3774 - A Prospective Observational Cohort Study Of Hypofractionated Palliative Radiotherapy (10 Gy x 3) For Advanced Cervical Cancer In Sub-Saharan Africa
Presenter(s)
K. Hughes1, S. Amoo-Mitchual2, R. Bhatia3, S. Zhang4, D. T. Reta5, M. Awol5, B. T. Deressa6, E. MacDuffie7, M. Nsingo8, B. Monare9, R. Ketlametswe9, M. Anchondo10, M. Brockman11, and S. Grover7,9; 1University of Oklahoma College of Medicine, Oklahoma City, OK, 2Johns Hopkins University School of Medicine, Baltimore, MD, 3Department of Radiation Oncology, Emory University, Atlanta, GA, 4Biostatistics Analysis Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, 5Addis Ababa University, Addis Ababa, Ethiopia, 6Adama Hospital Medical College, Adama, Ethiopia, 7Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 8Department of Oncology, Gaborone Private Hospital, Gaborone, Botswana, 9Botswana-University of Pennsylvania Partnership, Gaborone, Botswana, 10University of Texas at Southwestern Medical School, Dallas, TX, 11University of North Carolina, Chapel Hill, NC
Purpose/Objective(s):
There are a variety of regimens for palliative pelvic radiation in the setting of locally advanced disease; however, there is little data on its efficacy and feasibility in resource-limited settings. One of the most reported palliative EBRT regimens for cervical cancer is 10 Gy to the pelvis repeated at monthly intervals for a total of three fractions. This study aims to prospectively determine the symptom response in controlling pelvic symptoms in patients with advanced cervical cancer in a multi-institutional study. The primary endpoint is the proportion of patients who achieve symptom improvement (=1 on a 0–5 scale).Materials/Methods:
A single-arm prospective study was conducted among patients with histologically proven, locally advanced cervical cancer requiring palliative radiation in Ethiopia and Botswana. Patients received 2D or 3D whole-pelvic external-beam radiation therapy (EBRT). Baseline demographic and clinical data were collected during the first 10-Gy fraction. Patients returned monthly for scheduled second and third fractions, followed by a 3-month follow-up. Chi-square (?²), Fisher’s exact tests, and time-to-symptom improvement were assessed using Kaplan Meier (KM) analysis. Longitudinal changes in symptom severity were analyzed at baseline, after the 3rd fraction (RT3), and at the final follow-up (3 months after RT3). Firth’s penalized logistic regression was performed to identify baseline predictors of regimen completion.Results:
57 patients were enrolled between November 2021 and January 2024 from Ethiopia (n=52) and Botswana (n=5). The median age was 51 years, and the most common stage at presentation was IVA (n=36). The most common treatment indication was renal dysfunction (n=47). A total of 57 patients received the first fraction, 50 proceeded to the second fraction, 42 completed RT3, and 34 returned for the final follow-up. Compared to baseline, the proportion of patients reporting =1 symptom severity vs. >1) at RT3 was greater for vaginal bleeding (33.3% vs 97.5%, p< 0.001), vaginal discharge (17.5% vs 92.5%, p < 0.001), pelvic pain (3.3% vs 85.4%, p< 0.001). GI toxicity was reported in 31 patients (grade 0 in 5; 1–2 grade in 19; grade = 3 in 7). In Firth penalized logistic regression, baseline profuse bleeding was independently associated with RT3 completion (OR 3.54, 95% CI 1.10–12.58, p=0.03), while ECOG =2 at baseline demonstrated trends of lower rates of completion for all fractions. Lastly, the KM analysis demonstrated that the majority of symptom responses occurred within 30–60 days of treatment initiation, whereas improvement in ECOG performance status was more limited.Conclusion:
These findings support a short course of 10 Gy x 3 monthly fractions as an effective form of palliative treatment to reduce vaginal bleeding, discharge, and pelvic pain. Further studies are needed to investigate toxicities after 3 months of follow-up. The findings support the incorporation of this regimen into palliative care pathways in Sub-Saharan Africa.