Contraindications to cisplatin based chemoradiotherapy in the treatment of cervical cancer in Sub-Saharan Africa.
OBJECTIVE
We conducted a prospective study to assess the eligibility of patients presenting with cervical cancer in the developing world for chemoradiotherapy.


METHODS
Patients with biopsy proven cervical cancer were eligible. Workup included history, examination, pre-treatment Karnofsky performance score, evaluation under anaesthesia to establish FIGO stage, complete blood count, renal and liver functions tests, HIV test and ultrasound of the abdomen and pelvis.


METHODS
stage IA, stage IV, HIV status positive, Karnofsky performance score <60, age >70 years, hydronephrosis, haemoglobin <8 g/dL, white cell count <2,000/microL, platelets <100,000/microL, creatinine >97 micromol/L.


RESULTS
314 patients were included. After workup, 47 patients (15.1%) were eligible for combined modality treatment and 190 (60.5%) were not eligible. Eligibility could not be established in 77 cases (24.4%). 37 (11.6%) of the group were HIV positive, HIV status was not established in 38.4% of cases. The most frequently encountered exclusion criteria were hydronephrosis and anaemia. Application of a haemoglobin cut off point of 8 g/dL for cisplatin based chemotherapy resulted in the exclusion of 55 (17.4%) patients. A limit of 10 g/dL excluded an additional 11 patients. Hydronephrosis was diagnosed on ultrasound in 99 (31.4%) patients. 56% had unilateral hydronephrosis, 44% had bilateral hydronephrosis.


CONCLUSIONS
A small proportion of our patients with cervical cancer would benefit from chemoradiotherapy with concomitant cisplatin, illustrating the difficulties of applying "standard" treatment to the developing world. The introduction of national screening programmes and the provision of accessible radiotherapy facilities should be the major priorities in the developing world setting.
McArdle
Orla
O
St. Luke's Hospital, Rathgar, Ireland. omcardle@yahoo.com
Kigula-Mugambe
Joseph B
JB
D017954:Africa South of the Sahara; D000368:Aged; D000740:Anemia / Q000209:etiology; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D002945:Cisplatin / Q000009:adverse effects / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D003906:Developing Countries; D005260:Female; D006801:Humans; D006869:Hydronephrosis / Q000209:etiology; D008875:Middle Aged; D014454:Uganda; D002583:Uterine Cervical Neoplasms / Q000150:complications* / Q000188:drug therapy / Q000532:radiotherapy
D000970:Antineoplastic Agents; D002945:Cisplatin