2914 - Acute Radiotherapy-Related Side Effects in Cervical Cancer Patients: A 12-Month Retrospective Study from a Cancer Center in Sub-Saharan Africa

Purpose/Objective(s): Globally, there has been a decline in the incidence of late-stage cervical cancer due to increased screening efforts and HPV vaccinations. However, many Sub-Saharan African countries where screening is limited and vaccination is not widely available carry the majority of the global burden of advanced disease. For locally advanced cervical cancers, radiotherapy (RT) is one of the main treatment methods. This study assessed the prevalence and patterns of acute RT-related side effects (SE) in cervical cancer patients treated at a cancer center in Lagos, Nigeria.

Materials/Methods: This retrospective cohort study evaluated RT-related toxicities in patients treated for cervical cancer at the center between January and December 2024. The validated Common Terminology Criteria for Adverse Events (CTCAE) tool was used to document SE at weekly RT monitoring clinic visits. Data on acute SE occurrence was extracted from electronic medical records. Correlation analysis was done using statistical software, and p<0.05 was considered statistically significant.

Results: Out of 260 cervical cancer patients, 122 (47%) received RT treatment and met inclusion criteria. Of these, 115 (94.3%) received RT with curative intent, while 7 (5.7%) underwent palliative RT. The cohort’s age ranged from 21-90 years, with a mean of 55.68 years. Most patients presented with stage III disease (35.2%), followed by stage II (27%). Brachytherapy combined with external beam radiotherapy (EBRT) was the leading RT regimen (52.5%) followed by EBRT (41%) or brachytherapy alone (6.5%). A proportion of the patients were referred to the center for 3D brachytherapy after having received EBRT at outside hospitals, while others underwent EBRT at the center and then received 2D brachytherapy outside as it is a more cost-effective option. Less than 1/3 (32.8%) of patients received concurrent chemotherapy. Overall, 44 patients (36.1%) endorsed acute RT-related SE. A positive correlation was found between the receipt of RT and SE (p=0.005, 95% CI: 0.079-0.412). Fatigue (29.5%) was the most frequently reported SE, followed by poor appetite (18.1%), lower back pain (15.9%), and constipation (15.9%). Urinary frequency, dizziness & abdominal pain (9.0%) were uncommon, and nausea & diarrhea (4.5%) were the least common.

Conclusion: Fatigue emerged as the most frequently reported acute RT-related SE in cervical cancer patients in this cohort. Previous research from high-income countries has shown that psychological distress is a major contributor to fatigue after cancer treatments & the findings from this study indicate similar patterns in resource-strained settings such as Nigeria. The high rate of locally advanced disease at diagnosis (81%) suggests persisting disparity in access to timely and comprehensive preventive and diagnostic care. These findings re-emphasize the need for enhanced screening programs, strengthening of diagnostic and supportive care infrastructure, & expansion of HPV vaccination coverage in Nigeria.