Browsing by Author "Fakie, Nazia"

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    Open Access
    A retrospective audit of young patients diagnosed with cervical cancer over ten years at Groote Schuur Hospital, Cape Town between 1 January 2003 and 31 December 2012, and their outcome at five-year follow-up compared to women in the prior decade
    (2020) Govindasamy, Suveshni; Mbatani, Nomonde; Fakie, Nazia
    Background : Cervical cancer is the second commonest gynaecological cancer amongst women worldwide and the leading cause of cancer deaths in developing countries – contributing 83% of new cases and 85% of all deaths annually to the burden of this disease. Information and awareness of this illness in the developing world is still inferior, and mortality is increasing. In the developing world, late presentation, advanced-stage disease and a poorly run screening programme (covering only 55% of the South African population) are all contributing factors to this statistic. Approximately 20% of all South African women in their reproductive age are also HIV positive. With the rising burden of cervical cancer and the emergence of HIV as an influencing comorbidity, South Africa adopted a national cervical screening programme, rolled out in 2000 as well as an HCT (HIV counselling and testing) programme formalised in 2011. With these initiatives now in place, this study examined trends and compared 5-year survival outcomes between two decades for cervical cancer among young women. Methods : The study undertook a retrospective audit of files and information on the pre-existing cervical cancer database, and appropriate data was extracted (HREC REF 344/2011). Survival and disease outcomes at five years, as well as time to recurrence, was assessed, together with other demographics of the study population. Patients included in the study were non-pregnant female patients, aged 40 years and younger at the time of registration with the Groote Schuur Hospital (GSH) Oncology Unit (LE 33). The diagnosis of cervical cancer had to have been confirmed histologically, as either squamous cell carcinoma or adenosquamous carcinoma or adenocarcinoma. Patients must have attended at the LE 33 unit on or from 1 January 1993 until and including 31 December 2012. The two decades were studied and 5-year outcomes from each decade were analysed and reviewed using Kaplan-Meier curves and univariate analyses. The study compared data using Log Rank tests and p-values. Findings : The two decade-groups under study showed no difference in trends of survival regarding age, treatment type and histology. Albeit small numbers, adenocarcinoma was the histology that had the best probability of survival during both decades. There were more patients with early-stage cancer (stage 1 and 2) diagnosed in decade B (2003 – 2012) than A (1993 – 2002). Within this early-stage cervical cancer cohort, there is a trend toward more locally-advanced (stage 2) cancer in the more recent decade. The proportion of patients presenting with stage 1a and 1b cancer with tumours 4 cm and less has halved from decade A to decade B. The proportion of stage 2 cancers presenting with tumours 2 – 4cm in size during decade B has risen almost 3-fold to that of decade A. This suggests a developing trend of presentation of more locally-advanced cancer. During both decades, stage 1 cervical cancers had the best probability of survival, with an improvement in mean survival from decade A (average of 44 months) to decade B (average of 58 months). The trend of stage 2 disease has deteriorated, with a decrease in mean survival (from 48 months in decade A to 21 months in decade B), an increase in cancer-related deaths and a shorter time to relapse. The number of patients presenting with late-stage disease (stages 3 and 4) has declined. HIV positive status played an influential role in tumour size on presentation and probability of 5-year disease-free survival. Young women who were HIV positive also fared less favourably when compared to NP (not positive) women in terms of mean survival. Due to the small sample size and that the majority of patients in decade A were untested, further HIV comparisons were not credible. Interpretation : The study suggests a moving trend towards young patients that are being diagnosed with the more locally-advanced early-stage disease in the more recent decade than ten years prior. HIV status seemingly played an influential comorbid role in patients diagnosed with cervical cancer. Patients with the locallyadvanced disease appear to have worse outcomes in the latter decade. In an attempt to curb this potentially curable disease in this subset of young women, a greater focus on earlier screening interventions, prompt diagnosis and appropriate and timeous treatment of cervical cancer, together with optimisation of comorbidities like HIV are needed.
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    Advanced breast cancer: A retrospective review comparing two palliative radiotherapy protocols used at Groote Schuur Hospital between 2010 and 2013
    (2016) Fakie, Nazia; Simonds, Hannah M; Naiker, Thurandarie
    Purpose: To retrospectively evaluate and compare the loco-regional progression free survival (PFS), overall survival (OS) and acute effects of the two breast palliative regimes used in patients with locally advanced or metastatic breast cancer between 2010 and 2013 in a single institution. Methods: Compliance to treatment, acute skin reactions, progression free and overall survival were retrospectively evaluated in patients who received palliative breast radiotherapy for locally advanced breast cancer between 2010 and 2013. The radiotherapy regimes were either 4Gy per fraction for 5 fractions treated 4 times a week (20Gy) or 6Gy per fraction for 6 fractions treated once a week (36Gy). They may have received previous chemotherapy with minimal or no clinical response, as well as hormonal treatment. Results: Forty three patients were followed up over a median period of 24 months, 14 of which received 20Gy and 29 received 36Gy. The average age was 64 years old. Compliance was 88% in both groups. Both groups had either grade 1 (71% vs 62%), grade 2 (21% vs 24%) or grade 3 (8% vs 14%) acute skin reactions. No grade 4 skin reactions were documented. The PFS was shorter at 4.5 months in the 20Gy group compared to 7.7 months in the 36Gy group (p=0.27). The OS was also shorter at 25.8 months in the 20Gy group compared to 29.6 months in the 36Gy group (p=0.51) Conclusion: This study did not show a statistically significant difference in terms of PFS and OS between the two radiotherapy regimes. They both remain reasonable options in local palliation in patients with locally advanced breast cancer.
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    Impact of no residual versus residual disease after hysterectomy for stage 1 cervical cancer on recurrence
    (2025) Ntunja, Sive; Mbatani, Nomonde; Fakie, Nazia
    Background: Histopathological risk factors for recurrence of cervical cancer following hysterectomy for stage I disease are well established. The impact of residual disease after LEEP in patients undergoing hysterectomy for stage 1 cervical cancer on recurrence has not been extensively studied. Design and Methods: Records of all patients who underwent hysterectomy for stage I cervical cancer from 1st January 2008 to 31st December 2017 were reviewed. The follow-up period was at least 60 months or until death. Data collected included demographic information, histopathological risk factors, residual disease status on hysterectomy specimen, treatment modalities and recurrence rates. Results: We analysed 147 patients: 55 stage 1A1, 11 stage 1A2, 80 stage 1B1 and 1 with stage 1B2. Median age was 47 (27 – 76) years. All patients had a cervical excision procedure (LEEP OR CKC) for histological diagnosis, followed by simple hysterectomy (29.6%), simple hysterectomy with lymphadenectomy (12.3%) or radical hysterectomy (58.2%). The prevalence of residual disease on hysterectomy specimen was 56.5%, versus no residual disease (43.5%). The overall recurrence rate was 9.5%. Thirty patients received adjuvant radiotherapy, of these, 29 had residual disease, with 6.2% of them developing disease recurrence. The overall survival (OS) and disease-free interval (DFI) were 96.6% and 91.6% respectively. Conclusion: This study found a correlation between presence of residual disease and known histological risk factors, that is size of the lesion and depth of stromal invasion. However, there was no strong correlation between residual disease and lymphovascular space invasion in this study. All patients that had recurrence had residual disease. When excluding those with lymph node metastasis, there were no recurrences in the group with no residual disease.
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    Patterns of care and outcomes for women with locally advanced cervical cancer, treated with curative intent, between 2013-2017 at a tertiary centre in South Africa
    (2024) Maina, Juliet; Fakie, Nazia
    Objective Cervical cancer is the leading most common cause of cancer-related deaths in South Africa. The standard treatment guidelines of locally advanced cervical cancer (LACC) is external beam radiation followed by brachytherapy with concurrent platinum based chemotherapy. The aim of this study is to evaluate the patterns of care and outcomes for patients with LACC (Stage IB1 – IVA) treated with curative intent at a tertiary center in South Africa. Materials and Methods This is a retrospective study conducted at Groote Schuur Hospital (GSH) in Cape Town, South Africa between July 2013 – July 2017. Overall survival (OS) and disease free survival (DFS) were evaluated using the Kaplan–Meier method. Factors associated with outcomes were analyzed using Cox proportional hazards regression modeling. Logistic regression modeling was performed to assess factors associated with chemotherapy receipt and baseline hemoglobin ≥ 10 g/dL. Results A total of 278 women were eligible to participate in this study, of which 28.4% (n=79) were HIV infected and 71.6% (n=199) were HIV uninfected. Among the patients with HIV the median CD4 count was 441 cells/μL (IQR; 315-581 /μL) and all had been initiated ART before commencing treatment. The median age for all patients 51 years(IQR; 41-60). Most patients had stage II disease accounting for 48.6% (n=135) or stage III disease accounting for 45.3% (n=126). Majority of the patients had squamous cell carcinoma (SCC) 88.4% (n=246). Evaluation of baseline investigation showed median Hb for all patients was 11.3g/dL (IQR; 9.70-12.8). Patients who received concurrent chemotherapy were 64.8% (n=180) for a median of 5 cycles. Median EQD2 dose 74.5Gy (IQR;69-80.9). The 2-year OS and DFS in the entire population was 73.3% and 72.3% respectively. Factors associated with improved OS in our cohort were receipt of chemotherapy (HR 0.32, p=0.005) and higher baseline haemoglobin (HR 0.86; p=0.018). On multivariate logistic regression adjusting for age, stage, and HIV status, showed that patients with stage III/IV disease were less likely to receive chemotherapy (HR 48.17, p<0.001) and were less likely to have haemoglobin >=10g/dL (HR 0.20, p<0.001). The 2- year OS was 87.4% for patients who received concurrent chemoradiotherapy (CCRT) vs. 52.8% for those who received radiotherapy (RT) alone (p<0.001). The 2-year DFS was 80.2% for those who received CCRT vs 58.3% for those who received radiotherapy alone(p=<0.001). Conclusion Concurrent chemotherapy is significantly associated with increased survival. In this study, patients with stage III and IV treated with curative intent did not receive chemotherapy, which was detrimental to their survival. Therefore, if performance status allows, it is essential for all to receive chemotherapy. However, patients with low Hb may require transfusion to necessitate they receive chemotherapy.
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    The incidence, management and outcomes of stage IIIB cervical cancer in a low- and middle-income setting
    (2025) Dalvie, Zaeem; Fakie, Nazia; Adams, Tracey
    Background: Cervical cancer is the second most common cancer in South Africa with stage III being the most common presenting stage. Hydronephrosis is a frequent complication in advanced disease and is associated with poorer outcomes. This review aims to evaluate the management and outcomes of patients with stage IIIB cervical cancer. Aim: To describe the incidence, treatment offered and outcomes in women with stage IIIB cervical cancer in a middle-income setting. It further aims to evaluate these differences in women with pelvic sidewall (PSW) involvement alone versus PSW with unilateral and bilateral hydronephrosis. Objectives: Determine the overall survival and disease-free survival of patients with stage IIIB cervical cancer with specific attention to those patients with hydronephrosis, determine the incidence of unilateral and bilateral hydronephrosis, determine how many patients with bilateral hydronephrosis were offered percutaneous nephrostomies, describe the treatment offered and outcomes of the women who were offered nephrostomies, describe the complications that arose by inserting nephrostomies, and to determine how many patients with hydronephrosis received concurrent chemoradiation. Methods: A retrospective audit was conducted to review clinical data of a cohort of patients who received treatment for stage IIIB cervical cancer at Groote Schuur Hospital between January 2017 and December 2018. The data collected included age, HIV status, comorbidities, pelvic sidewall involvement, hydronephrosis, treatment intent, treatment modalities, nephrostomy referral, treatment response and survival outcome. Results: A total of 132 patients were deemed eligible for our study with a mean age of 52. There was no statistically significant association between overall survival and disease-free survival with age and comorbidities apart from HIV. The median overall survival was 15 months and median disease-free survival for patients who completed radical treatment was 13 months. Overall survival and disease-free survival between presence and absence of hydronephrosis was not statistically significant. Conclusions: Hydronephrosis was not found to have a statistically significant impact on overall survival or disease-free survival. There remains a place for percutaneous nephrostomies in the acute setting and is preferred over ureteral stents in a resource-constrained setting. HIV was found to have an association with increased incidence of stage IIIB cervical cancer, as well as a negative prognostic factor for overall survival and disease-free survival.
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    Volumetric modulated Arc Therapy versus 3D conformal radiotherapy in the treatment of locally advanced cervical cancer. A single institution, comparative dosimetric study
    (2020) Bhagaloo, Visham; Fakie, Nazia
    Background: External Beam Radiotherapy is essential in the management of locally advanced cervical cancer (LACC). Generally, VMAT is thought to achieve higher conformity to the Planned Target Volume (PTV) and better sparing of organs at risk (OAR) when compared to 3D-CRT. This study focused on these principles as it applied to treatment and potential toxicity in the management of LACC. Aim: To compare dosimetric parameters between VMAT and 3D-CRT in the management of LACC. Setting: The study analysed patients treated at Groote Schuur Hospital between May and December 2017. Method: A non-randomized comparative retrospective study. EBRT plans for 3D-CRT and VMAT were generated and data on treatment parameters for PTV D50%, Dmax, Dmean, Conformity Index (CI), Homogeneity Index, Treated Volume (TV), Irradiated Volume (IV) and OAR constraints; femoral heads, bladder, bowel bag, rectum and bone marrow were collected. Results: Of the 45 patients assessed, VMAT showed significantly lower treatment parameter values for CI (1.09 vs 1.49; p< .001) whereas, 3D-CRT showed lower Dmax (48.1Gy vs 49.2Gy; p< .001) and rectum (88.5% vs 96%). A reduced 3D-CRT dose was noted for bladder Dmax (47.4Gy vs 48.3Gy; p< .001). Conclusion: VMAT offered a superior dosimetric option, with better OAR dose sparing and optimal tumour dosimetry.