9
Procedure
Number of patients treated
=
2011
2012
126
114
384
299
Tandem/Ovoid/Ring Combinations
=
Vaginal cylinders
= 35
_______
= 419
Total number of procedures
55
______
354
8) Internal Administrations
Radioactive Iodine administration for cancers
2011
32
2012
24
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7. Gynae Oncology - Sample Registry Data
All
Cervix
Uterus
Ovary
Vulva
Vagina
GTN
TOTAL
CERVICAL CANCER 14 YEARS INCL
2012
250
200
150
100
Series1
50
Linear (Series1)
0
1
3
5
7
9
11 13
UTERINE CANCER 14 YEARS INCL
2012
100
80
60
Series1
40
Linear (Series1)
20
0
1
3
5
7
9
11 13
2011
2012
177
67
39
18
1
7
309
185
78
46
18
4
4
335
10
OVARIAN CANCER 14 YEARS INCL
2012
70
60
50
40
30
20
10
0
Series1
Linear (Series1)
1
3
Cervix Stage
I
II
III
IV
Recurrence
Uterus Stage
I
II
III
IV
Recurrence
Sarcoma
Stage Ovary
I
II
III
IV
GCT
Stromal
presumed
5
7
9
11 13
2011
66
48
67
2
2012
48
53
62
20
2
2
2011
31
3
10
8
2012
34
3
11
8
0
1
15
20
2011
11
2
12
1
2012
21
4
6
3
4
3
5
1
0
10
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D. STAFF
Medical Staff
RP Abratt
Professor and Head of Department:
Dr J Parkes
Head of Clinical Unit
Neurosurgery, Sarcoma and Paediatric
Dr L Van Wijk
Gynaecology
Dr H Simonds
Breast
Dr Z Mohamed
Lymphomas and Kaposi Sarcomas
Dr B Robertson
GIT, Thyroid, Unknown Primary
Dr J Wetter
Head and neck, Eyes
Dr S Dalvie
Bronchus, Melanoma and Ear Nose and Throat
Dr R Burger
Urology and Oesophagus
Dr L Shepherd
Principal Medical Officer
Registrars: 8
Supernumerary Registrars: 8
A number of doctors have been appointed to assist with teaching through clinics.
Radiobiologists
Dr A Hunter and Dr A Hendrikse
Radiation Therapists
33 Full Time Equivalents - i.e. including 1 x 6/8, 1 on contract and 3 Community
Service.
Nursing Staff
For the Wards and Out Patients:
22 Sisters and 33 Nurses. Total = 55
Social Workers
For the Wards and Out Patients: Total = 4
Pharmacists
In Outpatients = 2
12
Research Nurses and Study Personnel
Total = 6, mainly on a part time basis.
Administrative Staff
Chief Clerk : 1
Senior Admin Clerk: 16
Registry Clerks: 1
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SPECIALIST PORTFOLIOS
CLINICS SERVICE
Clinical & RT Protocols
RT Users group
Pharmacy
IPP
George Hosp services
Community Outreach
L van Wijk
Clinic Specialist
J Parkes & H Simonds
B. Robertson
L van Wijk
L van Wijk, Z Mohamed, H Simonds
L van Wijk & R Burger
ACADEMIC ACTIVITIES - TEACHING
Procedures in Learning Portfolio’s
J Club, Bun Club
T & P Monday Mtg
Med Student tuts
Under grad program
Post grad program
Tues pm Tutorials
CPD records
J Parkes
Clinic Specialist
B Robertson
S Dalvie
J Wetter & R Burger
J Wetter & R Burger
J Parkes & H Simonds
J Wetter
S Dalvie
ACADEMIC ACTIVITIES - RESERACH
Commentaries & Mini theses
EPR
Data base of Research projects
H Simonds
R Abratt H Simonds
L van Wijk, H Simonds
A. Hunter
RELATIONSHIPS
External Relationships
Internal Relationships
Human Resources
Registrar support
Supernumerary Reg support
Registrar Leave
Registrar Rotation
Physics & RT rotations
Z Mohamed
R. Abratt
Clinic Specialist
Z Mohamed
J Parkes & Z Mohamed
Clinic specialist
R Burger
B Robertson & R Burger
R Burger
ENVIRONMENT
Finances & fund raising
Functional Business Unit audits
Facility Upgrade
Library
Facility Safety Officer
Maintenance D floor
Maintenance E floor
Safety D floor
R Abratt
R Abratt
R. Burger
J Parkes
B Robertson
A Hendrikse
E Greeff & area managers
R Burger
S Tovey
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E. TRAINING
Departmental Programme
Day
Monday
Time
Activity
Venue
Convenor
1:15 pm
Techniques &
Protocols
4.00 pm
Any Additional
Lectures, ad hoc
As arranged
Tuesday
4:30 pm
Clinical Tutorials
Dr J Wetter
Wed.
4:00 – 6:00 pm
Physics &
Statistics
Med Physics
Seminar room
Thursday
1:15 pm
Journal Club
D35 Lecture Theatre Dr B. Robertson
Last 2 wks
of month
Other 1.
D35 Lecture Theatre Dr S. Dalvie
Hester Burger
Bun Club
Radiobiology Lectures arranged at time which is mutually suitable – usually
Thursday 4.00 pm
Lecturers are Dr. Hunter and Dr. Hendrikse
Other 2.
5th year Medical Students: Tutorials: Thursday and Friday from noon to 1.00
pm
Other 3
Firm based Activities include review of logbooks & tutorials e.g. RT planning.
These are arranged within each firm.
A logbook of procedures is maintained by all Registrars and reviewed by their
supervising Specialists.
Graduation as specialists in 2012 = 6:
Drs D. Anderson, S. Ibrahim, M. Elhassan, K. Mohamed, K. Alleyne-Mike and N.
Vawda.
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F: ACADEMIC ACTIVITIES
Publications 2012
1. Cancer Care in South Africa (correspondence)
RP Abratt, L Dreosti and P Ruff
LANCET ONCOLOGY - 13, 324, 2012.
2. The fast neutron therapy program in South Africa should come to an end (letter)
R P Abratt
SOUTH AFRICAN MEDICAL JOURNAL -103, 58, 2012.
3. Neutron radiotherapy in South Africa Abratt response (letter)
RP Abratt
SOUTH AFRICAN MEDICAL JOURNAL - 102, 269-270, 2012.
4. Radiotherapy for ocular tumours
C Stannard, W Sauerwein, G Maree, K Lecuona
Eye ( London, England) 11/2012; DOI:10.1038eye.2012.241.
5. Radiation biology – An important science for an advanced nuclear nation like
South Africa
A. Hunter
South African Journal of Science 2012;108(7/8) 1-10.
6. Treatment of carcinoma of the anal canal at Groote Schuur Hospital
B Robertson, L Shepherd, R P Abratt, A Hunter, P Goldberg
South African Medical Journal 2012; 102(6):558-561.
7. Tumour lysis syndrome
M Irhuma, Z Mohamed, G. Maartens
South African Medical Journal CME Vol 30, No2, 79, 2012.
8. Completion of and early response to chemoradiation among human
immunodeficiency virus (HIV)-positive and HIV-negative patients with locally
advanced cervical carcinoma in South Africa.
HM Simonds, J.D Wright, N du Toit, AI Neugut, and JS Jacobson,
Cancer 118(11), pp. 2971-2979. 2012.
(The work for this publication took place at Tygerberg Hospital).
9. Lung Cancer – (Book Chapter)
RP Abratt and S. Dalvie
MIMS Handbook of Oncology – in press.
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10. A Late Haemorrhagic Complication in an ArterioVenous Malformation Cured
with Radiosurgery, Case Report
D.E.J Le Feuvre, J.D Parkes, P. Mukheiber, R. James, A.G Taylor
Interventional Neuroradiology 18: 000-000, 2012.
11. Distinct genetic association at the PLCE1 locus with oesophageal squamous cell
carcinoma in the South African population.
Bye H, Prescott NJ, Lewis CM, Matejcic M, Moodley L, Robertson B,
v.Rensburg
C, Parker MI, Mathew CG.
Carcinogenesis. 2012 Nov;33(11):2155-61. doi: 10.1093/carcin/bgs262. Epub
2012 Aug PMID: 22865593 [PubMed - in process].
PRESENTATIONS 2012:
1. Results of irradiating post-enucleated non-metastatic retinoblastoma patients
with a positive optic nerve resection margin beyond the orbital apex.
Jeffrey Kotzen, Clare Stannard et al.
SIOP (International Society of Paediatric Oncology) Africa 2012,
Cape Town. March 2012.
2. Poster. Brachytherapy of the orbit in young children
W Sauerwein, C Stannard, G Maree, et al.
ESTRO 31, World Congress of Brachytherapy
Barcelona, Spain. May 2012.
3. Poster: The “Claws” – A gold applicator loaded with I-125 seeds for localised
whole eye radiotherapy
C J Trauernicht, G J Maree, E R Hering, F C P du Plessis, C Stannard,
K Lecuona,
R Munro, S Tovey, R Mateyse
ESTRO 31, World Congress of Brachytherapy, Barcelona, Spain, May 2012.
4. Poster: Ergebnisse der Bestrahlung der Orbita bei Kindern mit
Augentumoren.
W. Sauerwein, C. Stannard, G. Maree, D. Fluhs, A. Wittig, P. Temming,
B. Timmerman, E. Biewald, N. Bornfeld.
18. Jahrestagung der Deutschen Gesellschaft fur Radioonkologie
Wiesbaden,Germany, June 2012.
5. Invited talk. Radiotherapy for ocular tumours.
Clare Stannard, Wolfgang Sauerwein, Gerrie Maree, Karin Lecuona.
42nd Cambridge Ophthalmology Symposium 2012. Cancer and the Eye,
Cambridge, England.2012.
6. Head and Neck Roundtable: Radiotherapy for Nasopharynx Carcinoma
Khadiga Mohammed: ASTRO conference May 2012.
7. CNS Roundtable- Glioblastoma Multiforme: A case presentation
Kellie Alleyne-Mike: ASTRO conference May 2012
8. Urology Roundtable Salvage Radiotherapy in a Patient with Biochemical
Failure post Radical Prostatectomy
Sebathu Chiyapo: ASTRO conference May 2012.
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9. Head and Neck Roundtable: Squamous cell carcinoma of the oral cavity
Moawia El Hassan: ASTRO conference May 2012.
10. GIT Roundtable: Long-course pre-operative radiotherapy in a patient with
rectal adenocarcinoma and a single liver metastasis.
Komeela Naidoo: ASTRO conference May 2012.
11. A Descriptive Analysis of HIV-positive patients with Multicentric Castleman’s
Disease seen at Groote Schuur Hospital Oncology Department from 20052011
Z Mohamed and N Novitzky
6th Annual Haematology – Oncology Symposium
Cape Sun Hotel, Cape Town. 2012.
12. Hodgkin’s Lymphoma: 2004-2009, A Groote Schuur Hospital Experience
N Vawda, Z Mohamed and N Novitzky
6th Annual Haematology – Oncology Symposium
Cape Sun Hotel, Cape Town.2012.
13. Submyeloablative Therapy and Tandem Transplantation for patients with
Multiple Myeloma at the UCT Myeloma Clinic
N Novitzky, C Du Toit, V Thomas and Z Mohamed
6th Annual Haematology – Oncology Symposium
Cape Sun Hotel, Cape Town 2012.
14. Invited Speaker; General Oncology talk: “The Smart and the Art of Oncology”
Zainab Mohamed
Western Cape Provincial Pharmacy Conference
Protea Hotel, Stellenbosch.2012.
15. A 30 year audit of patients presenting with ependymoma to Red Cross and
Groote Schuur Hospitals, Cape Town
Jeanette Parkes
SIOP Africa, March 2012.
16. Invited Speaker: Developing radiotherapy services in Africa
Jeanette Parkes
SIOP Africa, Cape Town, March 2012.
17. A Descriptive Analysis of HIV-positive patients with Multicentric Castleman’s
Disease seen at Groote Schuur Hospital Oncology Department from 20052011.
Z Mohamed and N Novitzky
6th Annual Haematology – Oncology Symposium
Cape Sun Hotel, Cape Town. 2-3 November 2012.
18
18. Hodgkin’s Lymphoma: 2004-2009, A Groote Schuur Hospital Experience
N Vawda, Z Mohamed and N Novitzky
6th Annual Haematology – Oncology Symposium
Cape Sun Hotel, Cape Town. 2-3 November 2012.
19. Submyeloablative Therapy and Tandem Transplantation for patients with
Multiple Myeloma at the UCT Myeloma Clinic
N Novitzky, C Du Toit, V Thomas and Z Mohamed
6th Annual Haematology – Oncology Symposium
Cape Sun Hotel, Cape Town. 2-3 November 2012.
20. Invited Speaker; General Oncology talk: “The Smart and the Art of
Oncology”
Zainab Mohamed
Western Cape Provincial Pharmacy Conference
Protea Hotel, Stellenbosch. 24-26 August 2012.
21. Paediatric CNS tumours: The Groote Schuur and Red Cross Children's
Hospital experience. Elhassan, M, Parkes, J. Poster at SIOP Africa 2012,
Cape Town.
22. A case review of a child with craniopharyngioma and the use of intratumoral
Interferon alfa (IFNa )at Groote Schuur Hospital (GSH), Cape Town.
Mohammed. K., Parkes. J. Poster SIOP Africa 2012.
G. PROFESSIONAL ORGANIZATIONAL ACTIVITIES
International Professional Organizations
American Society of Therapeutic Radiation and Oncology
RP Abratt - Member of International Educational Committee
Lancet Oncology
RP Abratt – member of the International Advisory Committee
Editorial Board of Radiotherapy and Oncology
RP Abratt
Editor J Clinical Oncology South Africa. (International appointment)
RP Abratt
Oncology at the Limits , 3nd Meeting. London 2012
RP Abratt – Member of Scientific Committee
African Regional Agreement
L van Wijk: Project coordinator International Breast Cancer Study Group for
Management of Common Cancers in Africa
19
South African Professional Organizations
University of Cape Town
A Hunter – member of the Faculty Research Committee
A Hunter – Member of Faculty Research Ethics Committee
South African Society of Clinical and Radiation Oncology RP Abratt – Member of the
Executive Committee
College of Radiation Oncology of South Africa
President of the College
RP Abratt
Member of Senate of Colleges of Medicine of South Africa
RP Abratt
Member of Council of the College of Radiation Oncology
RP Abratt, J Parkes
Society of Radiographers of S.A.
Treasurer: A V Gordon
Secretary.: SA Tovey
National Council Representative of the Cape Town Branch: S A Tovey
RT Rep. : J Van Niekerk
Combined Radiography Advisory Committee – W. Cape
Member: E A Greeff
South African Radiobiology Society (SARS)
A Hunter - Chairman
South African Association of Physicists in Medicine and Biology (SAAPMB)
A Hunter – Council member
16 Jan 2013