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“Systematic analysis of Electronic Medical Record of Patients enrolled for Radiation Therapy in year 2011 at “BA”Smt. L. C. Parikh Cancer Centre.”

S.S. Solanki1 , M. Loganathan1, R. Swathika’ 1 , Amol Palaskar1 , Boniface Chettri1 , Jyoti Pokale 1 , P.B. Lad2

1Department of Radiation Oncology, 2Department of Onco-Surgery, “BA” Smt. Lilaben Chimanlal Parikh Cancer Centre, Navsari , GujIntroductionComputerization of medical record of patients is one of the keys to access the information in least

time. To keep the patient’s data at par with good institutes, we use our own self developed Electronic

Medical Record (EMR) System in form of Microsoft’s Excel sheets in our day to day activities. This study is being conducted to show how the medical data is recorded and analyzed at our

centre for the year 2011.

ObjectivesTo find number of patients treated for curative and palliative intent. To find how many patients completed radiation therapy for their prescribed doses. To find present status of patients in terms of alive and dead through record search and phone

calls.To find overall survival in months for patients treated for Radiotherapy in year 2011.

Material and MethodsIn the year 2011, a total of 325 patients were enrolled for Radiotherapy. All information about patients details were first written on case sheet then typed on Microsoft’ s

excel sheet specially prepared for medical records. (Fig 1& 2- excel sheet for data).Treatment decisions were taken to treat patient for radiation therapy on clinical grounds for

curative intent (Radical, Post Op or Adjuvant EBRT) or for palliative intent( bone metastasis,

brain metastasis, or haemostatic EBRT) and doses were decided as per general practice.All Patients were immobilized with thermoplastic cast (ORFIT Industries) and CT scans done

(Siemens' Emotion Sprit) for planning purpose on flat indexed carbon couch (Civco) with help of

All in one Base plate (POCL). Fig 3

Patients were planned on Eclipse treatment planning system (version 8.9) (Fig. 4)All patients were treated on Varian’s Clinac iX Linear Accelerator daily for 5 days a week (Fig.5)Weekly OPD review for side effect related problem and adequate treatment. (Fig6) All Patients were given treatment summary after their completion of EBRT from the record.Patients are advised to come on follow up every 2-4 monthly in first year.To find present status of patients , they were called on phone in the month of March and Apr

2012 and their status regarding alive with disease free or with disease progression was noted and

if died then date of death was recorded.

The analysis was done only for those patients who have completed radiotherapy as per prescribed

doses. No analysis was done for those patients who have not completed radiotherapy or not started.The data was analyzed for treatment completion, overall survival and average survival in alive

and dead patients in major groups as well as subgroups. For Overall survival a formula was used:

Overall survival in months= (Date of evaluation- Date of Start of EBRT) / 30

ResultsOut of 325 (100%) patients, 288(88.61%) patients were given Radiotherapy with Curative intent

and 37 (11.38%) patients were given treatment on Palliative basis. (Table.1)A total of 292(89.8%) of patients were able to complete treatment as per prescribed doses,

26(8%) have not completed RT and 7 Patients have not started Radiation therapy A total of 214(73.28%) patients are still alive with average survival of 8.32 (1.36-14.63) months. Out of 292 patients 37(12.67%) are still suffering with disease progression. A Large number of patients 63/292(21.57%) have died with average survival of 5.51 (0.73-

12.63) months.

Curative intent group is divided into 11 major sub groups viz CNS tumors, Head and neck

tumors, Thoracic tumors, Breast tumors, Gastro Intestinal tumors , Urinary Tract tumors, Male

Genitourinary tumors, Gynecological tumors, Hematological and Lymphoma tumors, Sarcoma,

Pediatric tumors (Table 2) Palliative intent group is divided into from 4 major sub groups viz Metastasis- bone,

Metastasis- Brain, Metastasis Soft tissue, Haemostatic Radiotherapy. (Table 3.) In both Groups nearly 90% of patients have completed Radiotherapy for specify doses.

The subgroups were also studied for completion and survival figures. (Tables 4 to 14). In terms of number of patients, major subgroups in curative intent are Head and Neck tumors

171(59.37%), Gynecological tumors 38(13.19%) and Breast tumors 28 (9.72%).The sub groups tables shows percentage of alive patients from total completed patients as well as

overall survival in form of average months. (Tables 4 to 14)Patients who had no information about their status are represented in the no info column.

Fig 3- Orfit Cast, CT scan for Planning

Fig 4- Eclipse Treatment Planning System Fig 5- Clinac iX Linear Accelerator (Varian)

Fig 2- EMR of Patients (a screen shot)Fig 1- List of Patients in EMR

Fig 6- Weekly OPD review during TreatmentTable 1. EBRT Data Survival Figures

Major Groups Enrolled No RT started

Incomplete EBRT

Completed EBRT

Completed EBRT

Alive(dis. Free)

Alive ( with dis.)

Alive (Total)

Avg survival (months)

Total Dead Avg survival (months)

No Info

Curative intent288

(88.61%) 6 25 257 257 177 25 2028.35 (1.36-

14.63) 446.17 (0.73-

12.63) 11

Palliative intent 37

(11.38%) 1 1 35 35 0 12 127.90 (3.60-

13.90) 194.00 (0.86-

9.80) 4

Total325

(100%)7

(2.1%)26

(8%)292

(89.8%)292

(100%)177

(60.6%)37

(12.67%)214

(73.28%)8.32 (1.36-

14.63)63

(21.57%)5.51 (0.73-

12.63)15

(5.13%)

“Systematic analysis of Electronic Medical Record of Patients enrolled for Radiation Therapy in year 2011 at “BA” Smt. L. C. Parikh Cancer Centre.”

Table 2. EBRT Data Survival Figures

Curative intent-Major Groups

EnrolledNo RT started

Incomplete EBRT

Completed EBRT

Completed EBRT

Alive(dis. Free)

Alive ( with dis.)

Alive (Total)

Avg survival (months) Total Dead

Avg survival (months) No Info

CNS Tumors14

(4.86%) 0 0 14 14 7 4 119.80

(5.90 -14.13) 36.3

(4.03- 7.83) 0

Head and Neck Tumors

171 (59.37%) 0 18 153 153 103 10 113

8.16 (3.10 - 14.63) 32

6.49 (2.1-12.63) 8

Thoracic Tumors11

(3.81%) 0 2 9 9 5 1 67.88

(4.36 - 10.53) 32.57

(0.73-4.13) 0

Breast Tumors28

(9.72%) 2 0 26 26 25 1 267.69

(1.36 -14.60) 0 0 0

GI Tumors6

(2.08%) 0 2 4 4 4 0 47.61

(5.83 - 11.00) 0 0 0

Urinary Tract Tumors

3 (1.04%) 0 0 3 3 1 0 1 12.03 1 4.96 1

Male G.U. Tumors3

(1.04%) 0 0 3 3 2 0 24.86

(1.73 -8.00) 1 4.46 0

Gynecological Tumors

38(13.19%) 3 1 34 34 20 8 28

9.67 (2.93 -14.6) 4

6.87(3.93 -11.66) 2

Hematological and Lymphoma

10(3.47%) 0 2 8 8 7 1 8

7.29 (3.73 -11.36) 0 0 0

Sarcomas-Bone and Soft Tissue

2(0.69%) 0 0 2 2 2 0 2

10.56 (8.60 - 12.53) 0 0 0

Pediatric Tumors2

(0.69%) 1 0 1 1 1 0 1 6.33 0 0 0

Total288

(100%)6

(2.08%)25

(8.68%)257

(89.23%)257

(100%)177

(68.87%)25

(9.72%)202

(78.59%)8.34

(1.36-14.63)44

(17.12%)6.17

(0.73-12.63)11

(4.28%)

Table 3. EBRT Data Survival Figures

Palliative intent - Major Groups


Incomplete EBRT

Completed EBRT

Completed EBRT

Alive(dis. Free)

Alive ( with dis.)

Alive (Total)



Metastasis- Bone 27 (72.97%) 1 1 25 25 0 9 9 8.38 (3.60-13.90) 14 4.42(0.86-9.80) 2

Metastasis- Brain 7 (18.91%) 0 0 7 7 0 1 1 6.8 5 2.83 (1.86- 5.03) 1

Metastasis- Soft tissue 2 (5.40%) 0 0 2 2 0 2 2 6.33 (5.70-6.96) 0 0 0

Hemostatic EBRT 1 (2.70%) 0 0 1 1 0 0 0 0 0 0 1

Total37

(100%)1

(2.70%)1

(2.70%)35

(94.59%)35

(100%) 012

(34.28%)12

(34.28%)6.74

(3.60-12.70)19

(54.28%)4.00

(0.86-9.80)4

(11.42%)

Table 4 EBRT Data Survival Figures

CNS Tumors EnrolledNo RT started

Incomplete EBRT

Completed EBRT

Completed EBRT

Alive(dis. Free)

Alive ( with dis.)

Alive (Total)



Ependymoma 2 (14.28%) 0 0 2 2 2 0 2 11.31(10.03-12.6) 0 0 0

Astrocytoma Gr II 1 (7.14%) 0 0 1 1 0 0 0 0 1 7.2 0

Astrocytoma Gr III 2 (14.28%) 0 0 2 2 1 0 1 7.63 1 7.83 0

Oligodendroglioma 2 (14.28%) 0 0 2 2 2 0 2 13.26(12.40- 4.13) 0 0 0

Glioblastoma Gr IV 3 (21.42%) 0 0 3 3 0 2 2 8.03(6.43-9.63) 1 4.03 0

CNS Lymphoma 1 (7.14%) 0 0 1 1 0 1 1 12.8 0 0 0

Pitutary Adenoma 3 (21.42%) 0 0 3 3 2 1 3 7.51 (5.90-8.60) 0 0 0

Total 14 (100%) 0 0 14 (100%) 14 (100%) 7 (50%) 4 (28.57%) 11 (78.57%) 9.80 (5.90 -14.13) 3 (21.42%) 6.3 (4.03- 7.83) 0


Head and Neck Tumors


Incomplete EBRT

Completed EBRT

Completed EBRT

Alive(dis. Free)

Alive ( with dis.)

Alive (Total)



Tongue 47 (27.48%) 0 5 42 42 29 1 30 7.85 (3.10-13.66) 10 5.67 (2.36-8.66) 2Buccal Mucosa 41 (23.97%) 0 3 38 38 31 1 32 8.21 (3.1-13.96) 4 7.14(2.50-11.83) 2

Retromolar Triagon 12 ( 7.01%) 0 0 12 12 7 1 8 7.04 (4.86- 9.8) 3 7.34(4.7 -12.63) 1Alveolus 23 (13.45%) 0 4 19 19 11 3 14 8.27 (5.00- 14.63) 5 4.7(2.10- 9.86) 0

Hard Palate 1 (0.58%) 0 0 1 1 1 0 1 8.16 0 0 0

Nasopharynx 2 (1.16%) 0 0 2 2 1 0 1 11.56 1 8.5 0

Oropharynx 14 (8.18%) 0 4 10 10 5 1 6 8.36 (3.46- 10.96) 3 8.79(6.93 -11.03) 1Larynx 12 (7.01%) 0 1 11 11 6 2 8 8.48 (4.63- 11.70) 1 8.4 2

Hypopharynx 6 (3.50%) 0 0 6 6 5 0 5 5.5 (3.53- 9.10) 1 6.03 0

MUO 3 (1.75%) 0 0 3 3 0 0 0 0 3 7.60(4.96-10.46) 0

Parotid + minor salivary glands 5 (2.92%) 0 1 4 4 4 0 4 12.56 (8.43- 14.6) 0 0 0

Paranasal Sinus 2 (1.16%) 0 0 2 2 0 1 1 11.53 1 4.76 0

Orbit + Eye lid 2 (1.16%) 0 0 2 2 2 0 2 6.01 (3.93-12.03) 0 0 0

Thyroid Cancer 1 (0.58%) 0 0 1 1 1 0 1 12.33 0 0 0

Total171

(100%) 018

(10.52%)153

(89.47%)153

(100%)103

(67.32%)10

(6.53%)113

(73.85%)8.16

(3.10 - 14.63)32

(20.91%)6.49

(2.1-12.63)8

(5.22%)


Thoracic tumors EnrolledNo RT started

Incomplete EBRT

Completed EBRT

Completed EBRT

Alive(dis. Free)

Alive ( with dis.)

Alive (Total)



Lung Carcinoma 3 (27.27%) 0 0 3 3 3 0 3 6.04 (4.36-7.83) 0 0 0Esophageal Cancer 8 (72.72%) 0 2 6 6 2 1 3 9.73 (8.70-10.53) 3 2.57 (0.73- 4.13) 0

Total11

(100%) 02

(18.1%)9

(81.8%)9

(100%)5

(55.5%1

(11.11%)6

(66.6%)7.88

(4.36 - 10.53)3

(33.3%)2.57

(0.73-4.13) 0


1Department of Radiation Oncology, 2Department of Onco-Surgery, “BA” Smt. Lilaben Chimanlal Parikh Cancer Centre, Navsari , Guj

“Systematic analysis of Electronic Medical Record of Patients enrolled for Radiation Therapy in year 2011 at “BA” Smt. L. C. Parikh Cancer Centre.”

In one year of Radiation practice at Ba Cancer Centre we have tried our level best to ensure good radiation treatment for our patients. Overall 292/325 (89.8% ) of patients were able to complete their radiotherapy as per prescribed doses.From curative intent group 214/325 (78.3%) patients are still alive.Average survival of all alive Patients were 8.32 (range 1.36-14.63) months and all died patients were 5.51 (range 0.73-12.63) months. This study has given us strength to do more work in future. Fortunately this is not just study but the way of actual working at “BA” L C Parikh Cancer Centre.

Conclusions

Table7 EBRT Data Survival Figures

Breast Tumors EnrolledNo RT started

Incomplete EBRT

Completed EBRT

Completed EBRT

Alive(dis. Free)

Alive ( with dis.)

Alive (Total)



Breast Tumors- Post MRM

27 (96.42%) 2 0 25 25 24 1 25

7.60 (1.36- 14.60) 0 0 0

Breast Tumors- Post BCS

1 (3.57%) 0 0 1 1 1 0 1 9.96 0 0 0

Total 28 (100%) 2 (7.14%) 0 26 (92.85%) 26 (100%) 25 (96.15%) 1 (3.84%) 26 (100%) 7.69 (1.36 - 14.60) 0 0 0


Gastro-Intestinal Tumors


Incomplete EBRT

Completed EBRT

Completed EBRT

Alive(dis. Free)

Alive ( with dis.)

Alive (Total)



Stomach 1 (16.66%) 0 0 1 1 1 0 1 11 0 0 0

Pancrease 1 (16.66%) 0 1 0 0 0 0 0 0 0 0 0

Colon 1 (16.66%) 0 1 0 0 0 0 0 0 0 0 0

Rectum 2 (33.33%) 0 0 2 2 2 0 26.21

(5.83-6.60) 0 0 0

Anal Canal 1 (16.66%) 0 0 1 1 1 0 1 7.03 0 0 0

Total 6 (100%) 0 2 (33.33%) 4 (66.66%) 4 (100%) 4 (100%) 0 4 (100%) 7.61 (5.83 - 11.00) 0 0 0


Urinary Tract Tumors


Incomplete EBRT

Completed EBRT

Completed EBRT

Alive(dis. Free)

Alive ( with dis.)

Alive (Total)



Ureter 1 (33.33% 0 0 1 1 1 0 1 12.03 0 0 0

Bladder 2 (66.66% 0 0 2 2 0 0 0 0 1 4.96 1

Total 3 (100%) 0 0 3 (100%) 3 (100%) 1(33.33%) 0 1 (33.33%) 12.03 1 (33.33%) 4.96 1 (33.33%)


Male Genito urinary Tumors

Enrolled No RT started

Incomplete EBRT

Completed EBRT

Completed EBRT

Alive(dis. Free)

Alive ( with dis.)

Alive (Total)



No Info

Penis 1(33.33% 0 0 1 1 1 0 1 8 0 0 0

Prostate 2(66.66% 0 0 2 2 1 0 1 1.73 1 4.46 0

Total 3 (100%) 0 0 3 (100%) 3(100%) 2 (66.66%) 0 2 (66.66% 4.86(1.73 - 8.00) 1(33.33% 4.46 0


Hematological and Lymphoma

Enrolled No RT started

Incomplete EBRT

Completed EBRT

Completed EBRT

Alive(dis. Free)

Alive ( with dis.)

Alive (Total)



No Info

Hodgkin's Lymphoma 4(40%) 0 0 4 4 3 1 4 5.41(3.73-7.03) 0 0 0

Non Hodgkin's Lymphoma

5 (50%) 0 2 3 3 3 0 3 9.5(8.43- 11.36) 0 0 0

ALL-PCI 1 (10%) 0 0 1 1 1 0 1 8.2 0 0 0

Total 10 (100%) 0 2 (20%) 8 (80%) 8 (100%) 7 (87.5%) 1 (12.5%) 8 (100%) 7.29 (3.73 - 11.36) 0 0 0


Sarcomas-Bone and Soft Tissue


Incomplete EBRT

Completed EBRT

Completed EBRT

Alive(dis. Free)

Alive ( with dis.)

Alive (Total)



Soft tissue sarcoma 2(100%) 0 0 2 2 2 0 2 10.56(8.6- 12.53) 0 0 0Total 2 (100%) 0 0 2 (100%) 2(100%) 2(100%) 0 2 (100%) 10.56(8.6- 12.53) 0 0 0


Pediatric Tumors EnrolledNo RT started

Incomplete EBRT

Completed EBRT

Completed EBRT

Alive(dis. Free)

Alive ( with dis.)

Alive (Total)



Ewing sarcoma 1(50%) 0 0 1 1 1 0 1 6.33 0 0 0

CNS-pediatric tumor 1 (50%) 1 0 0 0 0 0 0 0 0 0 0

Total 2 (100%) 1 (50%) 0 1 (50%) 1(100%) 1(100%) 0 1(100%) 6.33 0 0 0


Gynecological Tumors

Enroll. No RT started

Incomp. EBRT Complete EBRT

Complete EBRT

Alive(Ds. Free)

Alive (ds stable/progr

ess) Alive (Total) Avg survival

(months) Total Dead Avg survival

(months)No Info

Endometrium 1 (2.63%) 0 0 1 1 1 0 1 10 0 0 0

Cervix 32 (84.21%) 3 1 28 28 15 8 23 9.12(2.93 -14.30) 3 5.27 (3.93-7.96) 2

Vaginal Vault 2 (5.26%) 0 0 2 2 2 0 2 14.11(13.63-14.6) 0 0 0

Vagina 2 (5.26%) 0 0 2 2 1 0 1 8.7 1 11.66 0

Sarcoma 1 (2.63%) 0 0 1 1 1 0 1 13.86 0 0 0

Total 38 (100%) 3 (7.89%) 1 (2.63%) 34 (89.47%) 34 (100%) 20 (58.82%) 8 (23.52%) 28 (82.35%) 9.67 (2.93 -14.6) 4 (11.76%) 6.87(3.93 - 11.66) 2 (5.88%)


1Department of Radiation Oncology, 2Department of Onco-Surgery, “BA” Smt. Lilaben Chimanlal Parikh Cancer Centre, Navsari , Guj

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