Profile of Radiotherapy Side Effects in Patients Treated for Breast Cancer in Cameroon: Case of the Douala General Hospital

Abstract

Background: Conventional radiation therapy is a technique that uses ionizing radiation to destroy tumor cells. Along with surgery, chemotherapy, hormonotherapy and target therapy, it plays a crucial role in the management of breast cancer by reducing its overall mortality and recurrences. Methods: We conducted a retrospective and descriptive study by using the records of patients treated in the radiotherapy department of the Douala General Hospital from January 2015 to December 2019. Data concerning radiation-induced toxicities were collected using a pre-established and pre-tested survey and transferred to the CTCAE Version 4.0 software. Data analysis was performed using SPSS version 20.0. Results: A total of 206 records were selected. The average age was 46.7 ± 8.2 years. The most represented histological type was invasive ductal carcinoma (n = 187, 90.7%). Multimodality treatment was used in every patient in our series with chemotherapy, surgery, and adjuvant radiation therapy (n = 88, 42.7%) been the most represented. More than half of the participants (n = 108, 52.4%) received a total dose >50 grays, only 89 (43.2%) received the classical fractionation of 2 grays/cession, and the average duration of radiation therapy was 36.8 ± 15.4 days. We encountered 155 (75.2%) side effects. There were more acute toxicities than late toxicities, at 115 (74.1%) versus 40 (25.8%). The main acute lesions were radiodermatitis (68.6%), breast pain (16.5%), radiation pneumonitis (12.2%), and acute pericarditis (2.6%). As late lesions, we identified radiodermatitis (52.5%), radiation pneumonitis (32.5%), and lymphoedema (15%). A total dose >50 grays [ p < 0.001 , OR: 2.7 (1.58 - 4.9) ], and conservative surgery [ p = 0.04 , OR: 2.3 (1.3 - 4.1) ], seemed to increase the occurrence of early side effects on bivariate analysis. However, after multivariate logistic regression, only a total dose >50 grays [ p = 0.005 , OR: 2.1 (1.1 - 6.7) ] remained a predictive factor associated to early side effects. We found no factors related to late side effect occurrences. Conclusion: The frequency of side effects of radiation therapy for breast cancer at the Douala General Hospital remains relatively high. Both early and late lesions remained present with early toxicities been the most common. Meticulous strategies along with an enhancement of both human and materials resources are paramount in order to reduce their frequency and morbidity.