Objectives: Non-localized cervical cancers include all malignant cervical tumors classified between IB3 and IV according to the FIGO classification. The objective of our study was to describe the management of these cancers at the Dakar Cancer Institute. Materials and Methods: This was a retrospective study conducted over a four-year period, including all histologically diagnosed cases of non-localized cervical cancer. Results: During the study period, 407 patient records were analyzed. The mean age of patients was 53.5 ± 11.2 years. Among them, 331 (81.3%) were married, and 373 (91.6%) were grand multiparas. Metrorrhagia was present in 342 patients (83.9%). FIGO stage IIb was the most frequent (98 cases, 24.1%), and the predominant histological type was squamous cell carcinoma (383 cases, 94.1%). All patients received neoadjuvant chemotherapy, primarily with a carboplatin-taxol regimen (396 cases, 97.3%), with a complete response observed in 225 patients (55.3%). Adjuvant treatment consisted of exclusive radiotherapy for 245 patients (60.2%), with an estimated three-year survival rate of 30%. Prognostic factors identified in multivariate analysis included parametrial involvement (p = 0.005), chemotherapy regularity (p = 0.013), and response to chemotherapy (p < 0.001). Conclusion: The management of non-localized cervical cancers primarily relies on radio-chemotherapy. In our context, the use of neoadjuvant chemotherapy remains essential.
References
[1]
Guèye, I., Diallo, A.I., Sangho, O., et al. (2021) Facteurs associés à la pratique du dépistage du cancer du col utérin dans le district sanitaire de Joal, Sénégal, 2018: Enquête ménage. Journal of Intervention Epidemiology and Public Health, 4, Article No. 11. https://doi.org/10.37432/jieph.supp.2021.4.4.03.11
[2]
Diop, P.S., Ka, I., Ndiaye, N. and Fall, B. (2012) Cancers gynécologiques et mammaires à l’hôpital général de Grand-Yoff de Dakar: Analyse et implications des aspects épidémiologiques à propos de 169 cas. Journal Africain du Cancer/African Journal of Cancer, 4, 176-179. https://doi.org/10.1007/s12558-012-0217-x
[3]
Diop, A., Mvundura, M., Dieng, Y., Anne, M. and Vodicka, E. (2024) Cervical Cancer Screening and Treatment Costing in Senegal. The Pan African Medical Journal, 47, Article 151. https://doi.org/10.11604/pamj.2024.47.151.41485
[4]
Simms, K.T., Steinberg, J., Caruana, M., Smith, M.A., Lew, J., Soerjomataram, I., et al. (2019) Impact of Scaled up Human Papillomavirus Vaccination and Cervical Screening and the Potential for Global Elimination of Cervical Cancer in 181 Countries, 2020-99: A Modelling Study. The Lancet Oncology, 20, 394-407. https://doi.org/10.1016/s1470-2045(18)30836-2
[5]
Parkin, D.M., Bray, F., Ferlay, J. and Pisani, P. (2005) Global Cancer Statistics, 2002. CA: A Cancer Journal for Clinicians, 55, 74-108. https://doi.org/10.3322/canjclin.55.2.74
[6]
Ferlay, J., Soerjomataram, I., Dikshit, R., Eser, S., Mathers, C., Rebelo, M., et al. (2014) Cancer Incidence and Mortality Worldwide: Sources, Methods and Major Patterns in GLOBOCAN 2012. International Journal of Cancer, 136, E359-E386. https://doi.org/10.1002/ijc.29210
[7]
Bosch, F.X., Lorincz, A., Munoz, N., Meijer, C.J.L.M. and Shah, K.V. (2002) The Causal Relation between Human Papillomavirus and Cervical Cancer. Journal of Clinical Pathology, 55, 244-265. https://doi.org/10.1136/jcp.55.4.244
[8]
Smith, J.S., Green, J., de Gonzalez, A.B., Appleby, P., Peto, J., Plummer, M., et al. (2003) Cervical Cancer and Use of Hormonal Contraceptives: A Systematic Review. The Lancet, 361, 1159-1167. https://doi.org/10.1016/s0140-6736(03)12949-2
[9]
Denny, L., Quinn, M. and Sankaranarayanan, R. (2006) Chapter 8: Screening for Cervical Cancer in Developing Countries. Vaccine, 24, S71-S77. https://doi.org/10.1016/j.vaccine.2006.05.121
[10]
Shastri, S.S., Mittra, I., Mishra, G.A., Gupta, S., Dikshit, R., Singh, S., et al. (2014) Effect of via Screening by Primary Health Workers: Randomized Controlled Study in Mumbai, India. JNCI Journal of the National Cancer Institute, 106, dju009. https://doi.org/10.1093/jnci/dju009
[11]
Bhatla, N., Aoki, D., Sharma, D.N. and Sankaranarayanan, R. (2018) Cancer of the Cervix Uteri. International Journal of Gynecology & Obstetrics, 143, 22-36. https://doi.org/10.1002/ijgo.12611
[12]
Bray, F., Carstensen, B., Møller, H., Zappa, M., Žakelj, M.P., Lawrence, G., et al. (2005) Incidence Trends of Adenocarcinoma of the Cervix in 13 European Countries. Cancer Epidemiology, Biomarkers & Prevention, 14, 2191-2199. https://doi.org/10.1158/1055-9965.epi-05-0231
[13]
Keys, H.M., Bundy, B.N., Stehman, F.B., Muderspach, L.I., Chafe, W.E., Suggs, C.L., et al. (1999) Cisplatin, Radiation, and Adjuvant Hysterectomy Compared with Radiation and Adjuvant Hysterectomy for Bulky Stage IB Cervical Carcinoma. New England Journal of Medicine, 340, 1154-1161. https://doi.org/10.1056/nejm199904153401503
[14]
Rose, P.G., Bundy, B.N., Watkins, E.B., Thigpen, J.T., Deppe, G., Maiman, M.A., et al. (1999) Concurrent Cisplatin-Based Radiotherapy and Chemotherapy for Locally Advanced Cervical Cancer. New England Journal of Medicine, 340, 1144-1153. https://doi.org/10.1056/nejm199904153401502
[15]
Whitney, C.W., Sause, W., Bundy, B.N., Malfetano, J.H., Hannigan, E.V., Fowler, Jr, W.C., et al. (1999) Randomized Comparison of Fluorouracil Plus Cisplatin versus Hydroxyurea as an Adjunct to Radiation Therapy in Stage IIB-IVA Carcinoma of the Cervix with Negative Para-Aortic Lymph Nodes: A Gynecologic Oncology Group and Southwest Oncology Group Study. Journal of Clinical Oncology, 17, 1339-1339. https://doi.org/10.1200/jco.1999.17.5.1339
[16]
Green, J.A., Kirwan, J.J., Tierney, J., Vale, C.L., Symonds, P.R., Fresco, L.L., et al. (2005) Concomitant Chemotherapy and Radiation Therapy for Cancer of the Uterine Cervix. Cochrane Database of Systematic Reviews, No. 3, CD002225. https://doi.org/10.1002/14651858.cd002225.pub2
[17]
Bhatla, N., Aoki, D., Sharma, D.N. and Sankaranarayanan, R. (2021) Cancer of the Cervix Uteri: 2021 Update. International Journal of Gynecology & Obstetrics, 155, 28-44. https://doi.org/10.1002/ijgo.13865
[18]
Cohen, P.A., Jhingran, A., Oaknin, A. and Denny, L. (2019) Cervical cancer. The Lancet, 393, 169-182. https://doi.org/10.1016/s0140-6736(18)32470-x
[19]
McCormack, M., Kadalayil, L., Hackshaw, A., et al. (2023) Impact of Neoadjuvant Chemotherapy on Survival in Locally Advanced Cervical Cancer: A Randomized Controlled Trial. Journal of Clinical Oncology, 41, 1234-1242.