Neoadjuvant chemotherapy and less invasive surgery for the management of early stage cervical cancer: A brief report from Botswana

Grover, Surbhi; Luckett, Rebecca; Bhatia, Rohini; Ralefala, Tlotlo; Ramogola‐Masire, Doreen; Monare, Barati; Bazzett‐Matabele, Lisa; Schmeler, Kathleen M.; Gaolebale, Ponatshego

doi:10.1016/j.gore.2022.101032

Cited by 2 publications

(11 citation statements)

References 12 publications

(16 reference statements)

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“…The potential benefit of this procedure was that it could be performed by a GG without subspecialized training. Despite the small sample size, findings were promising, showing survival of 100% at 3.5 years' follow‐up 28 . Another study described the multidisciplinary cancer care provided at a single institution, including gynecologic cancers; however, surgical care was complicated by the lack of a staffed GG and only intermittent availability of a GS.…”

Section: Discussionmentioning

confidence: 99%

“…[28][29][30][35][36][37] In four studies, GynOncs trained GGs to perform radical hysterectomies and in two instances also pelvic lymphadenectomies. [28][29][30]37 One study included eight patients who underwent neoadjuvant chemotherapy followed by simple hysterectomy with pelvic lymph node sampling for early-stage cervical cancer, instead of radical hysterectomy. The potential benefit of this procedure was that it could be performed by a GG without subspecialized training.…”

Section: Task-shifting or Task-sharingmentioning

confidence: 99%

“…A total of 11 studies (58%) focused on capacity-building interventions to build surgical capacity for gynecologic oncology. 16,[21][22][23][24][25][26][27][28][29][30] More traditional modes of training included fellowship programs and mentorship programs, such as the International Gynecologic Cancer Society (IGCS) Global Curriculum Mentorship and Training program. 16,27 Training was largely directed toward medical students, resident trainees, and fellows.…”

Section: Capacity Building Interventionsmentioning

confidence: 99%

“…Seven studies (37%) were found which focused on task-shifting and/or -sharing. [28][29][30][35][36][37] In four studies, GynOncs trained GGs to perform radical hysterectomy, [28][29][30]36 and pelvic lymphadenectomies in two. 29,30 One study showed a higher likelihood of optimal cytoreduction when operated on by a GynOnc (88%) compared to a GG (52%).…”

Section: Task-shifting or Task-sharingmentioning

confidence: 99%

“…The majority of studies captured by our search strategy evaluated capacity-building interventions. 16,[21][22][23][24][25][26][27][28][29][30] These 11 studies encompassed formal physician fellowship and mentorship programs, 16,27 partnerships with universities based in the Global North or external faculty, 16,21,[23][24][25]27,30 and tele-mentoring or virtual learning. 25 Challenges in implementation include inadequate diagnostic tools, poor preoperative staging, limited preoperative care, supply chain delays and interruptions, lack of necessary instruments, equipment failure, lack of available blood products, as well as transition to virtual learning and surgical backlog related to COVID.…”

Section: Capacity-building Interventionsmentioning

confidence: 99%

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Improving access to safe, quality surgical care for gynecologic cancers through capacity‐building interventions in low‐ and middle‐income countries: A scoping review

Hill,

Bempong‐Ahun,

Okolo

et al. 2023

Intl J Gynecology & Obste

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BackgroundFollowing the launch of the World Health Organization's Strategy to accelerate the elimination of cervical cancer, diagnosis is expected to increase, especially in low‐ and middle‐income countries (LMICs). A well‐integrated surgical system is critical to treat cervical cancer. Two major approaches have been employed to build human capacity: task‐sharing and training of gynecologic oncologists (GynOncs).ObjectivesThis review aimed to explore existing literature on capacity‐building for surgical management of early‐stage gynecologic cancers.Search StrategyThe search strategy was registered on Open Science Framework (doi 10.17605/OSF.IO/GTRCB) and conducted on OVID Medline, Embase, Global Index Medicus, and Web of Science. Search results were exported and screened in COVIDENCE.Selection CriteriaStudies published in English, Spanish, French, and/or Portuguese conducted in LMIC settings evaluating capacity building, task‐sharing, or outcomes following operation by subspecialists compared to specialists were included.Data Collection and AnalysisResults were synthesized using narrative synthesis approach with emergence of key themes by frequency.Main ResultsThe scoping review identified 18 studies spanning our themes of interest: capacity building, subspecialized versus non‐subspecialized care, and task‐shifting/−sharing.ConclusionsA multilayered approach is critical to achieve the WHO Strategy to Eliminate Cervical Cancer. Capacity‐building and task‐sharing programs demonstrate encouraging results to meet this need; nevertheless, a standardized methodology is needed to evaluate these programs, their outcomes, and cost‐effectiveness.

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Section: Discussionmentioning

confidence: 99%

Section: Task-shifting or Task-sharingmentioning

confidence: 99%

Section: Capacity Building Interventionsmentioning

confidence: 99%

Section: Task-shifting or Task-sharingmentioning

confidence: 99%

Section: Capacity-building Interventionsmentioning

confidence: 99%

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Improving access to safe, quality surgical care for gynecologic cancers through capacity‐building interventions in low‐ and middle‐income countries: A scoping review

Hill,

Bempong‐Ahun,

Okolo

et al. 2023

Intl J Gynecology & Obste

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Outcomes of neoadjuvant chemotherapy and radical hysterectomy for locally advanced cervical cancer at Kigali University Teaching Hospital, Rwanda: a retrospective descriptive study

Ngabonziza,

Ghebre,

DeBoer

et al. 2024

BMC Women's Health

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Background Half of countries in Africa lack access to radiation (RT), which is essential for standard treatment of locally advanced cervical cancers. We evaluated outcomes for patients treated with neoadjuvant chemotherapy (NACT) followed by radical hysterectomy in settings where no RT is available. Methods We performed a retrospective descriptive study of all patients with FIGO stage IB2-IIA2 and some exceptional stage IIB cases who received NACT and surgery at Kigali University Teaching Hospital in Rwanda. Patients were treated with NACT consisting of carboplatin and paclitaxel once every 3 weeks for 3–4 cycles before radical hysterectomy. We calculated recurrence rates and overall survival (OS) rate was determined by Kaplan-Meier estimates. Results Between May 2016 and October 2018, 57 patients underwent NACT and 43 (75.4%) were candidates for radical hysterectomy after clinical response assessment. Among the 43 patients who received NACT and surgery, the median age was 56 years, 14% were HIV positive, and FIGO stage distribution was: IB2 (32.6%), IIA1 (7.0%), IIA2 (51.2%) and IIB (9.3%). Thirty-nine (96%) patients received 3 cycles and 4 (4%) received 4 cycles of NACT. Thirty-eight (88.4%) patients underwent radical hysterectomy as planned and 5 (11.6%) had surgery aborted due to grossly metastatic disease. Two patients were lost to follow up after surgery and excluded from survival analysis. For the remaining 41 patients with median follow-up time of 34.4 months, 32 (78%) were alive with no evidence of recurrence, and 8 (20%) were alive with recurrence. One patient died of an unrelated cancer. The 3-year OS rate for the 41 patients who underwent NACT and surgery was 80.8% with a recurrence rate of 20%. Conclusions Neoadjuvant chemotherapy with radical hysterectomy is a feasible treatment option for locally advanced cervical cancer in settings with limited access to RT. With an increase in gynecologic oncologists skilled at radical surgery, this approach may be a more widely available alternative treatment option in countries without radiation facilities.

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Neoadjuvant chemotherapy and less invasive surgery for the management of early stage cervical cancer: A brief report from Botswana

Cited by 2 publications

References 12 publications

Improving access to safe, quality surgical care for gynecologic cancers through capacity‐building interventions in low‐ and middle‐income countries: A scoping review

Improving access to safe, quality surgical care for gynecologic cancers through capacity‐building interventions in low‐ and middle‐income countries: A scoping review

Outcomes of neoadjuvant chemotherapy and radical hysterectomy for locally advanced cervical cancer at Kigali University Teaching Hospital, Rwanda: a retrospective descriptive study

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