3D HDR brachytherapy for cervical cancer in LMIC: Audit of a single institution experience in Lagos, Nigeria.

Abstract

Background: The first 3D high-dose-rate brachytherapy (3D-HDR-BT) program for gynecological cancers in Lagos, Nigeria, was launched in August 2021. A retrospective audit of the pilot program was conducted to report the institution's initial experience in treating cervical cancer within the framework of the American Brachytherapy Society (ABS) guidelines.

Methods and materials: 24 patients were audited and divided into 2 groups: Group A, which included the first twelve (who had been treated within 3 months of the program launch), and Group B, which included the next twelve (who received treatment over a subsequent period of 5 months).

Results: The average age was 58.04 years, with the most common stage at presentation being FIGO Stage IIB (50%). Squamous cell carcinoma was the prevalent histologic type (87.5% of cases). The predominant EBRT regimen was 1.8Gy x 25 fractions in 66.67% of patients. For brachytherapy, 62.5% received the 8Gy x 3 fractions regimen. All patients received weekly concurrent chemotherapy with external beam radiation, with the majority getting cisplatin monotherapy during external beam radiotherapy (EBRT). The mean dose to D90 of the HR-CTV was 77.48 ± 6.95Gy and 88.93 ± 4.20Gy in Group A and B patients, respectively. A comparative assessment revealed significant improvement in HRCTV D90 doses for Group B patients.

Conclusion: We report evident improvement in HRCTV D90 doses with increasing numbers and duration of practice, indicating that team proficiency improves with an increasing number of patients treated. Future studies will focus on overall survival and local control rates among patients treated on the program.