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. 2023 Feb 16:17:1508.
doi: 10.3332/ecancer.2023.1508. eCollection 2023.

Challenges and opportunities for implementing hypofractionated radiotherapy in Africa: lessons from the HypoAfrica clinical trial

Elizabeth Olatunji  1   2 , William Swanson  3   2 , Saloni Patel  1 , Samuel Olaolu Adeneye  4 , Funmilayo Aina-Tofolari  4 , Stephen Avery  5 , Jumaa Dachi Kisukari  6 , Katy Graef  7 , Saiful Huq  8 , Robert Jeraj  9   10 , Adedayo O Joseph  4 , Joerg Lehmann  11   12   12 , Heng Li  1 , Abba Mallum  13   14 , Thokozani Mkhize  13   14 , Twalib Athumani Ngoma  6   15 , Andrej Studen  10   16 , Krishni Wijesooriya  17 , Luca Incrocci  18   19 , Wilfred Ngwa  1   20   19
Affiliations

Challenges and opportunities for implementing hypofractionated radiotherapy in Africa: lessons from the HypoAfrica clinical trial

Elizabeth Olatunji et al. Ecancermedicalscience. .

Abstract

The rising cancer incidence and mortality in sub-Saharan Africa (SSA) warrants an increased focus on adopting or developing approaches that can significantly increase access to treatment in the region. One such approach recommended by the recent Lancet Oncology Commission for sub-Saharan Africa is hypofractionated radiotherapy (HFRT), which can substantially increase access to radiotherapy by reducing the overall duration of time (in days) each person spends being treated. Here we highlight challenges in adopting such an approach identified during the implementation of the HypoAfrica clinical trial. The HypoAfrica clinical trial is a longitudinal, multicentre study exploring the feasibility of applying HFRT for prostate cancer in SSA. This study has presented an opportunity for a pragmatic assessment of potential barriers and facilitators to adopting HFRT. Our results highlight three key challenges: quality assurance, study harmonisation and machine maintenance. We describe solutions employed to resolve these challenges and opportunities for longer term solutions that can facilitate scaling-up use of HFRT in SSA in clinical care and multicentre clinical trials. This report provides a valuable reference for the utilisation of radiotherapy approaches that increase access to treatment and the conduct of high-quality large-scale/multi-centre clinical trials involving radiotherapy.

Trial registration: Not available yet.

Keywords: hypofractionated radiotherapy; prostate cancer; radiotherapy; sub-Saharan Africa.

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Conflict of interest statement

The authors declare that they have no conflicts of interest.

Figures

Figure 1.
Figure 1.. Data reported by the Directory of Radiotherapy Centers on the number of centres in SSA by country.
Figure 2.
Figure 2.. Data reported by the Global Cancer Observatory on the number of new prostate cancer incidences in SSA by country during 2020.
Figure 3.
Figure 3.. Reported accessible radiotherapy technology in African radiotherapy centres.
Figure 4.
Figure 4.. Reported HFRT familiarity among African radiotherapy centres.
Figure 5.
Figure 5.. Reported training received by radiation oncologists and medical physicists in African radiotherapy centres.
See this image and copyright information in PMC

References

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