Cervical Cancer: The Gabonese Experience

Abstract

Cervical cancer is the 7th most common cancer worldwide causing 260,000 deaths annually. Per region, Africa has the highest incidence and mortality due to cervical cancer. There is limited information regarding stage, treatment and outcomes of cervical cancer in Central Africa. Here, we evaluated the epidemiology and treatment patterns of cervical cancer, the second most common cancer among women in Gabon. In addition, we interrogated the impact of brachytherapy on disease recurrence and toxicities. We identified 117 patients treated for cervical cancer at a center in Libreville, Gabon from 2011 to 2019. Patient and disease characteristics including FIGO stage, treatment duration, external and/or brachytherapy dose, concurrent chemo-radiation were recorded in SPSS. Statistical analyses were performed using Stata. The majority of patients presented with Stage II disease (n = 51, 43.6%) while 19.6%, 17.9% and 18% presented with Stages I, III or IV disease respectively. The mean duration of total treatment time for all stages was 59.7 (SD 15.3; p = .005) though it was higher for advanced stage patients compared to early stage patients. During the study period, twenty-four patients experienced disease progression while ninety-three remained disease -free. The mean duration of treatment was 66 days among those who progressed and 57 days for those who did not (p = .009). Thirty-eight patients underwent surgery (p<.001). Ninety-one patients (78%) underwent concurrent chemoradiation. Sixty percent of Stage I patients received chemoRT compared with over 80% of Stage II, III or IV patients (p = .03). Fifteen patients (16%) received 5-6 cycles of chemotherapy. The median dose of external beam radiation therapy was 66 Gy (SD 8), for all stages but fell to 50.4 Gy for Stage I patients. Among the twenty-four patients who progressed, the mean external beam dose was 65 Gy while it was 60 Gy for those who did not progress (two-sided p = .0016). Two patients suffered from Grade III GI toxicity, and one patient suffered Grade III GU toxicity after external beam radiation treatment. However, the patients who received brachytherapy had fewer Grade II toxicities than those who received solely external beam radiotherapy. External beam radiation therapy, often with concurrent chemotherapy, is delivered safely and effectively at this Gabonese center with less than 1% of patients experiencing Grade III GU or GI toxicities. However, external beam doses for Stages II-IV are higher than those recommended in traditional NCCN/ESTRO/ASTRO guidelines which likely reflects forced improvisation due to a lack of HDR brachytherapy. Funds to replace the brachytherapy machine will positively impact the treatment of patients under their care.