Cervical cancer treatment in Rwanda: Resource-driven adaptations, quality indicators, and patient outcomes

DeBoer, Rebecca; Umutoni, Victoria; Bazzett‐Matabele, Lisa; Katznelson, Ethan; Nguyen, Cam; Umwizerwa, Aline; Bigirimana, Jean Bosco; Paciorek, Alan; Nsabimana, Nicaise; Ruhangaza, Deogratias; Ntasumbumuyange, Diomede; Shulman, Lawrence N.; Triedman, Scott A.; Shyirambere, Cyprien

doi:10.1016/j.ygyno.2021.12.002

Cited by 9 publications

(9 citation statements)

References 40 publications

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“…In qualitative research examining the values associated with radiotherapy prioritization in Rwanda, oncology clinicians highlighted the tension between their role as stewards of limited radiotherapy resources and their obligations to individual patients. 34 They emphasized the difficulty of not being able to send patients for palliative radiotherapy, but upheld that it would be unacceptable for a curable patient to lose a chance of cure because an incurable patient received priority.…”

Section: Lessons Learned From Experiences In Lmicsmentioning

confidence: 99%

“…36,37 In Rwanda, clinicians and program leaders widely agreed that life expectancy and potential life-years gained by curing disease should be considered in the allocation of limited radiotherapy resources, although opinions varied about the appropriateness of age cutoffs. 34 Recognizing that no single principle sufficiently captures all morally relevant considerations, multiprinciple allocation systems have been developed, such as the United Network for Organ Sharing 35 or priority scores for ventilator allocation durign the COVID-19 pandemic. 2 Third, fair decision-making procedures should be established to ensure moral legitimacy and accountability.…”

Section: Lessons Learned From Experiences In Lmicsmentioning

confidence: 99%

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Applying Lessons Learned From Low-Resource Settings to Prioritize Cancer Care in a Pandemic

et al. 2020

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Section: Lessons Learned From Experiences In Lmicsmentioning

confidence: 99%

Section: Lessons Learned From Experiences In Lmicsmentioning

confidence: 99%

Applying Lessons Learned From Low-Resource Settings to Prioritize Cancer Care in a Pandemic

et al. 2020

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“…In our study, the timely initiation of the adjuvant radiotherapy in the majority of patients confirmed the safety of early administration of adjuvant CT, which was consisting with previous study [ 24 ]. DeBoer et al also supported a role for temporizing CT if delays to CRT are anticipated [ 25 ].…”

Section: Discussionmentioning

confidence: 99%

The impacts of minimally invasive surgery on intermediate- or high-risk cervical cancer patients received adjuvant radiotherapy

Zhang

Wang

et al. 2022

World J Surg Onc

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Background Adjuvant chemoradiotherapy (CRT) has been shown to reduce the risk of recurrence for patients with risk factors after radical hysterectomy (RH). Early initiated CRT could result in superior oncological outcomes. Here, we aimed to compare the survival outcome of intermediate- or high-risk cervical cancer (CC) patients who, received adjuvant CRT between minimally invasive surgery (MIS) and open surgery. Methods Data on stage IB1-IIA2 patients who underwent RH and postoperative CRT in our institution, from 2014 to 2017, were retrospectively collected. Patients with high or intermediate-risk factors who met the Sedlis criteria received sequential chemoradiation (SCRT). According to the surgical approaches, the enrolled patients were divided into MIS and open surgery groups. Then, the disease-free survival (DFS), overall survival (OS), and prognostic factors were analyzed. Results Among 129 enrolled CC patients, 68 received open surgery and 61 received MIS. The median time interval from surgery to chemotherapy and to radiotherapy was shorter in the MIS group (7 days vs. 8 days, P=0.014; 28 days vs. 35, P<0.001). Three-year DFS and OS were similar in both groups (85.2% vs. 89.7%, P=0.274; 89.9% vs. 98.5%, P=0.499). Further, sub-analysis indicated that the DFS and OS in intermediate/high-risk groups had no significant difference. Cox-multivariate analyses found that tumor size >4 cm and time interval from surgery to radiotherapy beyond 7 weeks were adverse independent prognostic factors for DFS. Conclusion Based on the population we studied, for early-stage (IB1-IIA2) CC patients with intermediate- or high-risk factors who received postoperative SCRT, although the difference was not significant, the DFS and OS in the MIS group were slightly lower than the ORH group, and tumor size >4 cm and delayed adjuvant radiotherapy beyond 7 weeks were risk factors for recurrence.

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“…In all cervical cancer, squamous cell carcinoma accounts for 70%, followed by adenocarcinoma accounting for 20% ( 5 ). The standard therapies for cervical cancer include surgery, radiotherapy (RT), chemotherapy, and immunotherapy ( 6 ). For early-stage cervical cancer, radical surgery is the best option ( 7 ).…”

Section: Introductionmentioning

confidence: 99%

“…standard therapies for cervical cancer include surgery, radiotherapy (RT), chemotherapy, and immunotherapy (6). For early-stage cervical cancer, radical surgery is the best option (7).…”

mentioning

confidence: 99%

Recent progress of the tumor microenvironmental metabolism in cervical cancer radioresistance

et al. 2022

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Radiotherapy is widely used as an indispensable treatment option for cervical cancer patients. However, radioresistance always occurs and has become a big obstacle to treatment efficacy. The reason for radioresistance is mainly attributed to the high repair ability of tumor cells that overcome the DNA damage caused by radiotherapy, and the increased self-healing ability of cancer stem cells (CSCs). Accumulating findings have demonstrated that the tumor microenvironment (TME) is closely related to cervical cancer radioresistance in many aspects, especially in the metabolic processes. In this review, we discuss radiotherapy in cervical cancer radioresistance, and focus on recent research progress of the TME metabolism that affects radioresistance in cervical cancer. Understanding the mechanism of metabolism in cervical cancer radioresistance may help identify useful therapeutic targets for developing novel therapy, overcome radioresistance and improve the efficacy of radiotherapy in clinics and quality of life of patients.

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Cervical cancer treatment in Rwanda: Resource-driven adaptations, quality indicators, and patient outcomes

Cited by 9 publications

References 40 publications

Applying Lessons Learned From Low-Resource Settings to Prioritize Cancer Care in a Pandemic

Applying Lessons Learned From Low-Resource Settings to Prioritize Cancer Care in a Pandemic

The impacts of minimally invasive surgery on intermediate- or high-risk cervical cancer patients received adjuvant radiotherapy

Recent progress of the tumor microenvironmental metabolism in cervical cancer radioresistance

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