Management of febrile neutropenia in patients receiving chemotherapy for solid tumors: a retrospective study of twenty cases from the radiotherapy centre, Accra, Ghana.

BACKGROUND: One in ten patients on anticancer medication will develop febrile neutropenia irrespective of tumour type. There is need to protect our patients from this fatal condition while optimising chemotherapy. This may be difficult for a poor country. OBJECTIVE: to assess the management of cancer patients with febrile neutropenia in a low resource setting. METHODS: records of 20 cancer patients with febrile neutropenia (fn) over a three-year period were retrospectively analysed. data retrieved included age, sex, type of cancer and number of cycles of chemotherapy taken. Other parameters included initial temperature, site of infection, absolute neutrophil count (ANC) at presentation and antibiotic choice. Use of antifungal drugs, duration of fever and overall treatment outcome were also assessed. RESULTS: the male : female ratio was 3:2 with a median age of 24 years (range: 15 - 68 years), and a mean temperature of 38.8 oC (range 38.0-39.8 0C). Mean absolute neutrophil count was 0.2 x 109 (range: 0.0 to 0.6 x 109). Thirteen (65%) received Cisplatin, five (25%) received Adriamycin, two (10%) received Paclitaxel or Cyclophosphomide-Methotrexate-5, Fluorouracil (CMF). Ten(50%) developed FN with the first cycle of chemotherapy, and six(30%) in the second cycle. Twelve (60%) had oral infection, four(20%) had gastroenteritis and single episodes of respiratory and urinary tract infections. Eleven (55%), received Ceftriaxone and Gentamycin, five (25%) cases received Levofloxacin or ciprofloxacin and Amoxicillin/clavunate + metronidazole; two cases(10%), Ceftazidime and Gentamycin; two cases(10%) received Meropenem. Twelve (60%) patients had antifungal therapy for oral candidiassis. Eight (40%) patients received growth factors. The mean fever duration was 4.5 days (range 1-10 days). Two (10%) of the patients died. CONCLUSION: febrile neutropenia in resource limited countries can be managed with good history and physical examination skills. Aminoglycosides are important components of empiric treatment in Ghana.

Profile of breast diseases at a self-referral clinic in Ghana.

BACKGROUND: Breast cancer is a common malignancy in Ghana, and many patients are referred with advanced disease and long duration of symptoms. OBJECTIVE: To determine the spectrum of breast disease diagnosed through patient self-referral in Ghana. METHODS: A breast clinic, where patients could walk in without referral, was started in the Korle Bu Teaching Hospital in 2001. A team of surgeons, radiation oncologists, oncology nurses, a clinical psychologist and a clinical pharmacist sat in conference once a week to see and discuss self-referred patients. RESULTS: Seven hundred and forty eight patients, mean age 38.6 (range 8-85) years, were seen during a four-year period. There were 741 females and seven males. The main complaints were pain 450 (50.2%), lump 257 (28.7%) and nipple discharge 62 (8.3%). Fifty (5.6%) came for check-up; 139 (18.6%) had more than one complaint. The mean (S.D.) duration of symptoms was; for nipple discharge 14.1 (10.5) months, lump 11.9 (7.7) months, and pain 11.3 (8.9) months. The main diagnoses were: Normal breasts 192 (27.7%), mastalgia 135 (18.1%), fibroadenosis 114 (15.2%), fibroadenomas 84 (11.2%), breast cancer 58 (7.8%), suspected breast cancer 25 (3.3%), galactorrhea 9 (1.2%), mastitis 8 (1.1%), musculoskeletal pain 8 (1.1%), duct ectasia 8 (1.1%), mondor's disease 7 (0.94%) and recurrent breast cancer 6 (0.8%). In patients with breast cancer, 42 (66%) had advanced disease, 6 (9.4%) had recurrent disease and 4 (63%) had metastatic disease. CONCLUSION: The number of self-referrals, detected breast cancers and duration of symptoms justify the need for self-referral clinics in Ghana.

Treatment outcome of locally advanced nasopharyngeal cancer with concurrent chemoradiotherapy.

BACKGROUND: Treatment options for locally advanced Nasopharyngeal lancer include radiation alone or cisplatin based concurrent chemoradiotherapy. Concurrent chemoradiotherapy is associated with higher morbidity but has been shown to yield better survival. OBJECTIVE: This study was aimed at determining the outcome of treatment of Nasopharyngeal Cancer with concurrent chemoradiotherapy in our setup. METHODS: Twenty-six patients with biopsy proven disease who had undergone staging procedures were studied according to age, sex, WHO histological type and stage of disease. Treatment consisted of 70 Gy to the primary site and 60 Gy to the neck with disease. Chemotherapy was given as follows: three cycles of three weekly cisplatin at 80 mg/m2 during radiation followed by three cycles of three weekly cisplatin at 60 mg/m2 on day 1 and 5-fluorouracil at 1000 mg/m2 on days 1 to 5 in the adjuvant setting. Side effects of treatment, pattern of failure and survival were determined. RESULTS: The male to female ratio was 2:1, age range was 10-68 years. WHO type 3 was predominant at 50%. Stage IVB disease was present in 73.1% of patients. Average number of chemotherapy cycles received was three. Median follow up period was 30 months (8-56 months), 42.3% survived beyond 24 months. Twelve patients developed recurrence of disease, of which eight had local regional recurrence only. CONCLUSION: Concurrent chemoradiotherapy is possible in our setting with acceptable morbidity at the prescribed doses. Survival beyond two years is possible in our environment with this regime. Local failure is the predominant cause of death.

Ovarian cancer: an analysis of forty-four patients at the National Radiotherapy Centre, Accra--Ghana.

BACKGROUND: The median age for ovarian cancer is 60-65 years. Greater than 70% present with advanced disease but recent treatment advances have resulted in modest improvement in treatment outcome over the past decade. OBJECTIVE: To evaluate the median age, time of presentation, histology and treatment outcome of 44 cases referred to us for management. METHODS: We studied 44 cases of ovarian cancer. Chemotherapy consisted of 3 weekly cycles of Cisplatin at 75mg/m2 and Cyclophosphamide at 750mg/m2 or Paclitaxel at 175mg/m2. Parameters documented included age, histology, time of presentation stage and treatment response. These were obtained from clinical examination, operation notes, pathology reports, radiological exams and Cancer Antigen 125 tumor marker levels. RESULTS: Age range was 12-64 years with a median of 45 years. Thirty-seven (82%) had stage 3 or 4 disease. Thirty-seven (82%) presented after four months of which two-thirds presented more than one year after initial symptoms. Thirty-seven (82%) had epithelial ovarian cancer, four (9%) had germ cell tumours and three (7%) stromal tumors. Only twenty five patients could be assessed for treatment response. Twenty (80%) out of these 25 patients received Cyclophosphamide and Cisplatin chemotherapy. Total clinical response rate was 52%, with only four patients (16%) achieving complete clinical response and nine patients (36%), a partial response. CONCLUSION: Our patients presented with a median age of 45 years which is lower than what is reported for most countries. A large majority present with advanced disease and presented more than four months after initial symptoms. The response rate of cyclophosphamide/Platinum chemotherapy in this group with epithelial cell type was relatively low.

MANAGEMENT OF PROSTATE CANCER IN ACCRA, GHANA.

INTRODUCTION: Africans living with prostate cancer in Africa face problems of early diagnosis and appropriate treatment. AIM: To study the clinical incidence of prostate cancer, risk factors, TNM stage, their management and outcomes. METHODS: A prospective study of Prostate Cancer cases managed at Korle Bu Teaching Hospital and hospitals in Accra, diagnosed by history, abnormal PSA/DRE, physical examination and histologically confirmed by biopsy from 2004 to 2013 was carried out. The cases were TNM staged and managed by approved protocol. RESULTS: There were 669 cases with a mean age 70±0.045SE years, median Gleason Score of 7, organ confined Prostate Cancer(PC) in 415(62%), locally advanced in 167(25%) and metastatic Prostate Cancer in 87(13%) cases. The cases were followed for median of 10 months to ≥ 84 months. Organ confined cases were managed by: Radical Prostatectomy (RP) 92 (13.8%) with a mortality of 0.3%; brachytherapy 70 (10.5%) with a mortality of 0.1% and External Beam Radiotherapy (EBRT) 155 (23%) with a mortality 0.7%. In all, 98 men constituting (14.1%) cases with a mean age of 75+0.25SE years, life expectancy <10 years were treated by hormonal therapy with a mortality of 1.7%. Twenty cases who were for active surveillance (GS6), PSA <10ng/ml, life expectancy <10 years later all opted for EBRT. Locally advanced cases 25% all had neoadjuvant hormonal therapy then Brachytherapy in 3 (0.4%) mortality 0.15% and EBRT in 64 (9.5%), mortality 0.59%. Hormonal therapy was given in 100 (15%) locally advanced cases, mortality 5%. Metastatic prostate cancer cases (13%) were managed by hormonal therapy, mortality 6%. CONCLUSION: Improved facilities and dedicated skilled teams led to a significant rise in proportion of organ confined Prostate Cancer from 15.3% to 62% curable by Radical Prostatectomy, brachytherapy or EBRT with longer disease free survival.

Laryngeal cancer at the korle bu teaching hospital accra ghana.

SUMMARY INTRODUCTION: Laryngeal cancer is the commonest Head and Neck cancer seen at the Ear Nose and Throat (ENT) Unit Korle-Bu Teaching Hospital. The aim of this study was to determine the number of cases of laryngeal cancer seen at the Korle Bu Teaching Hospital, establish epidemiological parameters of the disease and to outline preventive measures. METHOD: One hundred and fifteen (115) patients who were managed for laryngeal cancer from 1(st) January 1998 to 31(st) December 2003 were studied retrospectively with respect to age, sex, duration of symptoms at presentation, risk factors, symptoms complex, histopathology, stage of tumor, details of treatment offered and follow up. RESULTS: The age range was 17-85 years with a mean of 55.5 years (SD10.7). Majority of the patients (90.4%) were above 40 years. The commonest symptom at presentation was dysphonia. A significant proportion of cases (37.3%) presented with locally advanced disease. The commonest histological type of laryngeal tumour seen was squamous cell carcinoma. The treatment offered consisted of radiotherapy for 83 (79.8%) patients and total laryngectomy with neck dissection when necessary for 17 (16.3%) patients who also had postoperative radiotherapy. Only 58 (69.9%) patients completed radiotherapy treatment and in all 32 (24.3 %) patients did not report for any treatment. Majority of patients failed to report for post treatment follow up. CONCLUSIONS: We conclude that significant number of patients with laryngeal cancer presented with locally advanced disease and dysphonia was the commonest symptom.