# Treatment response after chemoradiation with an external beam radiation therapy boost in cervical cancer patients in Rwanda

## TL;DR

This study evaluates how well cervical cancer patients in Rwanda respond to chemoradiation plus an external beam boost, finding a high complete response rate and suggesting this treatment could be a viable alternative to brachytherapy.

## Contribution

The study introduces the use of MRI-based RECIST criteria as a viable alternative to brachytherapy in assessing cervical cancer treatment response in resource-limited settings.

## Key findings

- 67% of patients achieved complete response after chemoradiation with an external beam boost.
- MRI-based RECIST criteria showed substantial agreement with clinical staging before and after treatment.
- Complete response rates were highest in early-stage cervical cancer patients.

## Abstract

Cervical cancer remains a significant public health burden in Rwanda, where brachytherapy is not widely available. This study assessed treatment response in cervical cancer patients post-chemoradiation using magnetic resonance imaging (MRI)-based Response Evaluation Criteria in Solid Tumors (RECIST), focusing on the effectiveness of external beam boost as an alternative.

This retrospective study was conducted at the Rwanda Cancer Centre, including patients treated with chemoradiation followed by an external beam boost from January 2020 to June 2022. MRI scans performed before treatment and 3-6 months post-treatment were analyzed using RECIST criteria to classify treatment response as complete response (CR), partial response (PR), stable disease (SD), or progressive disease (PD). Agreement between clinical and MRI staging pre- and post-treatment was assessed using kappa coefficients.

Eighty-eight patients were included (mean age: 57.7 ± 10.6 years). CR, PR, SD, and PD were observed in 67%, 17%, 9%, and 7% of patients, respectively. MRI findings demonstrated substantial agreement with clinical staging before pre-treatment (78%, K = 0.63) and after post-treatment (71%, K = 0.71). CR rates were highest in early-stage disease (FIGO stage I: 90%), whereas PD was more frequent in advanced stages (FIGO stage II: 9%; FIGO stage III: 13%).

The MRI-based RECIST criteria effectively assess the cervical cancer treatment response after post-chemoradiation. The high CR rate (67%) suggests that an external beam boost may serve as a viable alternative for brachytherapy. However, PD in advanced-stage disease highlights the need for further research to optimize treatment strategies. Future studies should evaluate long-term outcomes and explore advanced MRI techniques to enhance the response assessment.