The Prevalence and Factors Associated With Acute Complications of External Beam Radiotherapy Among Patients on Treatment for Anal Cancer in Kenyatta National Hospital
Abstract
Background
The treatment of anal carcinoma has tremendously evolved over the last three decades from
surgery to the current primary treatment of chemoradiation. However, the use of
chemoradiation has often been challenging and fraught with acute toxicity due to the
proximity of vulnerable organs in the field of treatment. Data on the impact and prevalence of
acute complications together with associated risk factors is limited and has not been
sufficiently demonstrated in our setting.
The purpose of the study
This study aimed to determine the prevalence and factors associated with acute complications
among patients treated with EBRT for anal carcinomas in Kenyatta National Hospital.
Study Setting and Population
The study was carried out in Kenyatta National Hospital in patients diagnosed with anal
carcinoma and receiving definitive radiotherapy treatment at Cancer Treatment Centre,
Surgical Outpatient Clinic (SOPC), and adult wards.
Study design and Methodology
This was a prospective cohort study of newly diagnosed anal carcinoma patients undergoing
EBRT at KNH who fulfilled the inclusion criteria and gave informed consent. Pretreatment
demographic and clinical data of the patients were collected and recorded before the
beginning of EBRT and acute complications involving the skin, genitourinary, lower
gastrointestinal systems were assessed, graded, and recorded at the mid-session of EBRT and
the end of EBRT administration using the NCI-CTC (The National Cancer Institute –
Common Terminology Criteria) grading scale.
Data Analysis
Data collected was entered and analyzed using Statistical Package for Social Sciences (SPSS)
for Windows Version 21. P values were generated and results were presented in tables,
figures, and graphs.
The utility of the study
The data generated will facilitate and develop local management protocols that would
mitigate against these adverse events, and optimize clinical outcomes and/or QOL among
patients with anal cancer. This study will also form a baseline for future studies on the role of
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radiotherapy in the management of cancer particularly with the emergence of newer
techniques of its administration.
Results
39 patients met the inclusion criteria, of which 29(85.7%) were female, with a median age at
diagnosis of 46 y (min-max: 29-79 y). The median time from the first symptom to diagnosis
was 14.5 weeks (min-max: 3-48 weeks). The most common presenting symptom was local
pain (n = 13; 41.9%), followed by hemorrhage (n = 11; 35.5%). Only 1(7,7%) patient was
HIV-positive. The tumor stage according to the 7th edition of the AJCC manual was
distributed as follows: Stage I: 2 cases (5.7%); Stage II: 10 cases (29.4%); Stage IIIA: 8 cases
(23.5%), stage IIIB: 14 cases (41.2%), and 4(12,5%) cases were cT4 tumors. Most patients
were treated with a dose of 50.4Gy to nodal basins and a total dose between 50.4 and 59Gy to
the tumor volume, using 2D-CRT in all. The median treatment duration was 44 days (minmax:
32-90). Radiotherapy delays due to toxicity – that was mostly Skin – occurred in 22
(62.9%) cases. The chemotherapy regimen used was mainly Cisplatin combined with 5-
fluorouracil, which was substituted for capecitabine in one patient. Grade 3 or greater acute
treatment toxicities occurred in 27(79.4%) cases and there were 2 deaths during treatment due
to septicemia. In 8(23.5%) cases, only one cycle of chemotherapy was administered due to
toxicity, and 7(20.6%) of patients underwent dose reductions. Febrile neutropenia occurred in
6(17.6%) cases.
Conclusion
In our experience, combined modality treatment with chemotherapy and radiation showed to
have similar efficacy to other published studies, despite a high rate of acute toxicities. Due to
the rarity of the disease and its complex management, treatment should be done at
experienced centers. Strict adherence to treatment guidelines and careful follow-up are
mandatory to optimize outcomes
Publisher
University of Nairobi
Rights
Attribution-NonCommercial-NoDerivs 3.0 United StatesUsage Rights
http://creativecommons.org/licenses/by-nc-nd/3.0/us/Collections
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