Original Research

A retrospective review of conventional versus hypo-fractionated pelvic radiotherapy for locally advanced cervical cancer, in limited-resource countries: The Uganda experience

Awusi Kavuma, Israel Luutu, Solomon Kibudde, Cissy Bangidde
South African Journal of Oncology | Vol 5 | a186 | DOI: https://doi.org/10.4102/sajo.v5i0.186 | © 2021 Awusi Kavuma, Israel Luutu, Solomon Kibudde, Cissy Bangidde | This work is licensed under CC Attribution 4.0
Submitted: 28 May 2021 | Published: 22 September 2021

About the author(s)

Awusi Kavuma, Department of Radiotherapy, Uganda Cancer Institute, Kampala, Uganda
Israel Luutu, Department of Radiotherapy, Uganda Cancer Institute, Kampala, Uganda
Solomon Kibudde, Department of Radiotherapy, Uganda Cancer Institute, Kampala, Uganda
Cissy Bangidde, Department of Radiotherapy, Uganda Cancer Institute, Kampala, Uganda


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Abstract

Background: Cervical cancer incidence in Uganda is 54.8 per 100 000 population. We annually treat over 800 new cervical cancers (40% of the workload), which is challenging to treat such numbers in limited resources settings. From July 2011, we commenced the use of hypo-fractionated radiotherapy (HFRT) of 45 Gy/15 fraction (#) as an alternative to conventional fractionated radiotherapy (CFRT) of 50 Gy/25#, for treatment of locally advanced cervical cancer (LACC).

Aim: To compare the 5-year follow-up treatment outcomes between CFRT and HFRT.

Settings: The study analysed patients treated at the Uganda Cancer Institute – a limited resource institution.

Methods: This was a non-randomised, retrospective study, where 414 patients’ files were reviewed according to demographic, clinical, radiotherapy fractionations and outcomes. Inclusion criteria were International Federation of Gynecology and Obstetrics stages IIB–IIIB cervical cancer cases and had completed external beam radiotherapy and intracavitary radiotherapy.

Results: Squamous cell carcinomas were 93.6% and adenocarcinomas were 3.0%. The median age was 49.5 (interquartile range [IQR]: 40.0–56.0) years. Stages IIB/IIIA/IIIB were 36.2%, 8.2%, 55.6%, respectively. Human immunodeficiency virus serology was positive, negative, and unknown in 70 (16.9%), 116 (28.0%) and 228 (55.1%), respectively. Concurrent chemo-radiation was administered in 182 (44.0%) patients. Conventional fractionated radiotherapy and HFRT were 221 (53.4%) and 193 (46.6%), respectively. At 6 months, the overall response rate was 73.3% for CFRT compared with 67.6% for HFRT (p = 0.085), whilst the grades 0–1 toxicities were 94.5% and for 94.7% CFRT and HFRT, respectively (p = 0.080). At 60 months, the survival probabilities were 44.9% for CFRT and 46.6% for HFRT (p = 0.293).

Conclusion: There is no significant statistical difference between CFRT and HFRT for the treatment of LACC. The HFRT could be considered for high volume limited resource settings.


Keywords

cervical cancer; conventional-radiotherapy; hypo-fractionated radiotherapy; limited-resource countries; 5-year survival rate

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