Main Session
Sep
28
PQA 04 - Breast Cancer, Patient Reported Outcomes/QoL/Survivorship, Functional Radiation Medicine, Hematologic Malignancies, Palliative Care, and International/Global Oncology
Presenter(s)
David Nganga, MD - University of North Carolina Hospitals, Chapel Hill, NC
D. Nganga1, A. Chirwa2, T. Chikaonda2, E. Kasonkanji2, M. Chikasema2, N. Mumba2, M. Mulenga2, T. Tomoka2, Y. Fedoriw3, S. Sud4, and M. Painschab5; 1Department of Radiation Oncology, University of North Carolina Hospitals, Chapel Hill, NC, 2University of North Carolina Project Malawi, Lilongwe, Malawi, 3University of North Carolina Chapel Hill, Chapel Hill, NC, 4Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC, 5Indiana University, Indianapolis, IN
Purpose/Objective(s):
Cancer care in Sub-Saharan Africa is challenging, in part due to decreased availability of radiation therapy (RT). In Malawi, the first LINAC was commissioned in July 2025. We performed a secondary analysis of a prospective cohort of lymphoma patients in Malawi to understand RT needs.Materials/Methods:
The Kamuzu Central Hospital (KCH) Lymphoma Study is a prospective, observational cohort of lymphoma patients treated at KCH in Lilongwe, Malawi, 2013-2025. The present study analyzed a cohort of patients with a diagnosis of diffuse large B-cell lymphoma (DLBCL) and classical Hodgkin lymphoma (cHL) for candidacy for RT. Eligibility for definitive intent RT was stage I/II disease and for palliative intent RT was stage III/IV with any of CNS involvement, bony disease for pain or stabilization, or symptomatic disease such as painful tumors, cord compression, airway obstruction, or vascular compromise. Patients with stage I/II disease were also considered for palliative RT if they had relapse/refractory disease following definitive therapy. Simple descriptive statistics were used to characterize patient demographics, disease characteristics and eligibility for RT.Results:
262 patients with DLBCL and 58 patients with cHL were included in this study. Of these, 159 (61%) DLBCL and 34 (58%) cHL patients were male, with a median age of 46 (range 16-92) and 28 (range 13-76), respectively. Stage I/II disease was present in 117 (45%) of DLBCL and 23 (40%) of cHL patients. HIV infection was present in 169 (64%) DLBCL and 18 (30%) cHL patients. In patients with DLBCL,198 (76%) met criteria for potential benefit from RT. Of the DLBCL patients meeting criteria, 116 (59%) would have qualified for definitive RT vs 81(41%) for palliative RT. Criteria warranting evaluation for definitive RT were stage I/II disease, of which 41 (37%) had non-bulky disease. Of the DLBCL patients needing evaluation for definitive therapy, 12 (10%) had disease refractory to first line therapy, while 16 (14%) had relapsed after remission and would have potentially benefitted from RT in the absence of transplant services. Reasons for needing evaluation for palliative RT in stage III/IV patients with DLBCL included CNS disease (4), airway obstruction (3), cord compression (1), bony disease (1) and bulky tumors (72). In patients with cHL, 29 (54%) met criteria for potential benefit from RT; 21 (72%) for definitive RT and eight (28%) for palliative RT. Bulky disease was the main reason for needing evaluation for palliative RT in patients with cHL.Conclusion:
There is a historic unmet need for RT services in patients with lymphoma and other malignancies in Malawi as evidenced by this study. Quantifying these RT gaps in potential utilization provides essential evidence to support strategic planning, infrastructure investment, policy and advocacy for RT expansion in Malawi and similar low-resource settings where salvage therapies such as CAR-T, bispecific antibodies and autologous stem cell transplant are not often available.