External Beam Radiotherapy and Brachytherapy for Cervical Cancer: The experience of The National Centre for Radiotherapy in Accra, Ghana

Publication date: Available online 21 December 2017
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Horia Vulpe, Francis Adumata Asamoah, Manjula Maganti, Verna Vanderpuye, Anthony Fyles, Joel Yarney
PurposeMost women with cervical cancer in Sub-Saharan Africa present with locally advanced disease. These women require external beam radiotherapy (EBRT) and brachytherapy for curative treatment, but data on their outcomes remain sparse. We report data on treatment characteristics, follow-up, toxicity, and cancer outcomes in a large population of patients from the XXXXX Centre XXX XXXXXXXXX in XXXX, Ghana.Materials/MethodsThe charts of patients treated from 2006-2011 were reviewed. Patients treated without brachytherapy or with palliative intent were excluded. Staging CT scans were not routinely performed. Cobalt-60 EBRT was followed by 2 low-dose-rate brachytherapy insertions. Concurrent weekly cisplatin was recommended. Because many patients experienced delays from diagnosis to treatment, we calculated overall survival (OS) and locoregional recurrence (LRR) from the date of first radiotherapy to the event date, or last follow-up, when no event recurred, using the Kaplan-Meier product-limit method.Results250 patients had a median age at diagnosis of 55 years. FIGO stage was IIB or lower in 63% of patients. Median dose to point A was 83Gy (range 60-97.5Gy). Median doses to the ICRU bladder and rectal points were 71Gy and 65Gy. 69% of patients received 4 or more cycles of concurrent cisplatin. Median overall treatment time was 73 days. Median follow-up was 2.4 years with a 3-year OS and LRR of 86% and 19% respectively. The most commonly reported late side effect was vaginal stenosis and shortening in 32% of patients. We also identified nearly 300 patients who were offered curative treatment but never returned to start.ConclusionWe report promising outcomes in a population of women with cervical cancer treated with concurrent chemo-RT and brachytherapy in Ghana. To our knowledge, this is the largest series of its kind, and demonstrates what can be achieved with a well-established cancer program in SSA.

Teaser

Most women with cervical cancer in Sub-Saharan Africa present with advanced disease. These women require treatment with concurrent chemo-radiotherapy and brachytherapy, but there is a scarcity of data on patient outcomes. We retrospectively reviewed the experience of The XXXX XXXX for XXXX and I in XXXXX, Ghana. We report encouraging results, demonstrating what can be achieved with a well-established cancer program in Sub-Saharan Africa.


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