Adedayo Joseph

3D HDR brachytherapy for cervical cancer in LMIC: Audit of a single institution experience in Lagos, Nigeria

The first 3D high-dose-rate brachytherapy (3D-HDR-BT) program for gynecological cancers in Lagos, Nigeria, was launched in August 2021. A retrospective audit of the pilot program was conducted to report the institution's initial experience in treating cervical cancer within the framework of the American Brachytherapy Society (ABS) guidelines. 24 patients were audited and divided into 2 groups: Group A, which included the first twelve (who had been treated within 3 months of the program launch), and Group B, which included the next twelve (who received treatment over a subsequent period of 5 months). The average age was 58.04 years, with the most common stage at presentation being FIGO Stage IIB (50%). Squamous cell carcinoma was the prevalent histologic type (87.5% of cases). The predominant EBRT regimen was 1.8Gy x 25 fractions in 66.67% of patients. For brachytherapy, 62.5% received the 8Gy x 3 fractions regimen. All patients received weekly concurrent chemotherapy with external beam radiation, with the majority getting cisplatin monotherapy during external beam radiotherapy (EBRT). The mean dose to D90 of the HR-CTV was 77.48 ± 6.95Gy and 88.93 ± 4.20Gy in Group A and B patients, respectively. A comparative assessment revealed significant improvement in HRCTV D90 doses for Group B patients. We report evident improvement in HRCTV D90 doses with increasing numbers and duration of practice, indicating that team proficiency improves with an increasing number of patients treated. Future studies will focus on overall survival and local control rates among patients treated on the program.

Development and implementation of a 3d-HDR brachytherapy program for cervical cancer in a sub-Saharan African centre

Cervical cancer is the second most common cancer among women in Nigeria where, the gap between need for, and access to, radiation therapy including brachytherapy is significant. This report documents the implementation of the first three-dimensional high-dose-rate (3D-HDR) brachytherapy service for cervical cancer in Nigeria. This report details the steps taken to implement the 3D-HDR brachytherapy program, the challenges faced, and the adaptive strategies employed to overcome them. Our objective is to provide a guide for teams and centers in similar resource-restricted settings to implement 3D-HDR brachytherapy services, by leveraging our shared experience and lessons learned. The implementation process required investment in infrastructure: creating a dedicated brachytherapy suite equipped with modern technology; and human capital: conducting both virtual and hands-on training for staff; and involving international experts during the initial treatment phases. Quality assurance protocols were established to ensure the accuracy and safety of treatments. Key adaptations included extensive remote training, international experts flying in for the initiation phase, and preemptively re-ordering the radioisotope to prevent delays. The 3D-HDR brachytherapy program was successfully implemented, with five cases treated in the first 2 months despite challenges such as high equipment costs, expertise and proficiency needs, and source replacement delays. Continuous training and quality assurance measures ensured the program's sustainability and effectiveness. Implementing a 3D-HDR brachytherapy program in a system with restricted resources is possible with thorough planning, flexible strategies, and adaptive measures. We document our experience to provide insights for other institutions aiming to establish similar programs. Collaboration and innovative financial strategies are essential for ensuring sustainable access to cancer treatment in the region. Strategies such as remote training and proactive resource management, are critical for overcoming implementation barriers.