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 xiii 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