Korle Bu Teaching Hospital, Accra, Ghana.
Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON, Canada.
JCO Glob Oncol. 2024 Feb;10:e2300266. doi: 10.1200/GO.23.00266.
To build capacity for improved treatment of locally advanced cervical cancer in Ghana, including computed tomography (CT) staging and intensity modulated radiotherapy (IMRT).
Patients with histologically confirmed cervical cancer were prospectively staged with abdominopelvic CT and ultrasound and offered the opportunity to have IMRT instead of conventional two-dimensional radiotherapy. The development of an efficient, high-quality, and safe IMRT program was facilitated by investment in new technology and comprehensive training of the interdisciplinary radiotherapy team in collaboration with a North American center of excellence.
Of 215 patients with cervical cancer referred in 2022, 66% were able to afford CT scans and 26% were able to afford IMRT. Lymph node metastases were identified in 52% of patients by CT but in only 2% of patients by ultrasound. The use of CT resulted in 63% of patients being upstaged and changed treatment intent or radiation treatment volumes in 67% of patients. Patients who had IMRT experienced fewer acute side effects and were more likely to complete treatment as planned.
It is feasible to provide state-of the-art cancer treatment with CT staging and IMRT to patients with cervical cancer in low-resource settings and achieve meaningful improvements in outcomes. It requires a broad commitment by program leadership to invest in technology and staff training. Major challenges include balancing improved clinical care with reduced patient throughput when radiation treatment capacity is constrained, and with the additional cost in the absence of universal health coverage.
在加纳建立更先进的局部晚期宫颈癌治疗能力，包括计算机断层扫描（CT）分期和调强放疗（IMRT）。
对经组织学证实的宫颈癌患者进行前瞻性的腹盆 CT 和超声分期，并提供调强放疗而非常规二维放疗的机会。通过投资新技术并与北美卓越中心合作，对跨学科放疗团队进行全面培训，促进了高效、高质量和安全的调强放疗计划的发展。
在 2022 年转诊的 215 例宫颈癌患者中，66%的患者能够负担得起 CT 扫描，26%的患者能够负担得起调强放疗。CT 发现 52%的患者有淋巴结转移，但超声仅发现 2%的患者有淋巴结转移。CT 的使用使 63%的患者分期升高，并改变了 67%的患者的治疗意图或放射治疗范围。接受调强放疗的患者急性副作用较少，更有可能按计划完成治疗。
在资源匮乏的环境中为宫颈癌患者提供 CT 分期和调强放疗等最先进的癌症治疗方法是可行的，并能显著改善治疗结果。这需要项目领导层做出广泛的承诺，投资于技术和员工培训。主要挑战包括在放疗能力受限的情况下，平衡改善临床护理与减少患者吞吐量，以及在缺乏全民健康覆盖的情况下，增加额外的成本。
