Prognostic Factors of Locally Advanced Cervical Cancers Seen at the Only Public Radiotherapy Center in Madagascar

Abstract

Introduction : In Madagascar, cervical cancer ranks second among cancer pathologies after breast cancer. It is diagnosed at a locally advanced stage in 79% of cases, where chemoradiotherapy followed by brachytherapy is the standard treatment. In the absence of brachytherapy, our objectives were to describe the evolution of locally advanced cervical cancers treated with chemoradiotherapy and to identify prognostic factors for progression and recurrence. Materials and Methods : This was a retrospective study including cervical cancers from stage IB3 to IVA between January 1, 2020, and December 30, 2021, at the Radiotherapy Department of the Joseph Ravoahangy Andrianavalona University Hospital. The median follow-up time was 15 months. Kaplan Meier analysis was used for disease-free survival. Proportion comparisons were made using the log-rank test and Cox model. Results : We collected data from 64 patients. The remission rate was 51.5% compared to a 48.4% therapeutic failure rate, of which 34.3% was progression and 14% was recurrence. The median time to progression and recurrence was 4 months and 8 months, respectively. The 15-month recurrence-free survival rate was 50%. Fixation to the pelvic wall (p = 0.0001), pelvic and/or lomboaortic lymph node involvement (p = 0.03), and stage (p = 0.001) were significantly associated with the occurrence of therapeutic failure. Conclusion : The prognosis for locally advanced cervical cancers is reserved, largely explained by the very advanced stage of the disease. To improve the therapeutic index, efforts should focus on prevention, and access to brachytherapy equipment is essential.