Browsing by Author "Sarria, GJ"

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Community-Led Action Research in Oncology: Pandemic-Appropriate Radiotherapy Innovations Evaluated (CLARO PARTE) for Latin America and the Caribbean Countries
(Lippincott Williams and Wilkins, 2024) Riano, I; Alas-Pineda, C; Reyes, Garcia, S; Murillo, R; Gutiérrez-Delgado, F; Cazap, E; Pais, Viegas, CM; Torre, MDL; Barahona, KC; Sarria, GJ; Del, Castillo, Bahi, R; Luongo-Céspedes, Á; Ovalles, B; Umaña, Herrera, FV; Sánchez, R; Mcvorran, S; Williams, B; Kascmar, J; Kennedy, LS; Lyons, KD; Bejarano, S; Wong, SL
PURPOSE This study aimed to identify, evaluate, and rank suitable safety innovations developed during the COVID-19 pandemic in Latin American and Caribbean (LAC) radiation oncology centers.METHODSWe conducted a multimodal participatory engagement collaboration with the Latin-American and Caribbean Society of Medical Oncology. The study consisted of four phases. Innovations were collected from a panel of radiotherapy experts representing a diverse group of 11 countries from LAC (Phase I). Next, a medical scientific team compared the innovations against international standards regarding their potential impact on risk of infection, clinical operation, and continuity of quality cancer care (Phase II). Their findings were supplied to the country representatives who rated the innovations for acceptability in their cancer centers (Phase III), resulting in a final report of the panel's recommendations (Phase IV). RESULTS A total of 81 innovations were reported by the country representatives and merged by the medical scientific team into 24 innovations that combined similar innovations. The 24 innovations were grouped into six categories including practices aimed at (1) reducing clinic crowding (n = 3), (2) increasing screening and vaccinations for COVID-19 disease (n = 5), (3) implementing social distancing (n = 6), (4) strengthening personal infection equipment and disinfection (n = 6), (5) avoiding delaying or shortening treatment protocols (n = 2), and (6) mixed procedures (n = 2). The medical scientific team found nearly all innovations were supported by international recommendations and rated as safe, efficient, and acceptable. CONCLUSION By using the lessons learned from the Community-Led Action Research in Oncology: Pandemic-Appropriate Radiotherapy Innovations Evaluated study, a manual of scalable practices in radiation oncology clinics may be developed to guide actions during future large-scale public health crises in low- and middle-income countries of LAC.
Exploring the Cost of Radiation Therapy Delivery for Locally Advanced Cervical Cancer in a Public and a Private Center in Latin America Using Time-Driven Activity-Based Costing
(Elsevier Inc., 2023) Li, B; Hirata, E; Trejo, JM; Garcia, B; Chang, B; Malhotra, S; Ning, M; Sarria, GJ
In low- and middle-income countries (LMICs), 85% of cervical cancer diagnoses and 88% of cervical cancer deaths occur annually.1,2 The majority of presentations (with reports up to 75%)3 are locally advanced (International Federation of Gynecology and Obstetrics stages IB2 and IIBIVA) where combination external beam radiation therapy (EBRT) followed by brachytherapy is indicated for curative treatment.4 Despite large bodies of evidence that radiation therapy (RT) is effective for treating cancer, a shortage of economic investment limits its availability and contributes to global shortages.5,6 RT is generally described as a costeffective treatment, but only limited data exists about the institutional cost of combination RT in LMICs.7 Understanding treatment costs is critical for cancer capacity planning efforts, particularly in regions where radiation oncology is less understood or newly developing.
Leveling Up the Access to Radiation Therapy in Latin America: Economic Analysis of Investment, Equity, and Inclusion Opportunities Up to 2030
(Elsevier Inc., 2023) Sarria, GR; Martinez, DA; Li, B; Castillo, RD; Salgado, A; Pinillos, L; Felix, A; Bobadilla, I; Ferraris, G; Castilho, M; Carmona, J; Leon, B; Aviles, L; Ricagni, L; Isa, N; Flores, C; Giordano, FA; Zubizarreta, EH; Polo, A; Sarria, GJ
Purpose: Latin America faces a shortage in radiation therapy (RT) units and qualified personnel for timely and high-quality treatment of patients with cancer. Investing in equitable and inclusive access to RT over the next decade would prevent thousands of deaths. Measuring the investment gap and payoff is necessary for stakeholder discussions and capacity planning efforts. Methods and Materials: Data were collected from the International Atomic Energy Agency's Directory of Radiotherapy Centers, industry stakeholders, and individual surveys sent to national scientific societies. Nationwide data on available devices and personnel were compiled. The 10 most common cancers in 2020 with RT indication and their respective incidence rates were considered for gap calculations. The gross 2-year financial return on investment was calculated based on an average monthly salary across Latin America. A 10-year cost projection was calculated according to the estimated population dynamics for the period until 2030. Results: Eleven countries were included in the study, accounting for 557,213,447 people in 2020 and 561 RT facilities. Approximately 1,065,684 new cancer cases were diagnosed, and a mean density of 768,469 (standard deviation ±392,778) people per available unit was found. By projecting the currently available treatment fractions to determine those required in 2030, it was found that 62.3% and 130.8% increases in external beam RT and brachytherapy units are needed from the baseline, respectively. An overall regional investment of approximately United States (US) $349,650,480 in 2020 would have covered the existing demand. An investment of US $872,889,949 will be necessary by 2030, with the expectation of a 2-year posttreatment gross return on investment of more than US $2.1 billion from patients treated in 2030 only. Conclusions: Investment in RT services is lagging in Latin America in terms of the population's needs. An accelerated outlay could save additional lives during the next decade, create a self-sustaining system, and reduce region-wide inequities in cancer care access. Cash flow analyses are warranted to tailor precise national-level intervention strategies.
Long-Term Outcomes of an International Cooperative Study of Intraoperative Radiotherapy Upfront Boost With Low Energy X-Rays in Breast Cancer
(Frontiers Media S.A., 2022) Sarria, GR; Ramos, ML; Palacios, A; Del Castillo, R; Castro, F; Calvo, A; Cotrina-Concha, JM; Heredia, A; Galarreta, JA; Fuentes-Rivera, P; Avalos, A; Martinez, DA; Colqui, K; Ziegler, G; Schmeel, LC; Pinillos, LV; Wenz, F; Giordano, FA; Sarria, GJ; Sperk, E
Purpose: The purpose of this study was to assess the effectivity of upfront kilovoltage intraoperative radiotherapy (IORT) as a boost in high-risk early-stage breast cancer patients from an international pooled cohort. Materials/Methods: Patients from four centers in three different countries were retrospectively screened. Those with a minimum 1-year follow-up were included. Cumulative local (LR), regional (RR), and distant metastasis rates (DM) were analyzed. Additionally, the estimated overall survival (OS) was assessed. The Cox regression analysis was performed to identify failure predicting factors. Results: A total of 653 patients from centers in Peru, Spain, and Germany were included. The median follow-up was 55 (12–180) months, and age was 58 (27–86) years. Clinical tumor (T) staging was T1 65.85%, T2 30.17%, and T3 3.98%. Positive margins were found in 7.9% and in-situ component in 20.06%. The median IORT dose was 20 (6–20). The median time from IORT to EBRT was 74.5 (13-364) days. An overall 3.4% (n = 22) of patients developed local recurrence at some point during follow-up. The 12-, 60-, and 120-month cumulative LR were 0.3%, 2.3%, and 7.9%, respectively. After multivariate analysis, only age <50 remained to be a significant prognostic factor for local recurrence (HR 0.19, 95% CI 0.08–0.47 p < 0.05). The 10-year estimated OS was 81.2%. Conclusion: Upfront boost with IORT yields similar local control outcomes to those EBRT-based reports. Results from prospective trials, regarding toxicity, cosmesis, and effectivity are awaited to confirm these findings.
Longitudinal Remote SBRT/SRS Training in Latin America: A Prospective Cohort Study
(Frontiers Media S.A., 2022) Sarria, GR; Timmerman, R; Hermansen, M; Malhotra, S; Chang, B; Carter, R; Martinez, DA; Sarria, GJ; Giordano, FA; Chetty, IJ; Roa, D; Li, B
Background: Continuing medical education in stereotactic technology are scarcely accessible in developing countries. We report the results of upscaling a longitudinal telehealth training course on stereotactic body radiation therapy (SBRT) and stereotactic radiosurgery (SRS), after successfully developing a pilot course in Latin America. Methods: Longitudinal training on SBRT and SRS was provided to radiation oncology practitioners in Peru and Colombia at no cost. The program included sixteen weekly 1-hour live conferencing sessions with interactive didactics and a cloud-based platform for case-based learning. Participant-reported confidence was measured in 16 SBRT/SRS practical domains, based on a 1-to-5 Likert scale. Pre- and post-curriculum exams were required for participation credit. Knowledge-baseline, pre- and post-curriculum surveys, overall and single professional-group confidence changes, and exam results were assessed. Results: One hundred and seventy-three radiotherapy professionals participated. An average of 56 (SD ±18) attendees per session were registered. Fifty (29.7%) participants completed the pre- and post-curriculum surveys, of which 30% were radiation oncologists (RO), 26% radiation therapists (RTT), 20% residents, 18% medical physicists and 6% neurosurgeons. Significant improvements were found across all 16 domains with overall mean +0.55 (SD ±0.17, p<0.001) Likert-scale points. Significant improvements in individual competences were most common among medical physicists, RTT and residents. Pre- and post-curriculum exams yielded a mean 16.15/30 (53.8 ± 20.3%) and 23.6/30 (78.7 ± 19.3%) correct answers (p<0.001). Conclusion: Longitudinal telehealth training is an effective method for improving confidence and knowledge on SBRT/SRS amongst professionals. Remote continuing medical education should be widely adopted in lower-middle income countries.
Phase I/II study on kilovoltage surface brachytherapy in conjunctival cancer: preliminary results
(Cancer Intellilgence, 2018) Sarria-Bardales, GR; Sarria, GJ; Rivera, PF; Zaharia, M; Serpa, S; Buitrago, M
Introduction: In ocular conjunctival carcinoma after surgery, adjuvant treatment has a role and kilovoltage surface brachytherapy opens a new door for the range of therapeutic options. Materials and methods: Between October 2014 and June 2017, at the National Institute of Neoplastic Diseases (INEN) from Peru, 39 patients with squamous cell carcinoma of ocular conjunctiva, T1-T3, resected, were selected to receive adjuvant treatment. The portable accelerator of 50-kV INTRABEAM (Carl Zeiss Meditec) was used, after local anaesthesia and blocking of ocular muscles movement. The doses used were 18 Gy for patients with free margins and 22 Gy for positive edges, according to calculation of equivalent dose of 2Gy per fraction of 46 and 66 Gy, respectively, assuming a tumoural α/β ratio of 8 Gy. The prescription was done to 2 mm depth. Results: The median age was 69 years, distributed evenly between both genders, with a median follow-up of 12 months. The surgical margins were 59% free and 41% committed, with no difference between the institutions where the surgery was performed (P = 0.069). The median tumour size was 7 mm with 2 mm of invasion, 61.5% was T2 and 35.9% T1. The mean time between surgery and irradiation was 1.5 months, 23.1% of patients developed grade I toxicity of spontaneous resolution, without evidence of greater degree in any case. The dose had no statistical relationship with toxicity (P = 0.533). One-year disease-free survival was 96.7%. Conclusions: Kilovoltage surface brachytherapy is an applicable and reproducible tool in the treatment of squamous cell carcinoma of ocular conjunctiva. The administered doses are well tolerated by patients with low levels of acute toxicity. Longer follow-up is needed to establish disease control rates and late toxicities.