GSOR05 Presentation Time: 5:20 PM

Abstract

Purpose

Bugando Medical Centre (BMC) is the only radiotherapy facility in northern Tanzania, and one of only two public facilities for radiotherapy in a country of 60 million. We aimed to characterize gynecologic brachytherapy at BMC and determine patient outcomes. This is the first clinical report from the department since it became operational in 2017.

Materials and Methods

This was a retrospective cohort study from 2019, including all patients treated with gynecologic brachytherapy at BMC. Treatment factors, patient characteristics, travel distance/time, and follow-up duration were the primary outcomes. Lack of survival data in available records precluded OS calculations.

Results

In 2019, BMC performed 662 brachytherapy procedures, including 204 new starts. HDR brachytherapy was performed with 2D techniques using one Cobalt-60 afterloader. Of the 204 new starts, 195 were evaluable. The median age was 51 years (IQR 44-61 yrs). Stage at diagnosis was 1B in 36 (19%), 2A in 46 (24%), 2B in 49 (25%), 3A in 9 (5%), and 3B in 50 (26%). Histology was squamous cell carcinoma in 139 (71%), adenocarcinoma in 12 (6%), and unknown/other in 44 (23%). HIV status was unknown in 148 (76%), and positive in 22 (11%). 67 patients (34%) were anemic with a hemoglobin of <10 at baseline. Patients came from 36 distinct districts in 11 regions. Median distance traveled was 144 kms (IQR 65-225 kms), and median travel time was 3 hours (IQR 1.8-4.3 hrs). There was no significant difference in disease stage by travel distance or time (p=0.7 & p=0.4). Most patients (86%) were uninsured, and 13% were covered by the national health insurance plan. All patients were treated with curative intent, 177 (91%) were treated with concurrent chemotherapy with EBRT prior to brachytherapy, and 181 (93%) completed planned brachytherapy. Majority of the cases were 3 fractions at 8 Gy/fx prescribed to point A (160 [82%]). Thirteen patients (7%) did not complete planned brachytherapy. Median total duration of treatment was 72 days (IQR 60-109 d). Median duration of EBRT and from EBRT to brachytherapy was 34 days (IQR 34-35 d) and 25 days (IQR 10-78 d) respectively. Median duration of brachytherapy was 14 days (IQR 14-18 d), and 13 (7%) had significant delays of over 40 days to complete brachytherapy. 24 of 167 patients (14%) with data available completed radiation treatment within 55 days. In post-treatment surveillance, 153 (78%) had survival follow up for review in the records. At a median follow up of 15.7 months (IQR 5.7-39.4 mos) for these patients, 2 death events were documented. Assuming a 2-year OS of 65% with 2D brachytherapy based on historical studies, we would have expected approximately 45 events during this timeframe.

Conclusions

In this initial report, we detailed the clinical and treatment characteristics of brachytherapy patients at BMC - the only facility in a catchment area of over 15 million in Tanzania. Prospective cohorts are being developed to overcome gaps in patient follow-up and to characterize survival outcomes in this high-volume center. Future studies are needed to determine barriers to timely care for brachytherapy and will be aimed at improving access and reducing total treatment time. This study provides a framework for future research at BMC radiation oncology.