H. Carvalho

Incidence, Treatment and Outcomes of Cervical Cancer in Low- and Middle-income Countries

Cervical cancer is one of the most common cancers in developing nations. It has had a tremendous impact on the lifetime of millions of women over the last century and continues to do so. In this collaborative clinicians' review, we highlight the incidence, treatment and clinical outcomes of cervical cancer in low-income (LICs) and low- and middle-income countries (LMICs) across Asia, South America, South Africa and Eastern Europe. With the cervical cancer burden and locally advanced cancers being high, the majority of LICs/LMICs have been striving to adhere to optimal evaluation and treatment guidelines. However, the huge gap in resource availability, rural versus urban disparity and access to resources have led to poor compliance to evaluation, treatment and post-treatment rehabilitation. To mitigate the overwhelming numbers, various treatment strategies like neoadjuvant chemotherapy, hypofractionation radiation schedules (both external and brachytherapy) have been attempted with no major success. Also, the compliance to concurrent chemoradiation in various regions is a major challenge. With the burden of advanced cancers, the lack of palliative care services and their integration in cancer care is still a reality.

History of radiotherapy in the treatment of uterine cervix cancer: an overview

Quality of life of patients submitted to radical radiochemotherapy for cervical cancer: Comparison of outcomes between 2D and 3D image guided brachytherapy

To assess QoL in patients with locally advanced cervical cancer treated with radical radiochemotherapy combined with either 2D or 3D brachytherapy, and to compare outcomes between both techniques. A cross-sectional analytical study was conducted from January 2019 to March 2020. EORTC QLQ-C30 and QLQ-CX24 questionnaires were applied at five time points: before treatment, and 1, 3, 6 and 12 months after treatment. Descriptive statistics, Pearson's chi-square, Fisher's exact test and Bonferroni test were used (p ≤ 0.05). Seventy six out of 82 patients completed all the assessments. The overall mean global health status significantly improved from 63.7 to 72.0 (p = 0.019), with no significant difference between the 2D and 3D brachytherapy groups (69.8 vs. 67.8; p = 0.672). All functional domains of the QLQ-C30 improved over time, including financial difficulties, regardless of the brachytherapy technique. Sexual activity increased significantly (2.5-32.4, p < 0.0001), but also did sexual worry, menopausal symptoms, reduced sexual enjoyment, and vaginal dysfunction. Overall improvement in global health and functioning were observed in patients with locally advanced cervical cancer, regardless of the brachytherapy technique used. Despite improved sexual activity, aspects of sexual dysfunction increased, highlighting the need for comprehensive, multidisciplinary care that includes sexual and psychological support, emphasizing the need for individualized care.