External Beam Radiation Therapy and Brachytherapy for Cervical Cancer: The Experience of the National Centre for Radiotherapy in Accra, Ghana

Vulpe, Horia; Asamoah, Francis Adumata; Maganti, Manjula; Vanderpuye, Verna; Fyles, Anthony; Yarney, Joel

doi:10.1016/j.ijrobp.2017.12.270

Cited by 22 publications

(27 citation statements)

References 20 publications

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“…Currently, pelvic EBRT with intracavity BT is the recommended standard treatment for the definitive treatment of CC (10). Although pelvic conventional RT for treating CC results in satisfactory therapeutic outcomes, it is associated with serious acute and chronic toxicity, including small bowel obstruction, enteritis, rectitis, and radiation cystitis (11).…”

Section: Discussionmentioning

confidence: 99%

Clinical Outcomes of Volumetric Modulated Arc Therapy Following Intracavitary/Interstitial Brachytherapy in Cervical Cancer: A Single Institution Retrospective Experience

et al. 2019

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Purpose: To evaluate treatment outcomes and toxicity in patients with cervical cancer (CC) treated with volumetric modulated arc therapy (VMAT), followed by three-dimensional high-dose-rate intracavity combined with interstitial brachytherapy (IC/IS BT) compared with intensity-modulated radiation therapy (IMRT) treatment. Materials and Methods: A total of 398 patients with stage IA–IVB CC treated with definitive radiotherapy with or without chemotherapy were retrospectively analyzed (331 VMAT and 67 IMRT). A total prescription dose of 45–50 Gy was delivered to pelvic field with VMAT/IMRT in 25/28 fractions, with five fractions per week. Every patient further received IC/IS BT for four to six 6.0-Gy fractions. Local control (LC), disease-free survival (DFS), overall survival (OS), and distant metastasis-free survival (DMFS) rates were calculated. Acute hematotoxicity and late toxicity were recorded. Results: The median follow-up period was 25.47 (range, 0.93–58.93) months for the VMAT and 35.07 (4.8–90.37) months for IMRT. The 3-year OS, DFS, LC, and DMFS rate were 80.5, 65.4, 88.7, and 78.1% in VMAT group, and 76.2, 76.4, 83.1, and 86.1% in the IMRT group, respectively. No significant differences were found between VMAT and IMRT groups for OS, DFS, LC, and DMFS rate. However, patients in the VMAT group had lower incidence of chronic enterocolitis complication (26.6 vs. 38.8%, p = 0.004). In addition, a total of 3 (0.9%) patients developed grade 3 chronic cystitis, and 7 (2.1%) patients developed grade 3 or greater chronic enterocolitis in VMAT group. Conclusion: VMAT combined with IC/IS BT can result in satisfactory curative outcomes and low incidences of late radiation enterocolitis and cystitis in CC treatment.

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Section: Discussionmentioning

confidence: 99%

Clinical Outcomes of Volumetric Modulated Arc Therapy Following Intracavitary/Interstitial Brachytherapy in Cervical Cancer: A Single Institution Retrospective Experience

et al. 2019

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“…We reported our experience using LDR brachytherapy with a 3-year locoregional recurrence rate of 19%, 3-year OS of 86%, and median treatment completion time of 73 days. 7 The center transitioned to an HDR brachytherapy program in 2014, which offers outpatient treatment, higher treatment capacity, and the potential to complete treatment within 9 weeks, which has been realized in this study.…”

Section: Discussionmentioning

confidence: 96%

“…The National Radiotherapy Oncology and Nuclear Medicine Center of Korle-Bu Teaching Hospital (NRONMC) treats a high volume of patients with cervical cancer in West Africa. 7 Moffitt Cancer Center (MCC) is a National Cancer Institute Comprehensive Cancer Center offering sophisticated cervical cancer treatment delivery. The objective of this study was to evaluate differences in patterns of care and disease characteristics between the two institutions to identify differences that affect clinical outcomes and opportunities for treatment optimization.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Definitive Cervical Cancer Management With Chemotherapy and Radiation Between Two Centers With Variable Resources and Opportunities for Improved Treatment

Asamoah

Yarney

Scott

et al. 2020

JCO Global Oncology

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PURPOSE Cervical cancer remains a major health challenge in low- to middle-income countries. We present the experiences of two centers practicing in variable resource environments to determine predictors of improved radiochemotherapy treatment. METHODS AND MATERIALS This comparative review describes cervical cancer presentation and treatment with concurrent chemoradiotherapy with high-dose-rate brachytherapy between 2014 and 2017 at the National Radiotherapy Oncology and Nuclear Medicine Center (NRONMC) in Korle-Bu Teaching Hospital, Accra, Ghana, and Moffitt Cancer Center (MCC), Tampa, FL. RESULTS Median follow-up for this study was 16.9 months. NRONMC patients presented with predominantly stage III disease (42% v 16%; P = .002). MCC patients received para-aortic node irradiation (16%) and interstitial brachytherapy implants (19%). Median treatment duration was longer for NRONMC patients compared with MCC patients (59 v 52 days; P < .0001), and treatment duration ≥ 55 days predicted worse survival on multivariable analysis (MVA; P = .02). Stage ≥ III disease predicted poorer local control on MVA. There was a difference in local control among patients with stage III disease (58% v 91%; P = .03) but not in survival between MCC and NRONMC. No significant difference in local control was observed for stage IB, IIA, and IIB disease. CONCLUSION Although there were significant differences in disease presentation between the two centers, treatment outcomes were similar for patients with early-stage disease. Longer treatment duration and stage ≥ III disease predicted poor outcomes.

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“…In addition, radiotherapy may present the only curative option for patients with inoperable tumors [5]. In practice, patients with stage IIB-IVA cervical cancer are treated with a combination of external beam radiotherapy, brachytherapy and chemotherapy [6]. Combined radiotherapy regimens offer maximal local control of cancerous lesions, while sparing the healthy tissues and extending the survival of patients [1,7].…”

Section: Introductionmentioning

confidence: 99%

“…This rare phenomenon, known as the Abscopal effect, has been linked to mechanisms involving the immune system, which mediates the regression of tumors throughout the body [11]. The activation of the immune system is induced by the radiation damage of cancer cells leading to specific type of apoptosis, immunogenic cell death [6]. This leads to an increased release of tumor antigens and damage-associated molecular patterns, that in the presence of antigen presenting cells (APCs), could prime the abscopal effect [12].…”

Section: Introductionmentioning

confidence: 99%

Single Radiotherapy Fraction with Local Anti-CD40 Therapy Generates Effective Abscopal Responses in Mouse Models of Cervical Cancer

Wood

Yasmin-Karim

Mueller

et al. 2020

Cancers

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Current treatment options for advanced cervical cancer are limited, especially for patients in poor-resource settings, with a 17% 5-year overall survival rate. Here, we report results in animal models of advanced cervical cancer, showing that anti-CD40 therapy can effectively boost the abscopal effect, whereby radiotherapy of a tumor at one site can engender therapeutically significant responses in tumors at distant untreated sites. In this study, two subcutaneous cervical cancer tumors representing one primary and one metastatic tumor were generated in each animal. Only the primary tumor was treated and the responses of both tumors were monitored. The study was repeated as a function of different treatment parameters, including radiotherapy dose and dosing schedule of immunoadjuvant anti-CD40. The results consistently suggest that one fraction dose of radiotherapy with a single dose of agonistic anti-CD40 can generate highly effective abscopal responses, with a significant increase in animal survival (p = 0.0004). Overall, 60% of the mice treated with this combination showed long term survival with complete tumor regression, where tumors of mice in other cohorts continued to grow. Moreover, re-challenged responders to the treatment developed vitiligo, suggesting developed immune memory for this cancer. The findings offer a potential new therapy approach, which could be further investigated and developed for the treatment of advanced cervical cancer, with major potential impact, especially in resource-poor settings.

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External Beam Radiation Therapy and Brachytherapy for Cervical Cancer: The Experience of the National Centre for Radiotherapy in Accra, Ghana

Cited by 22 publications

References 20 publications

Clinical Outcomes of Volumetric Modulated Arc Therapy Following Intracavitary/Interstitial Brachytherapy in Cervical Cancer: A Single Institution Retrospective Experience

Clinical Outcomes of Volumetric Modulated Arc Therapy Following Intracavitary/Interstitial Brachytherapy in Cervical Cancer: A Single Institution Retrospective Experience

Comparison of Definitive Cervical Cancer Management With Chemotherapy and Radiation Between Two Centers With Variable Resources and Opportunities for Improved Treatment

Single Radiotherapy Fraction with Local Anti-CD40 Therapy Generates Effective Abscopal Responses in Mouse Models of Cervical Cancer

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