Nasopharyngeal carcinoma in sub-Saharan Africa: clinicopathological profiles, patterns of care, and survival outcomes of patients treated at a leading radiotherapy center.
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INTRODUCTION: In sub-Saharan Africa, the clinicopathological features, management strategies, and survival outcomes of nasopharyngeal carcinoma (NPC) remain underreported, posing challenges to improving patient care and treatment outcomes. The aim of the study was to evaluate the clinicopathological profiles, patterns of care, and survival of patients with NPC treated with curative intent at a major radiotherapy center in sub-Saharan Africa. METHODS: This retrospective cohort study analyzed 83 patients with histopathologically confirmed NPC treated over a 10-year period. Data on demographics, clinical features, management, and treatment outcomes were extracted from patients' medical records. Statistical analyses were conducted using SPSS, with a significance threshold of p < 0.05. Survival analysis was performed using Kaplan-Meier curves, whilst associations between clinicopathological variables& survival were assessed using Cox proportional hazard models. RESULTS: The mean age was 32.8 ± 18.3 years whilst the male-to-female ratio was 2.3:1. In all, 8.4% had EBV-positive NPC, whilst 9.6% were tobacco smokers. Most participants (94%) had a good performance status. Overall, 38.6%, 26.5%, and 20.5% were diagnosed with stages IVB, IVA and III NPC respectively. In all, 75.9% received definitive chemo-radiation without either induction or adjuvant chemotherapy. A total of 78.3% were treated to a standard radiotherapy dose of 70 Gy in 35 fractions delivered over 7 weeks, whilst other patients were treated to lower doses of 68 Gy in 34 fractions (10.8%), 66 Gy in 33 fractions (4.8%) or 64 Gy in 32 fractions to meet critical organ constraints. There were low acute (25.3%) and long-term (15.7%) treatment-induced toxicity rates. The 1-, 3- and 5-year disease-free survival rates were 75%, 45%, and 25%, respectively whereas overall survival rates at the same time points were 90%, 65%, and 35%, respectively. CONCLUSION: Advanced-stage diagnosis remains a major challenge due to delayed detection and limited healthcare access. While Linac-based radiotherapy, including IMRT, is increasingly used, chemotherapy remains underutilized, raising concerns about treatment optimization.