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RADIATION ONCOLOGY GROOTE SCHUUR HOSPITAL & UNIVERSITY OF CAPE TOWNAUDIT OF ACTIVITIES 2012SUMMARY 2011 2012New Patients28792922Follow up visits3987936407Patient Chemotherapy Administrations 78978071New Patients treated with external beam irradiation14781427Patient attendees for irradiation1853816388Number of radiation fields5418455793Patients planned for irradiation (computer plans)20442173Total Procedures in planning3236130542Radio-active implants – largely for the eye6541Gynaecological sealed radio-active procedures419354Radioactive iodine administrations for cancer3224Registrars qualified as specialists46Scientific Presentations2222Scientific Publications611CONTENTSVISION STATMENTSKEY EVENTSCLINICAL SERVICESSTAFFTRAININGACADEMIC ACTIVITIESPROFESSIONAL ORGANIZATIONAL ACTIVITIESSTRATEGIC PLAN FOR 2012VISION AND VALUE STATEMENTSTo CareClinical ExcellenceTo serve patients with cancerAcademic ActivitiesTo grow through training, and researchRelationshipsTo flourish as a communityEnvironmentTo uplift us all- - Our Path to CarePositive AssumptionAbout?all people and what we can jointly achieve.AccomplishmentsWhich reflect our aims and?professionalism TeamworkThat is built on openness, responsiveness and fidelity.? ??Higher Values ?Which come from a sense of purpose and our common humanity KEY EVENTSClinical ServiceRadiation 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.Academic ActivitiesThe 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.RelationshipsA 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).Environment & FacilitiesA 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.CLINICAL SERVICES1) Weekly Multidisciplinary Combined Oncology Clinics ClinicsClinic includes Radiation Oncology + other departments as in list below 20112012New Patients2879*2924Other Clinic Visits3987936405SarcomaOrthopaedics, General Surgery7257MelanomaPlastic Surgery3032LymphomaHaematology, Radiology, Pathology, Haematopathology, Nuclear Medicine154134HaematologyHaematology, Radiology, Pathology, Haematopathology, Nuclear Medicine14ENTENT Surgery, Radiology, Speech Therapy, Dietetics10297Head and NeckENT Surgery, Plastic Surgery, Oral & Dental Surgery, Radiology, Dietetics136185Ocular TumourOphthalmology, Medical Physics5143SkinPlastic Surgery, Dermatology130109Kaposi Sarcoma-128111Miscellaneous LE32 -8317Breast ClinicSurgery, Plastic Surgery, Pathology, Radiology464504GynaeGynaecological oncology & Pathology287309NeuroNeurosurgery, Neuro-radiology, pathology, Neurology7675PituitaryNeurosurgery, Endocrine1530Paediatric neuron-oncology Paediatric oncology, paediatric endocrine, paediatric neurosurgery2437Paediatric oncologyCoordinated at Red Cross HospitalN/AMiscellaneous LE33-5016BronchusRespiratory Medicine, Radiology, Thoracic Surgery295332UrologyUrology, Radiology, Private Sector206174ThyroidGeneral Surgery, Nuclear medicine, Endocrinology, pathology2130Thyrotoxicosis-*OesophagusThoracic surgery, dietician135104GITSurgery, Radiology213244Unknown Primary-170180Miscellaneous LE34-3790These figures are from Clinicom.N/A = these patients are registered under Misc for Admin logistical reasons 2) Outpatient Clinics Attendances - E Floor New PatientsClinic Follow UpsRadiotherapy Treatment checks201120122011201220112012LE 32979908 9089 9070 933932 LE 3382386216069 14256 1957 1716 LE 3410771154 11368 10049 463382Total28792924 36526 33375335330303) Ward Statistics Total beds = 41WARD G7WARD G82011201220112012No of pt. 6481626459465939Admissions998913873974Discharges921818758878Bed Occupancy*86%77.5%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 Planning20112012Total Patients20232123New Patients 1524 1608Repeat Patients466515Planning CT scansDiagnostic CT4469051978Simulated Patients16831545No. Field Simulations29272723Total Procedures*3236130542* Includes other procedures e.g. computer plans. 5) External Beam Radiotherapy Administration New Patients / RetreatmentsAttendancesFields201120122011201220112012Linac.233114253991756157284459Linac.34175198355103142834142318Theratron 2-See comment11258451479833084Theratron 37025044601280597355830Med. Voltage17413834297102TOTAL1478142718538163885418455793Comments: 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 2012.6) Radioactive Implants I-125 SeedsEye plaques (I-125)201120123520???I-125 Claws / eye applicator112Sr-90 applicator: Beta Plaque??2011 2012I-125 Orbits implant79Patients1521?Other / oral cavity implants95Insertions4840Other (keloids)35TOTAL all implants6541?7) Intracavitary Administrations???GYNAE CT/ RECORDS C9 Procedure 20112012Number of patients treated =126 114Tandem/Ovoid/Ring Combinations =384 299Vaginal cylinders = 35 55 _____________Total number of procedures = 419 3548) Internal Administrations20112012Radioactive Iodine administration for cancers32247. Gynae Oncology - Sample Registry Data All20112012???Cervix177185Uterus6778Ovary3946Vulva1818Vagina14GTN74TOTAL 309 335 ???Cervix Stage20112012I6648II4853III6762IV220???Recurrence22Uterus Stage20112012I3134II33III1011IV88???Recurrence01???Sarcoma1520Stage Ovary20112012I1121II24III126IV13???GCT41Stromal30presumed510D. STAFFMedical Staff RP Abratt Professor and Head of Department: Dr J Parkes Head of Clinical Unit Neurosurgery, Sarcoma and Paediatric Dr L Van Wijk GynaecologyDr H SimondsBreastDr Z MohamedLymphomas and Kaposi SarcomasDr B RobertsonGIT, Thyroid, Unknown PrimaryDr J WetterHead and neck, EyesDr S DalvieBronchus, Melanoma and Ear Nose and ThroatDr R BurgerUrology and Oesophagus Dr L ShepherdPrincipal Medical OfficerRegistrars: 8Supernumerary Registrars: 8A number of doctors have been appointed to assist with teaching through clinics.RadiobiologistsDr A Hunter and Dr A HendrikseRadiation Therapists33 Full Time Equivalents - i.e. including 1 x 6/8, 1 on contract and 3 Community Service.Nursing StaffFor the Wards and Out Patients: 22 Sisters and 33 Nurses. Total = 55 Social WorkersFor the Wards and Out Patients: Total = 4PharmacistsIn Outpatients = 2Research Nurses and Study PersonnelTotal = 6, mainly on a part time basis.Administrative StaffChief Clerk : 1Senior Admin Clerk: 16Registry Clerks: 1SPECIALIST PORTFOLIOS CLINICS SERVICE L van WijkClinical & RT ProtocolsClinic SpecialistRT Users groupJ Parkes & H Simonds PharmacyB. RobertsonIPPL van WijkGeorge Hosp servicesL van Wijk, Z Mohamed, H SimondsCommunity OutreachL van Wijk & R BurgerACADEMIC ACTIVITIES- TEACHINGJ ParkesProcedures in Learning Portfolio’sClinic SpecialistJ Club, Bun Club B RobertsonT & P Monday MtgS DalvieMed Student tutsJ Wetter & R BurgerUnder grad programJ Wetter & R BurgerPost grad programJ Parkes & H SimondsTues pm TutorialsJ WetterCPD recordsS DalvieACADEMIC ACTIVITIES- RESERACHH SimondsCommentaries & Mini thesesR Abratt H SimondsEPRL van Wijk, H SimondsData base of Research projectsA. HunterRELATIONSHIPS Z MohamedExternal RelationshipsR. AbrattInternal RelationshipsClinic SpecialistHuman ResourcesZ MohamedRegistrar supportJ Parkes & Z Mohamed Supernumerary Reg supportClinic specialistRegistrar LeaveR BurgerRegistrar Rotation B Robertson & R Burger Physics & RT rotations R BurgerENVIRONMENTR AbrattFinances & fund raisingR AbrattFunctional Business Unit auditsR. BurgerFacility Upgrade J Parkes LibraryB RobertsonFacility Safety OfficerA HendrikseMaintenance D floorE Greeff & area managersMaintenance E floor R BurgerSafety D floorS ToveyE. TRAININGDepartmental ProgrammeDayTimeActivityVenueConvenorMonday1:15 pm4.00 pmTechniques & ProtocolsAny Additional Lectures, ad hocD35 Lecture TheatreDr S. DalvieAs arrangedTuesday4:30 pmClinical TutorialsDr J WetterWed.4:00 – 6:00 pmPhysics & StatisticsMed Physics Seminar roomHester BurgerThursdayLast 2 wks of month1:15 pmJournal ClubBun ClubD35 Lecture TheatreDr B. RobertsonOther 1.Radiobiology Lectures arranged at time which is mutually suitable – usually Thursday 4.00 pmLecturers are Dr. Hunter and Dr. HendrikseOther 2.5th year Medical Students: Tutorials: Thursday and Friday from noon to 1.00 pm Other 3Firm 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. F: ACADEMIC ACTIVITIES Publications 2012Cancer Care in South Africa (correspondence) RP Abratt, L Dreosti and P Ruff LANCET ONCOLOGY - 13, 324, 2012.The fast neutron therapy program in South Africa should come to an end (letter)R P AbrattSOUTH AFRICAN MEDICAL JOURNAL -103, 58, 2012.Neutron radiotherapy in South Africa Abratt response (letter) RP AbrattSOUTH AFRICAN MEDICAL JOURNAL - 102, 269-270, 2012.Radiotherapy for ocular tumours C Stannard, W Sauerwein, G Maree, K Lecuona Eye ( London, England) 11/2012; DOI:10.1038eye.2012.241.Radiation biology – An important science for an advanced nuclear nation likeSouth AfricaA. HunterSouth African Journal of Science 2012;108(7/8) 1-10.Treatment of carcinoma of the anal canal at Groote Schuur HospitalB Robertson, L Shepherd, R P Abratt, A Hunter, P Goldberg South African Medical Journal 2012; 102(6):558-561.Tumour lysis syndromeM Irhuma, Z Mohamed, G. MaartensSouth African Medical Journal CME Vol 30, No2, 79, pletion of and early response to chemoradiation among humanimmunodeficiency virus (HIV)-positive and HIV-negative patients with locallyadvanced 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).Lung Cancer – (Book Chapter)RP Abratt and S. DalvieMIMS Handbook of Oncology – in press.A Late Haemorrhagic Complication in an ArterioVenous Malformation Curedwith Radiosurgery, Case Report D.E.J Le Feuvre, J.D Parkes, P. Mukheiber, R. James, A.G TaylorInterventional Neuroradiology 18: 000-000, 2012.Distinct genetic association at the PLCE1 locus with oesophageal squamous cellcarcinoma in the South African population.Bye H, Prescott NJ, Lewis CM, Matejcic M, Moodley L, Robertson B, v.RensburgC, Parker MI, Mathew CG.Carcinogenesis. 2012 Nov;33(11):2155-61. doi: 10.1093/carcin/bgs262. Epub2012 Aug PMID: 22865593 [PubMed - in process]. PRESENTATIONS 2012: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.Poster. Brachytherapy of the orbit in young childrenW Sauerwein, C Stannard, G Maree, et al.ESTRO 31, World Congress of BrachytherapyBarcelona, Spain. May 2012.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 MateyseESTRO 31, World Congress of Brachytherapy, Barcelona, Spain, May 2012.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 RadioonkologieWiesbaden,Germany, June 2012.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.Head and Neck Roundtable: Radiotherapy for Nasopharynx CarcinomaKhadiga Mohammed: ASTRO conference May S Roundtable- Glioblastoma Multiforme: A case presentationKellie Alleyne-Mike: ASTRO conference May 2012Urology Roundtable Salvage Radiotherapy in a Patient with Biochemical Failure post Radical ProstatectomySebathu Chiyapo: ASTRO conference May 2012.Head and Neck Roundtable:?Squamous cell?carcinoma of the oral cavityMoawia El Hassan: ASTRO conference May 2012.GIT Roundtable:?Long-course pre-operative radiotherapy in a patient with rectal adenocarcinoma and a single liver metastasis.Komeela Naidoo: ASTRO conference May 2012.A Descriptive Analysis of HIV-positive patients with Multicentric Castleman’s Disease seen at Groote Schuur Hospital Oncology Department from 2005-2011Z Mohamed and N Novitzky6th Annual Haematology – Oncology SymposiumCape Sun Hotel, Cape Town. 2012.Hodgkin’s Lymphoma: 2004-2009, A Groote Schuur Hospital ExperienceN Vawda, Z Mohamed and N Novitzky6th Annual Haematology – Oncology SymposiumCape Sun Hotel, Cape Town.2012.Submyeloablative Therapy and Tandem Transplantation for patients with Multiple Myeloma at the UCT Myeloma ClinicN Novitzky, C Du Toit, V Thomas and Z Mohamed6th Annual Haematology – Oncology SymposiumCape Sun Hotel, Cape Town 2012.Invited Speaker; General Oncology talk: “The Smart and the Art of Oncology”Zainab MohamedWestern Cape Provincial Pharmacy ConferenceProtea Hotel, Stellenbosch.2012.A 30 year audit of patients presenting with ependymoma to Red Cross and Groote Schuur Hospitals, Cape TownJeanette ParkesSIOP Africa, March 2012.Invited Speaker: Developing radiotherapy services in AfricaJeanette ParkesSIOP Africa, Cape Town, March 2012.A Descriptive Analysis of HIV-positive patients with Multicentric Castleman’s Disease seen at Groote Schuur Hospital Oncology Department from 2005-2011.Z Mohamed and N Novitzky6th Annual Haematology – Oncology SymposiumCape Sun Hotel, Cape Town. 2-3 November 2012.Hodgkin’s Lymphoma: 2004-2009, A Groote Schuur Hospital ExperienceN Vawda, Z Mohamed and N Novitzky6th Annual Haematology – Oncology SymposiumCape Sun Hotel, Cape Town. 2-3 November 2012.Submyeloablative Therapy and Tandem Transplantation for patients with Multiple Myeloma at the UCT Myeloma ClinicN Novitzky, C Du Toit, V Thomas and Z Mohamed6th Annual Haematology – Oncology SymposiumCape Sun Hotel, Cape Town. 2-3 November 2012.Invited Speaker; General Oncology talk: “The Smart and the Art of Oncology”Zainab MohamedWestern Cape Provincial Pharmacy ConferenceProtea Hotel, Stellenbosch. 24-26 August 2012.Paediatric CNS tumours: The Groote Schuur and Red Cross Children's Hospital experience. Elhassan, M, Parkes, J. Poster at SIOP Africa 2012, Cape Town.A case review of a child with craniopharyngioma and the use of intratumoralInterferon alfa (IFNa )at Groote Schuur Hospital (GSH), Cape Town. Mohammed. K., Parkes. J. Poster SIOP Africa 2012.G. PROFESSIONAL ORGANIZATIONAL ACTIVITIESInternational Professional OrganizationsAmerican Society of Therapeutic Radiation and Oncology RP Abratt - Member of International Educational Committee Lancet OncologyRP Abratt – member of the International Advisory CommitteeEditorial Board of Radiotherapy and OncologyRP AbrattEditor J Clinical Oncology South Africa. (International appointment) RP AbrattOncology at the Limits , 3nd Meeting. London 2012 RP Abratt – Member of Scientific CommitteeAfrican Regional AgreementL van Wijk: Project coordinator International Breast Cancer Study Group for Management of Common Cancers in AfricaSouth African Professional OrganizationsUniversity of Cape TownA Hunter – member of the Faculty Research CommitteeA Hunter – Member of Faculty Research Ethics CommitteeSouth African Society of Clinical and Radiation Oncology RP Abratt – Member of the Executive Committee College of Radiation Oncology of South AfricaPresident of the College RP AbrattMember of Senate of Colleges of Medicine of South Africa RP AbrattMember of Council of the College of Radiation Oncology RP Abratt, J ParkesSociety of Radiographers of S.A.Treasurer: A V GordonSecretary.: SA ToveyNational Council Representative of the Cape Town Branch: S A ToveyRT Rep. : J Van NiekerkCombined Radiography Advisory Committee – W. CapeMember: 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 ................
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