Complication of radiotherapy in the management of invasive cancer of the cervix at Kenyatta National Hospital

Abstract

Background: Cancer of the cervix is not only the second most common cancer affecting women worldwide but is also the most common gynecological cancer in Kenya. An estimated 500,000 cases occur every year of which 80% are from the developing countries. Presentation is usually during late stages requiring radiotherapy as the main form of management. Radiotherapy has its side effects which could be late or early.
Objective: This study sought to evaluate the complications of radiotherapy among patients with advanced carcinoma of the cervix treated at the Kenyatta National Hospital.
Patient and Methods: This was a descriptive retrospective study of the data collected from the radiotherapy unit of Kenyatta National Hospital, which is the only public hospital with radiotherapy facilities in Kenya. The study population was from that of women treated for cervical cancer at Kenyatta National Hospital between 2000 to 2004. The data collected included age, parity, histological type, stage at presentation, cormobidities, duration and dose of radiotherapy and complications. The files were sampled in such a way that only every fifth file was analyzed for the above data.
Results: There were 1545 patients during this period. Of the above 306 files were analyzed. The average age at presentation was 48.6 years. 5.2% were HIV positive. 3.3% were at stage IB, 41.5% stage II, 47.5% stage III and 7.7% stage IV. 86.7% had squamous cell carcinoma. Common early toxicities included skin burn, diarrhea and rectal bleeding. The common late complication included skin fibrosis and proctitis.
Conclusion: Most patients present at late stage of the disease. The commonest complications affect skin and gastrointestinal systems. Duration and dosage of radiotherapy were significantly associated with the number of systems affected.