How can radiotherapy provision best respond to increasing numbers of obese patients?

Introduction. Obesity incidence across the western world is rising. By 2015 in the UK an estimate of 36% of males and 28% of females will be obese1. In many areas of healthcare efforts have ben made to meet the needs of this patient group2. However, these changes have not been seen in the radiotherapy department leading to a lack of specialist provision for these individuals3.

Method and Materials. A systematic review of Medline, CINAHL, EMBASE was carried out for relevant literature in all oncology sites. 212 papers were highlighted in the search, with 42 papers meeting the inclusion criteria for full evaluation in the study.

Results. Four themes emerged from the study

• Differences in Set-up Error
• Radiotherapy Side Effects
• Radiotherapy Outcome
• Immobilisation

Site Recommendation.

Head and neck. Further research to determine if:

• Shell immobilisation is adequate
• BMI is related to outcome

Stereotactic lung

• Closer follow-up for obese patients owing to potential for increased risk of chest wall toxicity.
• Additional research into the adequacy of immobilisation used for stereotactic obese patients.

Pelvis (all)

• An increase in set-up margins may be required for obese patients
• Where time and resources allow, daily image guidance should be implemented
• Reduced outcome highlighted in prostate patients

Breast

• Increased skin and lung toxicities were highlighted
• 3DCRT or IMRT planning is required for obese patients to reduce dose inhomogeneities
• Increase the frequency of treatment verification for obese left-sided breast cancer patients
• Prone immobilisation may be of benefit for obese patients
• Increase the frequency of on treatment reviews, follow-ups and cardiac perfusions scans post-radiotherapy

Conclusion. Despite a limited evidence base, this study has highlighted the need for specialist provision for the patient group to ensure radiotherapy is delivered accurately and safely.