Survival Outcomes and Prognostic Factors in Non-Metastatic Nasopharyngeal Cancer Treated with Conventional Radiotherapy in Cameroon: A 6-Year Retrospective Cohort Study in Douala
Survie et Facteurs Pronostiques du Cancer du Nasopharynx Non Métastatique Traité par Radiothérapie Conventionnelle au Cameroun : Une Étude de Cohorte Rétrospective de 6 Ans à Douala
DOI:
https://doi.org/10.5281/zenodo.18964388Keywords:
cancer, nasopharynx, 2D radiotherapy, cobalt 60, survival Cameroon, Douala General Hospital, Chemo radiationAbstract
ABSTRACT
Introduction. Non-metastatic nasopharyngeal cancer is a public health issue in Cameroon, where access to modern radiotherapy is limited. Douala General Hospital operates the country's only public 2D radiotherapy machine. This study aimed to analyze overall survival (OS) and recurrence-free survival (RFS) in patients treated under these constraints and identify prognostic factors. Methods. This retrospective cross-sectional study included all patients with histologically confirmed non-metastatic nasopharyngeal cancer (stages I-IVA, AJCC 8th) treated with radiotherapy at Douala General Hospital from 2017 to 2022. Data were collected from medical records and telephone interviews. Survival was analyzed using Kaplan-Meier method and Cox regression. Results. Among 75 patients, mean age was 42.4±16.2 years, with male predominance (62.7%). Stage III disease was most common (57.3%), followed by stage IVA (20%). Nearly all patients (96%) received concurrent chemoradiation with 60-66 Gy delivered over 59.1±11.5 days. Five-year OS and RFS were 5% and 4%, respectively. Median OS was 25 months; median RFS was 23 months. In multivariate analysis, age >65 years was independently associated with poor RFS (HR=14.7; 95%CI 5.04-42.6; p<0.001), while age 18-35 years was associated with better OS (HR=0.25; 95%CI 0.08-0.79; p=0.018). Conclusion. Survival rates for non-metastatic nasopharyngeal cancer in Cameroon are dramatically below international standards, reflecting late diagnosis and limitations of 2D Cobalt-60 radiotherapy. Urgent modernization to intensity-modulated radiotherapy (IMRT) and intensified early detection efforts are essential.
RESUME
Introduction. Le cancer du nasopharynx non métastatique est un problème de santé publique au Cameroun, où l'accès à la radiothérapie moderne est limité. L'Hôpital Général de Douala dispose de la seule machine publique de radiothérapie 2D du pays. Cette étude a visé à analyser la survie globale (SG) et la survie sans récidive (SSR) des patients traités sous ces contraintes et à identifier les facteurs pronostiques. Méthodologie. Une étude rétrospective transversale a inclus tous les patients atteints d'un cancer du nasopharynx non métastatique (stades I-IVA, AJCC 8e) histologiquement prouvé, traités par radiothérapie à l'Hôpital Général de Douala de 2017 à 2022. Les données ont été recueillies à partir des dossiers médicaux et d'entretiens téléphoniques. La survie a été analysée par la méthode de Kaplan-Meier et la régression de Cox. Résultats. Sur 75 patients, l'âge moyen était de 42,4±16,2 ans, avec une prédominance masculine (62,7 %). Le stade III était le plus fréquent (57,3 %), suivi du stade IVA (20 %). La quasi-totalité des patients (96 %) ont reçu une radiochimiothérapie concomitante avec une dose de 60-66 Gy délivrée en 59,1±11,5 jours. La SG et la SSR à 5 ans étaient respectivement de 5 % et 4 %. La SG médiane était de 25 mois ; la SSR médiane de 23 mois. En analyse multivariée, l'âge >65 ans était indépendamment associé à une mauvaise SSR (HR=14,7 ; IC95 % 5,04-42,6 ; p<0,001), tandis que l'âge 18-35 ans était associé à une meilleure SG (HR=0,25 ; IC95 % 0,08-0,79 ; p=0,018). Conclusion. Les taux de survie pour le cancer du nasopharynx non métastatique au Cameroun sont dramatiquement inférieurs aux standards internationaux, reflétant un diagnostic tardif et les limites de la radiothérapie 2D au Cobalt-60. Une modernisation urgente vers la radiothérapie conformationnelle avec modulation d'intensité (RCMI) et des efforts nationaux de détection précoce sont essentiels.
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Copyright (c) 2026 Meka’h Mapenya Ruth, Maison Anne Marthe, Nguéléodaï Roger Tchidémé, Bodo Ntédé Georges, Hiol Nicolas, Elame Franck, Essomba Biwole, Mouelle Soné
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