Advancing Pediatric Radiation Therapy in sub-Saharan Africa: Report from a Pediatric Radiation Oncology Program in Nigeria

Abstract

Objectives

Pediatric radiation oncology is a rapidly emerging field in sub-Saharan Africa (SSA). There remain multiple opportunities for improvement despite ongoing advancements. This report documents the development, and implementation of a pediatric radiation oncology program in Nigeria.

Methods

A framework for the development and implementation relevant and feasible in light of local resources was designed. Preparation began in September 2022 and focused on three goals: Patients (improve outcomes and minimize side effects), Professionals (build capacity and multidisciplinary practice), and Protocols (local data and research). Key enabling factors were technology, training, and cohesion. Training, tumor board meetings, and weekly chart rounds, were initiated in collaboration with international experts. Equipment such as pediatric size immobilization devices were procured, and the unit was launched officially in September 2023.

Results

The pediatric radiation unit consists of two radiation oncologists, two medical physicists, three radiation therapy technologists, two oncology nurses, and trainees. The facility has three Linear Accelerators enabling the team to deliver conformal radiotherapy (IMRT/VMAT and SBRT). A retrospective review of pediatric cancer treatment at the facility revealed a total of 210 pediatric patients treated between 2020 and 2023 with an average age of 10.9 years. CNS tumors represented 28.1% of cases and 55.7% of patients received radiotherapy (RT). Among those who received RT, 54.7% had treatment breaks, 24.8% abandoned treatment and 75.2% completed their treatment. Recruitment of allied professionals such as physical or rehabilitation therapists specialized in pediatric oncology is a persisting challenge. Future efforts will focus on reducing treatment interruptions and abandonment.

Conclusion

Dedicated pediatric radiation oncology programs are an important step to improve pediatric cancer outcomes in SSA. Articulating goals, opportunities, challenges, solutions, and enabling factors as well as investment in capacity building, infrastructure, research, and collaboration are necessary for successful implementation.