Survey of current practices in the management of cervical cancer by Moroccan radiotherapists

Abstract

To assess the applicability degree of the international guidelines by Moroccan radiotherapists, in order to improve the management of cervical cancer (CC), since CC is the second most common cancer for women in Morocco. This is a cross-sectional study carried out using a questionnaire, which was sent online to Moroccan radiotherapists. The questionnaire covered participants' characteristics, initial assessment and treatment preparation, techniques and indications for radiotherapy and brachytherapy, dose and indications, as well as on the protocol adopted in the intermediate stages and the location of adjuvant treatments and assessments' follow-up. 74 radiotherapists out of 300 have responded to the survey. Only 27% of practitioners reported discussing patient records systematically in a multidisciplinary consultation meeting (MCM). For the initial assessment, 77% requested pelvic magnetic resonance imaging (MRI). It is significantly less requested in regional oncology centers (ROCs) than in university hospital centers (UHCs) or the private sector (P < 0.001). Furthermore, Clinicians in ROCs do not have access to new techniques of radiotherapy. In 83.80% of cases, the most prescribed radiotherapy protocols were 45–46 Gy in 1.8–2 Gy per fraction. Three-dimensional gynaecological brachytherapy high-throughput dose guided by dosimetric scanner was available in 75.5% of structures while interstitial gynaecological brachytherapy was only available in 23% of centers. The two most prescribed dose protocols were 4 × 7 Gy and 3 × 7 Gy in 74.4% and 21.6% of cases, respectively. Finally, monitoring during the first two years was based mainly on pelvic MRI (82.2%) while PET/CT was recommended by only less than 10%. The findings obtained show that our radiotherapists generally comply with international guidelines for the cervical cancer management. However, they should still enhance their practices for the first staging evaluation, the use of systematic MCMs, the doses and treatment techniques used, and the follow-up evaluation.