3463 - Underutilization Despite Availability: Real-World Radiotherapy Patterns in Lung Cancer in Sub-Saharan Africa
Presenter(s)
O. Fagbemide1, N. Adedewe2, A. O. Ojetunde2, and A. O. Joseph3,4; 1Lagos University Teaching Hospital LUTH Idi-Araba, Lagos, Nigeria, 2Medserve-LUTH Cancer Centre, Lagos University Teaching Hospital, Lagos, Nigeria, 3Medserve - Lagos University Teaching Hospital, Lagos, Nigeria, 4Department of Radiation Biology, Radiotherapy and Radiodiagnosis (RBRR), University of Lagos, College of Medicine, Lagos, Nigeria
Purpose/Objective(s):
Radiation therapy (RT) is central in the management of primary lung cancer. In many low- and middle-income sub-Saharan Africa (SSA) countries, access to RT is hindered by infrastructure and expertise limitations. Recent investments through private partnerships and global collaborations have increased infrastructure availability and provider proficiency. Understanding local patterns of radiotherapy utilization is increasingly crucial to identify and address barriers, optimize proficiency and practice, and shape effective national control strategies.Materials/Methods:
We retrospectively reviewed electronic records of all lung cancer patients who received radiation therapy at a high-volume lung cancer program in Lagos, Nigeria, between January 2020 and December 2024. Demographic, clinical, and treatment data were extracted, including indication, technique, and fractionation. The data were analyzed using descriptive methods to characterize utilization patterns.Results:
Data from 174 patients were analyzed, of which 78 (44.8%) received RT. Mean age at diagnosis was 58.7 years (range 28–80), and 52.6% were female. Non-small cell lung cancer was predominant (79.5%); with adenocarcinoma (51.3%) and squamous cell carcinoma (25.6%) being the most frequent subtypes. 76.9% of patients (n=60) had chest CT only, 14.1% (n=11) had PET-CT, and 8.9% (n=7) had both. Immunohistochemistry was performed in a quarter (26.9%) of cases. The majority (94.9%) had stage IV disease at presentation in the center with metastases to bone (55.1%), brain (46.2%), bone and brain (12.8%), liver (15.4%) and other sites (2.6%). Of the 78 who had RT, intent of treatment was palliative in 92.5%. Overall, they received a total of 117 courses of RT to the whole brain (47.4%), spine (44.9%), pelvis (15.4%), and other sites (30.8%). Common regimens included 3Gy x 10 and 4Gy x 5 fractions for metastases, and 2 Gy x 30 fractions for the primary tumor. Conformal techniques (IMRT and VMAT) were employed in 84.2%. 35.8% had treatment breaks and 86.7% of patients completed the full course. Other interventions included primary surgery (17.9%) and systemic therapy (46.2%) with carboplatin (50%), cisplatin (30.6%), and targeted therapy (26.9%) - most commonly Erlotinib (57.1%) and Bevacizumab (38.1%).Conclusion: Despite the increasing availability of modern conformal techniques, radiation therapy utilization for lung cancer in SSA remains overwhelmingly palliative due to the frequency, and extent, of metastatic disease at the time of evaluation. Other findings included limited molecular testing, restricting personalized therapy. Primary lung radiotherapy is increasingly feasible in SSA with investments in infrastructure, capacity building and the advent of conformal radiation therapy. Utilization to increase survival remains suboptimal due to pervasive advanced stage disease at the time of presentation.