Background: Colorectal cancer (CRC) ranks as the third most prevalent cancer and is the second leading cause of cancer-related deaths globally. Despite global advancements, sub-Saharan Africa, particularly the Democratic Republic of Congo, faces considerable challenges in implementing effective treatment protocols, negatively impacting patient outcomes. This study analyzes 43 rectal cancer patients treated at the Muk and Maseb Radiotherapy Centre within the Centre Hospitalier Nganda in Kinshasa. Methodology: We conducted a cohort study with a retrospective data collection approach. The study encompassed all rectal cancer patients treated from January 1, 2020, to December 2024, with follow-up until October 2025. Data were collected between July 2025 and October 30, 2025, and analyzed using SPSS 2021. Results: The average age of patients was 51.67 years, with ages ranging from 22 to 74. The male-to-female ratio was 0.72 (18/25). Performance status was predominantly 0 (44.2%), followed by 1 (41.9%). Tumors were classified as T3 (48.8%) or T4 (51.2%), with lymph node involvement in 76.7% of cases. Curative intent radiotherapy was planned for 86% of patients, with the PRODIGE 23 protocol being the most commonly implemented. The main chemotherapy regimens were FOLFOX 4 (20.93%) and XELOX (18.60%). The delay from diagnosis to radiotherapy consultation averaged 134 days, significantly affecting management. The mean overall survival was 24.30 months (95% CI 19 - 30), with a 3-year survival rate of 20.9%. Conclusion: In summary, timely and high-quality care is crucial for improving survival rates in rectal cancer patients in the Democratic Republic of Congo. Addressing delays in treatment and implementing standardized protocols can significantly enhance patient outcomes and overall prognosis.
KeywordsRectalCancerRadiotherapyOutcomesKinshasa
Arhin, N., Ssentongo, P., Taylor, M., Olecki, E.J., Pameijer, C., Shen, C., et al. (2022) Age-Standardised Incidence Rate and Epidemiology of Colorectal Cancer in Africa: A Systematic Review and Meta-Analysis. BMJ Open , 12, e052376. https://doi.org/10.1136/bmjopen-2021-052376
Morris, V.K., Kennedy, E.B., Baxter, N.N., Benson, A.B., Cercek, A., Cho, M., et al. (2023) Treatment of Metastatic Colorectal Cancer: ASCO Guideline. Journal of Clinical Oncology , 41, 678-700. https://doi.org/10.1200/jco.22.01690
Affleck, A., Koprowskia, M.A., Nabavizadehb, N. and Tsikitis, V.L. (2022) The Evolution of Rectal Cancer Treatment: The Journey to Total Neoadjuvant Therapy and Organ Preservation. Annals of Gastroenterology , 35, 1-8. http://www.annalsgastro.gr/files/journals/1/earlyview/2022/ev-04-2022-04-AG_6595-0712.pdf
Center, M.M., Jemal, A., Smith, R.A. and Ward, E. (2009) Worldwide Variations in Colorectal Cancer. CA : A Cancer Journal for Clinicians , 59, 366-378. https://doi.org/10.3322/caac.20038
Lekoane, K.M.B., Kuupiel, D., Mashamba-Thompson, T.P. and Ginindza, T.G. (2019) Evidence on the Prevalence, Incidence, Mortality and Trends of Human Papilloma Virus-Associated Cancers in Sub-Saharan Africa: Systematic Scoping Review. BMC Cancer , 19, Article No. 563. https://doi.org/10.1186/s12885-019-5781-3
Imad, F.E., Drissi, H., Tawfiq, N., Bendahhou, K., Jouti, N.T., Benider, A., et al. (2019) Aspects épidémiologiques, nutritionnels et anatomopathologiques des cancers colorectaux dans la région du grand Casablanca. Pan African Medical Journal , 32, Article 56. https://doi.org/10.11604/pamj.2019.32.56.10548
Martins, T., Merriel, S.W.D. and Hamilton, W. (2020) Routes to Diagnosis of Symptomatic Cancer in Sub-Saharan Africa: Systematic Review. BMJ Open , 10, e038605. https://doi.org/10.1136/bmjopen-2020-038605
Lee, R. and Holmes, D. (2023) Barriers and Recommendations for Colorectal Cancer Screening in Africa. Global Health Action , 16, Article ID: 2181920. https://doi.org/10.1080/16549716.2023.2181920
Engbang, J.P., Fouda, F.B., Chanwa, U. and Ngowe, M.N. (2021) Prognostic Factors and Survival of Colorectal Cancer in Cameroon: A Retrospective Hospital-Based Study. Open Journal of Gastroenterology , 11, 53-66. https://doi.org/10.4236/ojgas.2021.113006
Akoko, L., Brand, N., Kotecha, V., Byabato, S., Ndumbalo, J., Mwashambwa, M., et al. (2023) Colorectal Cancer in Tanzania: The Current Status and Future Directions. eCancer , 17, Article 1564. https://doi.org/10.3332/ecancer.2023.1564
Knapp, G.C., Alatise, O.I., Olasehinde, O.O., Adeyeye, A., Ayandipo, O.O., Weiser, M.R., et al. (2019) Is Colorectal Cancer Screening Appropriate in Nigeria? Journal of Global Oncology , 5, 1-10. https://doi.org/10.1200/jgo.19.00035
Lambert, H. and Kahindo Mbeva, J. (2020) Femmes et accès aux soins en République démocratique du Congo: Des barrières liées au genre. Santé Publique , 31, 735-744. https://doi.org/10.3917/spub.195.0735
Dijkstra, E.A., Nilsson, P.J., Hospers, G.A.P., Bahadoer, R.R., Meershoek-Klein Kranenbarg, E., Roodvoets, A.G.H., et al. (2023) Locoregional Failure during and after Short-Course Radiotherapy Followed by Chemotherapy and Surgery Compared with Long-Course Chemoradiotherapy and Surgery: A 5-Year Follow-Up of the RAPIDO Trial. Annals of Surgery , 278, e766-e772. https://doi.org/10.1097/sla.0000000000005799
Tseng, M., Soon, Y.Y., Vellayappan, B., Ho, F. and Tey, J. (2019) Radiation Therapy for Rectal Cancer. Journal of Gastrointestinal Oncology , 10, 1238-1250. https://doi.org/10.21037/jgo.2018.12.04
Siegel, R.L., Wagle, N.S., Cercek, A., Smith, R.A. and Jemal, A. (2023) Colorectal Cancer Statistics, 2023. CA : A Cancer Journal for Clinicians , 73, 233-254. https://doi.org/10.3322/caac.21772
Wang, H., Gies, N., Wong, C., Sadowski, D., Moysey, B. and Fedorak, R.N. (2012) Patients Undergoing Colorectal Cancer Screening Underestimate Their Cancer Risk and Delay Presentation for Screening. Canadian Journal of Gastroenterology , 26, 419-423. https://doi.org/10.1155/2012/937184
Bang, G.A., Goura, G.A., Chopkeng, J.C., Savom, E.P., Boukar, Y.M.E., Biwole, D.B., et al. (2022) Emergency Digestive Oncological Surgery in Yaounde (Cameroon): Indications and Short-Term Results. Surgical Science , 13, 198-206. https://doi.org/10.4236/ss.2022.134025
Ouedraogo, S., Tapsoba, T.W., Bere, B., Ouangre, E. and Zida, M. (2019) Épidémiologie, traitement et pronostic du cancer colorectal de l’adulte jeune en milieu sub-saharien. Bulletin du Cancer , 106, 969-974. https://doi.org/10.1016/j.bulcan.2019.08.021
Péus, D., Newcomb, N. and Hofer, S. (2013) Appraisal of the Karnofsky Performance Status and Proposal of a Simple Algorithmic System for Its Evaluation. BMC Medical Informatics and Decision Making , 13, Article No. 72. https://doi.org/10.1186/1472-6947-13-72
Chiu, M.S., Verma, V., Bennion, N.R., Bhirud, A.R., Li, J., Charlton, M.E., et al. (2016) Comparison of Outcomes between Rectal Squamous Cell Carcinoma and Adenocarcinoma. Cancer Medicine , 5, 3394-3402. https://doi.org/10.1002/cam4.927
Dubansky, B., Lewis, S. and Telgenhoff, D. (2023) Classification and Histological Characteristics of Colorectal Cancer. American Society for Clinical Laboratory Science , 36, 50-54. https://doi.org/10.29074/ascls.2022003206
Brierley, J., Giuliani, M., O’Sullivan, B., Rous, B., van Eycken, E. and Union for International Cancer Control (2025) TNM Classification of Malignant Tumours. 9th Edition, Wiley, 251 p.
Ong, M.L.H. and Schofield, J.B. (2016) Assessment of Lymph Node Involvement in Colorectal Cancer. World Journal of Gastrointestinal Surgery , 8, 179-192. https://doi.org/10.4240/wjgs.v8.i3.179
Kim, H.J. and Choi, G. (2019) Clinical Implications of Lymph Node Metastasis in Colorectal Cancer: Current Status and Future Perspectives. Annals of Coloproctology , 35, 109-117. https://doi.org/10.3393/ac.2019.06.12
Shin, A.E., Giancotti, F.G. and Rustgi, A.K. (2023) Metastatic Colorectal Cancer: Mechanisms and Emerging Therapeutics. Trends in Pharmacological Sciences , 44, 222-236. https://doi.org/10.1016/j.tips.2023.01.003
Rocha, L.S.d.S. and Riechelmann, R.P. (2018) Treatment of Patients with Metastatic Colorectal Cancer and Poor Performance Status: Current Evidence and Challenges. Clinics , 73, e542s. https://doi.org/10.6061/clinics/2018/e542s
Qiu, M., Hu, J., Yang, D., Cosgrove, D.P. and Xu, R. (2015) Pattern of Distant Metastases in Colorectal Cancer: A SEER Based Study. Oncotarget , 6, 38658-38666. https://doi.org/10.18632/oncotarget.6130
Benson, A.B., Venook, A.P., Cederquist, L., Chan, E., Chen, Y., Cooper, H.S., et al. (2017) Colon Cancer, Version 1.2017, NCCN Clinical Practice Guidelines in Oncology. Journal of the National Comprehensive Cancer Network , 15, 370-398. https://doi.org/10.6004/jnccn.2017.0036
Shinji, S., Yamada, T., Matsuda, A., Sonoda, H., Ohta, R., Iwai, T., et al. (2022) Recent Advances in the Treatment of Colorectal Cancer: A Review. Journal of Nippon Medical School , 89, 246-254. https://doi.org/10.1272/jnms.jnms.2022_89-310
Liu, Q., Shan, Z., Luo, D., Cai, S., Li, Q. and Li, X. (2019) Palliative Beam Radiotherapy Offered Real-World Survival Benefit to Metastatic Rectal Cancer: A Large US Population-Based and Propensity Score-Matched Study. Journal of Cancer , 10, 1216-1225. https://doi.org/10.7150/jca.28768
Cameron, M.G., Kersten, C., Vistad, I., Fosså, S. and Guren, M.G. (2013) Palliative Pelvic Radiotherapy of Symptomatic Incurable Rectal Cancer—A Systematic Review. Acta Oncologica , 53, 164-173. https://doi.org/10.3109/0284186x.2013.837582
Cameron, M.G., Kersten, C., Vistad, I., van Helvoirt, R., Weyde, K., Undseth, C., et al. (2016) Palliative Pelvic Radiotherapy for Symptomatic Rectal Cancer—A Prospective Multicenter Study. Acta Oncologica , 55, 1400-1407. https://doi.org/10.1080/0284186x.2016.1191666
Willett, C.G. and Gunderson, L.L. (2004) Palliative Treatment of Rectal Cancer: Is Radiotherapy Alone a Good Option? Journal of Gastrointestinal Surgery , 8, 277-279. https://doi.org/10.1016/j.gassur.2003.11.015
Beppu, N., Ikeda, M., Kataoka, K., Kimura, K., Ikeuchi, H., Uchino, M., et al. (2023) Total Neoadjuvant Chemotherapy in Rectal Cancer: Current Facts and Future Strategies. Journal of the Anus , Rectum and Colon , 7, 1-7. https://doi.org/10.23922/jarc.2022-060
Kim, J.H. (2015) Chemotherapy for Colorectal Cancer in the Elderly. World Journal of Gastroenterology , 21, 5158-5166. https://doi.org/10.3748/wjg.v21.i17.5158
Benson, A.B., Venook, A.P., Al-Hawary, M.M., Azad, N., Chen, Y.J., Ciombor, K.K., et al. (2022) Rectal Cancer, Version 2.2022, NCCN Clinical Practice Guidelines in Oncology. Journal of the National Comprehensive Cancer Network , 20, 1139-1167. https://jnccn.org/view/journals/jnccn/20/10/article-p1139.xml
Agyemang-Yeboah, F., Yorke, J., Obirikorang, C., Nsenbah Batu, E., Acheampong, E., Amankwaa Frimpong, E., et al. (2018) Colorectal Cancer Survival Rates in Ghana: A Retrospective Hospital-Based Study. PLOS ONE , 13, e0209307. https://doi.org/10.1371/journal.pone.0209307
Carlomagno, C., De Stefano, A., Rosanova, M., De Falco, S., Attademo, L., Fiore, G., et al. (2018) Multiple Treatment Lines and Prognosis in Metastatic Colorectal Cancer Patients. Cancer and Metastasis Reviews , 38, 307-313. https://doi.org/10.1007/s10555-018-9748-7
Mesli, S.N., Regagba, D., Tidjane, A., Benkalfat, M. and Abi-Ayad, C. (2016) Analyse des facteurs histo-pronostiques du cancer du rectum non métastatique dans une série ouest Algérienne de 58 cas au CHU-Tlemcen. Pan African Medical Journal , 24, Article 5. https://doi.org/10.11604/pamj.2016.24.5.8580
Shan, T., Chen, S., Chen, X., Lin, W., Li, W., Ma, J., et al. (2019) Association of Family History of Tumors with Clinicopathological Characteristics and Prognosis of Colorectal Cancer. European Journal of Cancer Prevention , 28, 258-267. https://doi.org/10.1097/cej.0000000000000482
Gbessi, D.G., Seto, D.M., Antidehou, S.L., Lawani, I., et al. (2015) Facteurs pronostiques de mortalite precoce dans les cancers colo-rectaux au Benin. Benin Medical , No. 59, 21-26. https://bec.uac.bj/uploads/publication/724282668289ec9f27f931d090fb05e7.pdf
Arfa, N., Hamdani, I., Gharbi, L., Ben Abid, S., Ghariani, B., Mannai, S., et al. (2006) Survie et facteurs pronostiques des adénocarcinomes colorectaux: Étude analytique uni-et multifactorielle de 150 cas. Annales de Chirurgie , 131, 104-111. https://doi.org/10.1016/j.anchir.2005.12.012
Pita-Fernández, S., González-Sáez, L., López-Calviño, B., Seoane-Pillado, T., Rodríguez-Camacho, E., Pazos-Sierra, A., et al. (2016) Effect of Diagnostic Delay on Survival in Patients with Colorectal Cancer: A Retrospective Cohort Study. BMC Cancer , 16, Article No. 664. https://doi.org/10.1186/s12885-016-2717-z
Global Burden of Disease 2019 Cancer Collaboration, Kocarnik, J.M., Compton, K., Dean, F.E., Fu, W., Gaw, B.L., et al. (2022) Cancer Incidence, Mortality, Years of Life Lost, Years Lived with Disability, and Disability-Adjusted Life Years for 29 Cancer Groups from 2010 to 2019: A Systematic Analysis for the Global Burden of Disease Study 2019. JAMA Oncology , 8, 420-444. https://jamanetwork.com/journals/jamaoncology/fullarticle/2787350
Cossu, G., Saba, L., Minerba, L. and Mascalchi, M. (2018) Colorectal Cancer Screening: The Role of Psychological, Social and Background Factors in Decision-Making Process. Clinical Practice & Epidemiology in Mental Health , 14, 63-69. https://doi.org/10.2174/1745017901814010063
Irabor, D. (2017) Emergence of Colorectal Cancer in West Africa: Accepting the Inevitable. Nigerian Medical Journal , 58, 87-91. https://doi.org/10.4103/0300-1652.234076