Techniques and Practice of Post Mastectomy Radiotherapy in Nigeria: A Multi-Centre Study

Breast cancer affect millions of women worldwide with an increasing incidence in developing countries. In Nigeria, late presentation is the norm, with most patients presenting at stages III and IV. Patients may be at risk of local recurrence after mastectomy due to areas of microscopic residual disease such as the chest wall and regional nodal basins. Post-mastectomy radiotherapy (PMRT) has been found to reduce this risk. The aim of the study was to evaluate the techniques and practice of post mastectomy radiotherapy among breast cancer patients treated in Nigeria. This descriptive retrospective study was carried out for all histologically confirmed breast cancer cases that had post mastectomy radiotherapy between 2004 and 2015, in all (8) centres in Nigeria. Information from patient’s records were extracted using data proforma. Data of 2,143 patients were analysed. All patients received radiation to the chest wall. Thirty nine point one percent had two regional nodes irradiated, while 38% had only axilla treated, and 6.3% had three regional lymph nodes irradiated. All patients had treatment planning, majority (93.7%) with conventional technique. The primary beam used was photon with electron boost to the scar (62.8%). Fractionation method was mostly 50Gy in 25 fractions over 5 weeks (61.8%). Three fields were used in treating more than half of the patients (63.0%) while 30.9% were treated with 4 fields’ techniques. The study revealed a short fall in access to radiotherapy within the study period. Two dimensional treatment planning method was the dominant with considerable variations across centres in terms of practice and techniques.