Evaluation of Radiotherapy Outcomes in Cervical Cancer: A Multicenter Case Series Study from Libya (2019–2022)

Abstract

Background: The cervical cancer is considered as fourth most common female cancer with estimated frequency was 662,301 new cases annually worldwide particularly in low- and middle-income courtiers (LMICs). The treatment options depend on cervical cancer staging at time of diagnosis which includes surgery interventions, chemoradiation, and combination of both.

Aims: This study aimed to evaluate the radiotherapy outcomes among Libyan women with cervical carcinoma.

Methods and Materials: This study was case series study carried out at multicenter settings included three radiation oncology departments in three different cities in Libya included Tripoli University Hospital, National Cancer Institute Misruata and National Cancer Institute Sabruata between January 2019 and December 2022. The study included adult Libyan women who diagnosed by cervical cancer. The data was collected and analyzed by Statistical Package for the Social Sciences (SPSS) version 24.

Results: In this study, the mean age was 55.59 years ± 12.015 SD, 79.4% (27) were multipara, According to FIGO classifications, 29.4% (10) had stage IB1 followed by 17.6% (6) had stage IIB and similar percentage recognized for stage IIIB. 70.6% (24) had squamous cell carcinoma. And most patients had negative margin resection accounted for 88.2% (30). Half of patients had expressed lymphovascular invasion and lymph node metastasis. About 67.6% (23) had received concurrent chemo radiotherapy while 32.4% (11) had received radiotherapy only because patients were unfit for operation. And 85.3% (29) had received External Beam Radiation Therapy (EBRT) alone while 14.7% (5) had received both EBRT combined with brachytherapy. Acute and late side effects of radiotherapy had been identified. About half of patients had good outcomes followed radiotherapy with five years survival rate for 55.9% (19), out of five cases from those 19 cases had received brachytherapy combined with external beam radiation therapy which found to had statistically significant results (P-value = 0.001).

Conclusion: In this study, the majority of cervical cancer cases had squamous cell carcinoma, which frequently relays between IB1 and IIIB staging, with a high rate of negative margin resection identified. The rate of radiotherapy side effects was reported to be higher among cases who received external beam radiotherapy followed by brachytherapy in comparison to those who underwent external beam radiotherapy alone. Moreover, despite the absence of brachytherapy facilities in our country but the five cases who received it outside the country exhibit good health outcomes with five years survival rate.