Overview of breast cancer external beam radiation therapy in Ghana: Towards the establishment of a national standardized treatment guidelines for improved patient care

Background and purpose: This paper reports on results from the foremost national survey on external beam radiation therapy (EBRT) treatment practice at the three radiotherapy (RT) facilities in Ghana. It is to survey the current EBRT treatment protocols and its resources available in the country for breast cancer treatment. Results are intended to form the foundation for future clinical research into developing standardized institutional and/or National breast cancer treatment planning guidelines. This will introduce uniformity into EBRT protocols across the three facilities in the country for their breast cancer patients. Materials and methods: The survey was conducted with two online-based questionnaires; a general questionnaire that targeted radiation oncology professionals working in the three RT facilities in Ghana and a follow-up specifically for the radiation oncologists. The first survey was rolled out from 21st August 2020 to 31st December 2020. The second survey was conducted from 15th February 2021 to 31st March 2021 after the initial analysis of the responses from the first survey. The first questionnaire had 54 general EBRT breast cancer treatment questions. The second questionnaire had 14 questions focusing on dose fractionation regimens, definition of treatment targets and organs at risk (OAR) delineation. Results: The Google web-based questionnaires had in total 11 responses from the targeted radiation oncologists, medical physicists, and radiation therapists working in the three radiotherapy facilities in the country. The facility response rate was 100% for the survey as there were participation from all three RT facilities. CT-based breast planning was considered standard and used in all three facilities. Reference markers to aid patient positioning and target delineations were employed during simulations. Majority of the relevant OAR associated with breast EBRT were very well defined. 3 dimensional conformal radiotherapy (3DCRT) planning with forward-planning field-in-field (FP-FIF) technique has become the preferred planning of choice. From this survey, there were three medical linear accelerators (Linacs) and two Cobalt-60 (Co-60) treatment units used in treating an average of 750 breast cancer patients annually. Conclusion: Results from the survey gave an in-depth overview of the current state of EBRT resources available in the treatment and management of breast cancer in Ghana. Minor protocol variations amongst the facilities were observed. However, there were strong consensus amongst the facilities regarding majority of their current existing protocols and possible future techniques/technology implementation.