Didactics-Gestational Trophoblastic Neoplasia Treatment at the Butaro Cancer Center of Excellence in Rwanda

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The study examines the treatment of Gestational Trophoblastic Neoplasia (GTN) at the Butaro Cancer Center of Excellence (BCCOE) in Rwanda, a resource-limited setting. GTN primarily affects young women and is highly treatable. The research spanned from 2012 to 2014, reviewing the cases of 35 GTN patients. It assessed the disease using International Federation of Gynecology and Obstetrics staging and the WHO scoring system, relying on beta human chorionic gonadotropin (b-hCG) levels, chest X-rays, and ultrasounds.<br /><br />Of the patients, 74% were categorized as high-risk and 26% as low-risk. Before reaching BCCOE, procedures like dilation and curettage or hysterectomy had been performed in many cases; however, pathology reports were available for only 48% of these surgical cases. Systemic chemotherapy was administered based on risk stratification: 43% received methotrexate, 50% received EMACO, and 7% received other regimens, with some cases requiring treatment escalation due to methotrexate failure.<br /><br />At a median follow-up of 7.8 months, the survival probability was 100% for low-risk patients and 63% for high-risk patients. Although preliminary, these outcomes indicate the feasibility of GTN treatment in rural and resource-limited environments through a protocol-driven approach assisted by remote expert guidance. Challenges included treatment delays due to medication stockouts and incomplete diagnostic work-ups, such as insufficient pathology reporting and limited imaging resources, leading to potential understaging.<br /><br />The study advocates for enhanced imaging, consistent access to b-hCG testing, and chemotherapeutic resources to improve care. It underscores the potential of leveraging existing health and telemedicine infrastructure to improve cancer care access in underserved areas, highlighting the success of integrating local non-oncologists in treatment protocols with specialist support to deliver effective cancer care in low-resource settings.

Asset Subtitle

Temidayo Fadelu/ Neo Tapela /Tharcisse Mpunga / Rahel G. Ghebre

Keywords

Gestational Trophoblastic Neoplasia

Butaro Cancer Center

Rwanda

resource-limited

chemotherapy

treatment outcomes

beta human chorionic gonadotropin

telemedicine

cancer care

low-resource settings