| Peer-Reviewed

Techniques and Practice of Post Mastectomy Radiotherapy in Nigeria: A Multi-Centre Study

Received: 10 August 2018     Accepted: 28 August 2018     Published: 8 October 2018
Views:       Downloads:
Abstract

Breast cancer affect millions of women worldwide with an increasing incidence in developing countries. In Nigeria, late presentation is the norm, with most patients presenting at stages III and IV. Patients may be at risk of local recurrence after mastectomy due to areas of microscopic residual disease such as the chest wall and regional nodal basins. Post-mastectomy radiotherapy (PMRT) has been found to reduce this risk. The aim of the study was to evaluate the techniques and practice of post mastectomy radiotherapy among breast cancer patients treated in Nigeria. This descriptive retrospective study was carried out for all histologically confirmed breast cancer cases that had post mastectomy radiotherapy between 2004 and 2015, in all (8) centres in Nigeria. Information from patient’s records were extracted using data proforma. Data of 2,143 patients were analysed. All patients received radiation to the chest wall. Thirty nine point one percent had two regional nodes irradiated, while 38% had only axilla treated, and 6.3% had three regional lymph nodes irradiated. All patients had treatment planning, majority (93.7%) with conventional technique. The primary beam used was photon with electron boost to the scar (62.8%). Fractionation method was mostly 50Gy in 25 fractions over 5 weeks (61.8%). Three fields were used in treating more than half of the patients (63.0%) while 30.9% were treated with 4 fields’ techniques. The study revealed a short fall in access to radiotherapy within the study period. Two dimensional treatment planning method was the dominant with considerable variations across centres in terms of practice and techniques.

Published in International Journal of Clinical Oncology and Cancer Research (Volume 3, Issue 3)
DOI 10.11648/j.ijcocr.20180303.15
Page(s) 41-48
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2018. Published by Science Publishing Group

Keywords

Breast Cancer, Nigeria, Post Mastectomy Radiotherapy

References
[1] Ntekim A, Nufu FT, Campbell OB. Breast cancer in young women in Ibadan, Nigeria. Afr Health Sci. 2009;9(4):242–246.
[2] Durosinmi-Etti FA. Cancer patients in Nigeria: Causes of delay before diagnosis and treatment. Nig. Qtly. J. Hosp. Med. 1985;3(1):28-30.
[3] Huo D, Ikpatt F, Khramtsov A et al. Population differences in breast cancer: survey in indigenous African women reveals over-representation of triple-negative breast cancer. Journal of Clinical Oncology. 2009;27(27):4515-4521
[4] Barret A, Dobbs J, Morris S, Roques T. Practical Radiotherapy Planning, 4th ed. London: Hodder Arnold; 2009, P. 200 – 13.
[5] Harris S. Radiotherapy for early and advanced breast cancer. Int J Clin Pract. 2001;55:609–612.
[6] Veronesi U, Cascinelli N, Mariani L et al. Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early BC. N Engl J Med. 2002;347:1227-32.
[7] Anele A, Bowling M, Eckert G et al. Treatment of breast cancer: Imo State, Nigeria versus Indiana, USA women – comparative analytic study. Journal of the West African College of Surgeons. 2014;4(4):39-69.
[8] Paterson R, Russell MH. Breast cancer: evaluation of post-operative radiotherapy. J Fac Radiol. 1959;10:174.
[9] Darby S, McGale P, Correa C, et al. Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10,801 women in 17 randomised trials. Lancet. 2011;378:1707-1716.
[10] Cuzick J. Radiotherapy for breast cancer. JNCI J Natl Cancer Inst. 2005;97(6):406-407.
[11] Hojris I, Overgaard M, Christensen JJ et al. Morbidity and mortality of ischaemic heart disease in high-risk breast-cancer patients after adjuvant postmastectomy systemic treatment with or without radiotherapy: analysis of DBCG 82b and 82c randomised trials. Radiotherapy Committee of the Danish Breast Cancer Cooperative Group. Lancet. 1999;354:1.
[12] Irabor OC, Nwankwo KC, Adewuyi SA. The stagnation and decay of radiation oncology resources: lessons from Nigeria. Int. J. Radiat. Oncol. Biol. Phys. 2016;95:1327–1333.
[13] Van der Laan H, Hurkmans CW, Kuten A, et al. Current technological clinical practice in breast radiotherapy; results of a survey in EORTC-Radiation Oncology Group affiliated institutions. Radiotherapy and Oncology. 2010;94(3):280-285.
[14] Adewuyi SA, Campbell OB, Ketiku KK et al. Current status of radiation oncology facilities in Nigeria. West Afr J Radiol. 2013; 20:30-6.
[15] Atun R, Jaffray DA, Barton MB et al. Expanding global access to radiotherapy. The Lancet Oncology. 2015; 16(10):1153-1186.
[16] El Saghir NS, Khalil MK, Eid T et al. Trends in epidemiology and management of breast cancer in developing Arab countries: A literature and registry analysis. Int. J. Surg. 2007; 5(4):225-233.
[17] Nwankwo KC, Dawotola DA, Sharma V. Radiotherapy in Nigeria: Current status and future challenges. West Afr J Radiol. 2013; 20:84-8.
[18] International Atomic Energy Agency. Setting up a Radiotherapy Programme: Clinical, Medical Physics, Radiation Protection and Safety Aspects. Vienna: International Atomic Energy Agency; 2008:6-45.
[19] Ajogwu G. Nigeria Still Lacks Functioning Radiotherapy Machines @56. Daily Times [Internet]. 2016 [cited 25 August 2017]. Available from: http://dailytimes.ng/nigeria-still-lacks-functioning-radiotherapy-machines-56/.
[20] Ferlay J, Soerjomataram I, Ervik M et al. GLOBOCAN 2012 v1.0, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 11 [Internet]. Lyon, France: International Agency for Research on Cancer; 2013. Available from: http://globocan.iarc.fr/old/summary_table_site-html.asp?selection=3152&title=Breast&sex=2&type=1&window=1&africa=1&sort=0&submit=%C2%A0Execute%C2%A0, accessed on 25/August/2017.
[21] Kingham TP, Alatise OI, Vanderpuye V et al. Treatment of cancer in sub-Saharan Africa. Lancet Oncol. 2013;14(4):e158-67.
[22] Grover S, Xu MJ, Yeager A et al. A Systematic Review of Radiotherapy Capacity in Low- and Middle-Income Countries. Frontiers in Oncology. 2014;4:380.
[23] Zubizarreta EH, Fidarova E, Healy B et al. Need for radiotherapy in low and middle income countries—the silent crisis continues. Clin Oncol (R Coll Radiol). 2015;27(2):107–14.
[24] Ifijeh M. FG to Provide 7 Radiotherapy Machines This Year, Says Adewole. This Day [Internet]. 2016 [cited 20 August 2017]. Available from: http://www.thisdaylive.com/index.php/2016/04/07/fg-to-provide-7-radiotherapy-machines-this-year-says-adewole-2/
[25] Olson JE, Neuberg D, Pandya KJ et al. The role of radiotherapy in the management of operable locally advanced breast carcinoma: results of a randomized trial by the eastern cooperative oncology group. Cancer. 1997;79(6):1138–1149.
[26] Jinli Ma, Jiongyan Li, Jiang Xie. Post mastectomy linac IMRT irradiation of chest wall and regional nodes: dosimetry data and acute toxicities. Radiation Oncology. 2013;8(1):1.
[27] Siddon RL, Buck BA, Harris JR et al.Three-field technique for breast irradiation using tangential field corner blocks. International Journal of Radiation Oncology*Biology*Physics. 1983;9(4):583-588.
[28] Jabbari K, Azarmahd N, Babazade S et al. Optimizing of the tangential technique and supraclavicular fields in 3 dimensional conformal radiation therapy for breast cancer. Journal of Medical Signals and Sensors. 2013;3(2):107-116.
[29] Onwumere O. Government’s Role in Cancer Multiplication. Osun Defender [Internet]. 2016 [cited 20 August 2017]. Available from: http://www.osundefender.com/?p=252660.
[30] Veness MJ, Delaney G. Variations in breast tangent radiotherapy: a survey of practice in New South Wales and the Australian Capital Territory. Australas Radiol. 1999;43:334–8.
[31] Pereira GC, Traughber M, Muzic RF, Jr. The role of imaging in radiation therapy planning: Past, present, and future. BioMed Research International. 2014;231090:1-9.
[32] Gaffney DK, Prows J, Leavitt DD et al. Electron arc irradiation of the postmastectomy chest wall: clinical results. Radiotherapy and Oncology. 1997;42(1):17-24.
[33] MacDonald SM, Patel SA, Hickey S et al. Proton therapy for breast cancer after mastectomy: Early outcomes of a prospective clinical trial. International Journal of Radiation Oncology*Biology*Physics. 2013;86(3):484-490.
[34] Bartelink H, Horiot JC, Poortmans PM et al. Impact of a higher radiation dose on local control and survival in breast-conserving therapy of early breast cancer: 10-year results of the randomized boost versus no boost EORTC 22881-10882 trial. J Clin Oncol. 2007;25:3259–65.
[35] Rafsanjani Z, Mosleh-Shirazi MA, Faghihi R et al. Breast Cancer and its radiotherapeutic methods. Iranian Journal of Medical Physics. 2012;9(2):75-85.
[36] Höcht S, Aebersold DM, Albrecht C, et al. Hypofractionated radiotherapy for localized prostate cancer. Strahlentherapie Und Onkologie. 2017;193(1):1-12.
[37] Connell PP, Hellman S. Advances in radiotherapy and implications for the next century: a historical perspective. Cancer Res. 2009;69:383–92.
[38] Plataniotis G. Hypofractionated radiotherapy in the treatment of early breast cancer. World Journal of Radiology. 2010;2(6):197-202.
[39] Bentzen SM, Agrawal RK, Aird EG et al. The UK Standardisation of Breast Radiotherapy (START) Trial A of radiotherapy hypofractionation for treatment of early breast cancer: a randomised trial. Lancet Oncol. 2008;9:331–341.
[40] Whelan T, MacKenzie R, Julian J et al. Randomized trial of breast irradiation schedules after lumpectomy for women with lymph node-negative breast cancer. J Natl Cancer Inst. 2002;94:1143–1150.
Cite This Article
  • APA Style

    Salako Omolola, Aliyu Usman Malami, Jimoh Mutiu Alani, Oboh Oseiwe Evaristus, Nwankwo Kenneth, et al. (2018). Techniques and Practice of Post Mastectomy Radiotherapy in Nigeria: A Multi-Centre Study. International Journal of Clinical Oncology and Cancer Research, 3(3), 41-48. https://doi.org/10.11648/j.ijcocr.20180303.15

    Copy | Download

    ACS Style

    Salako Omolola; Aliyu Usman Malami; Jimoh Mutiu Alani; Oboh Oseiwe Evaristus; Nwankwo Kenneth, et al. Techniques and Practice of Post Mastectomy Radiotherapy in Nigeria: A Multi-Centre Study. Int. J. Clin. Oncol. Cancer Res. 2018, 3(3), 41-48. doi: 10.11648/j.ijcocr.20180303.15

    Copy | Download

    AMA Style

    Salako Omolola, Aliyu Usman Malami, Jimoh Mutiu Alani, Oboh Oseiwe Evaristus, Nwankwo Kenneth, et al. Techniques and Practice of Post Mastectomy Radiotherapy in Nigeria: A Multi-Centre Study. Int J Clin Oncol Cancer Res. 2018;3(3):41-48. doi: 10.11648/j.ijcocr.20180303.15

    Copy | Download

  • @article{10.11648/j.ijcocr.20180303.15,
      author = {Salako Omolola and Aliyu Usman Malami and Jimoh Mutiu Alani and Oboh Oseiwe Evaristus and Nwankwo Kenneth and Ogunnorin Babatunde Olutoye and Habeeb Muhammed and Olukiran Olugbenro Emmanueal and Ahmed Rilwan and Joseph Adedayo and Roberts Alero Ann and Oyesegun Razaak and Ketiku Kingsley Kayode and Adenipekun Adeniyi Adesina and Campbell Oladapo Babatunde and Adewuyi Sunday and Chukwuocha Ikechukwu and Otene Samuel Anaja and Duncan Josbert Thomas Kofi and Durosinmi-Etti Francis Abayomi},
      title = {Techniques and Practice of Post Mastectomy Radiotherapy in Nigeria: A Multi-Centre Study},
      journal = {International Journal of Clinical Oncology and Cancer Research},
      volume = {3},
      number = {3},
      pages = {41-48},
      doi = {10.11648/j.ijcocr.20180303.15},
      url = {https://doi.org/10.11648/j.ijcocr.20180303.15},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijcocr.20180303.15},
      abstract = {Breast cancer affect millions of women worldwide with an increasing incidence in developing countries. In Nigeria, late presentation is the norm, with most patients presenting at stages III and IV. Patients may be at risk of local recurrence after mastectomy due to areas of microscopic residual disease such as the chest wall and regional nodal basins. Post-mastectomy radiotherapy (PMRT) has been found to reduce this risk. The aim of the study was to evaluate the techniques and practice of post mastectomy radiotherapy among breast cancer patients treated in Nigeria. This descriptive retrospective study was carried out for all histologically confirmed breast cancer cases that had post mastectomy radiotherapy between 2004 and 2015, in all (8) centres in Nigeria. Information from patient’s records were extracted using data proforma. Data of 2,143 patients were analysed. All patients received radiation to the chest wall. Thirty nine point one percent had two regional nodes irradiated, while 38% had only axilla treated, and 6.3% had three regional lymph nodes irradiated. All patients had treatment planning, majority (93.7%) with conventional technique. The primary beam used was photon with electron boost to the scar (62.8%). Fractionation method was mostly 50Gy in 25 fractions over 5 weeks (61.8%). Three fields were used in treating more than half of the patients (63.0%) while 30.9% were treated with 4 fields’ techniques. The study revealed a short fall in access to radiotherapy within the study period. Two dimensional treatment planning method was the dominant with considerable variations across centres in terms of practice and techniques.},
     year = {2018}
    }
    

    Copy | Download

  • TY  - JOUR
    T1  - Techniques and Practice of Post Mastectomy Radiotherapy in Nigeria: A Multi-Centre Study
    AU  - Salako Omolola
    AU  - Aliyu Usman Malami
    AU  - Jimoh Mutiu Alani
    AU  - Oboh Oseiwe Evaristus
    AU  - Nwankwo Kenneth
    AU  - Ogunnorin Babatunde Olutoye
    AU  - Habeeb Muhammed
    AU  - Olukiran Olugbenro Emmanueal
    AU  - Ahmed Rilwan
    AU  - Joseph Adedayo
    AU  - Roberts Alero Ann
    AU  - Oyesegun Razaak
    AU  - Ketiku Kingsley Kayode
    AU  - Adenipekun Adeniyi Adesina
    AU  - Campbell Oladapo Babatunde
    AU  - Adewuyi Sunday
    AU  - Chukwuocha Ikechukwu
    AU  - Otene Samuel Anaja
    AU  - Duncan Josbert Thomas Kofi
    AU  - Durosinmi-Etti Francis Abayomi
    Y1  - 2018/10/08
    PY  - 2018
    N1  - https://doi.org/10.11648/j.ijcocr.20180303.15
    DO  - 10.11648/j.ijcocr.20180303.15
    T2  - International Journal of Clinical Oncology and Cancer Research
    JF  - International Journal of Clinical Oncology and Cancer Research
    JO  - International Journal of Clinical Oncology and Cancer Research
    SP  - 41
    EP  - 48
    PB  - Science Publishing Group
    SN  - 2578-9511
    UR  - https://doi.org/10.11648/j.ijcocr.20180303.15
    AB  - Breast cancer affect millions of women worldwide with an increasing incidence in developing countries. In Nigeria, late presentation is the norm, with most patients presenting at stages III and IV. Patients may be at risk of local recurrence after mastectomy due to areas of microscopic residual disease such as the chest wall and regional nodal basins. Post-mastectomy radiotherapy (PMRT) has been found to reduce this risk. The aim of the study was to evaluate the techniques and practice of post mastectomy radiotherapy among breast cancer patients treated in Nigeria. This descriptive retrospective study was carried out for all histologically confirmed breast cancer cases that had post mastectomy radiotherapy between 2004 and 2015, in all (8) centres in Nigeria. Information from patient’s records were extracted using data proforma. Data of 2,143 patients were analysed. All patients received radiation to the chest wall. Thirty nine point one percent had two regional nodes irradiated, while 38% had only axilla treated, and 6.3% had three regional lymph nodes irradiated. All patients had treatment planning, majority (93.7%) with conventional technique. The primary beam used was photon with electron boost to the scar (62.8%). Fractionation method was mostly 50Gy in 25 fractions over 5 weeks (61.8%). Three fields were used in treating more than half of the patients (63.0%) while 30.9% were treated with 4 fields’ techniques. The study revealed a short fall in access to radiotherapy within the study period. Two dimensional treatment planning method was the dominant with considerable variations across centres in terms of practice and techniques.
    VL  - 3
    IS  - 3
    ER  - 

    Copy | Download

Author Information
  • Department of Radiotherapy, Lagos University Teaching Hospital, Lagos, Nigeria

  • Department of Radiotherapy and Oncology, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria

  • Department of Radiation Oncology, University College Hospital, Ibadan, Nigeria

  • Department of Radiation and Clinical Oncology, University of Benin Teaching Hospital, Benin, Nigeria

  • Department of Radiation Oncology, University of Nigeria Teaching Hospital, Enugu, Nigeria

  • Department of Radiotherapy and Oncology, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria

  • Department of Radiotherapy, Lagos University Teaching Hospital, Lagos, Nigeria

  • Department of Radiotherapy, Lagos University Teaching Hospital, Lagos, Nigeria

  • Department of Radiotherapy and Oncology, National Hospital, Abuja, Nigeria

  • Department of Radiotherapy, Lagos University Teaching Hospital, Lagos, Nigeria

  • Department of Community Health, Lagos University Teaching Hospital, Lagos, Nigeria

  • Department of Radiotherapy and Oncology, National Hospital, Abuja, Nigeria

  • Department of Radiation Oncology, EKO Hospital, Lagos, Nigeria

  • Department of Radiotherapy and Oncology, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria

  • Department of Radiotherapy and Oncology, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria

  • Department of Radiotherapy and Oncology, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria

  • Department of Radiotherapy and Oncology, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria

  • Department of Radiotherapy and Oncology, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria

  • Department of Radiation Oncology, EKO Hospital, Lagos, Nigeria

  • Department of Radiotherapy, Lagos University Teaching Hospital, Lagos, Nigeria

  • Sections