The challenges of treating locally advanced cervix carcinoma in resource limited settings – what are the options?

Abstract

Delivery of oncological care in Southern Africa remains a challenge for us all with long surgical waiting lists, radiotherapy waiting lists, stock-outs of chemotherapy and staff shortages to mention just a few. Many of us make modifications to internationally accepted protocols to adapt to our environments, for example the use of hypofractionation, excluding cisplatin in Stage IIIB patients, neoadjuvant chemotherapy and stratification of patients based on risk factors such as hydronephrosis. What has remained unanswered in many scenarios is whether there is any evidence-base to these decisions.