Cervical cancer remains a major global health problem and continues to disproportionately affect low- and middle-income countries, particularly in sub-Saharan Africa, where high incidence and mortality rates coexist with limited access to specialized cancer care [1][2]. This situation is linked to several factors, including diagnostic delays, insufficient screening, incomplete human papillomavirus vaccination coverage, and inequalities in access to surgery, external beam radiotherapy, and brachytherapy [1][2].

Standard treatment for locally advanced cervical cancer relies on platinum-based concurrent chemoradiotherapy followed by brachytherapy, which remains an essential component of curative treatment [3]-[7]. Historical randomized trials have shown that combining cisplatin-based chemotherapy with radiotherapy significantly improves overall survival and progression-free survival compared to radiotherapy alone [3][8]. These data have subsequently been consolidated by meta-analyses confirming the benefit of concurrent chemoradiotherapy in the treatment of locally advanced cervical cancer [5]. At the same time, international guidelines emphasize that brachytherapy cannot be omitted or replaced by external beam radiotherapy alone, even when it relies on modern irradiation techniques [6][7].

Technological advances in radiation oncology have led to the development of intensity-modulated radiotherapy and, subsequently, volumetric modulated arc therapy (VMAT), an advanced delivery technique that provides dynamic dose modulation during gantry rotation [9][10]. VMAT enables dynamic dose delivery through continuous rotation of the accelerator arm, modulation of the dose rate, and synchronized movement of the multileaf collimator blades [9][10]. This technique offers several potential advantages, including improved dose conformation to the target volume, better protection of organs at risk, reduced treatment time, and greater delivery efficiency compared to some conventional approaches or static IMRT plans [9]-[11].

In cervical cancer, VMAT has shown promising dosimetric advantages, including improved target volume coverage and reduced irradiation of organs at risk such as the bladder, rectum, bowel, pelvic bone marrow, and femoral heads [11]-[14]. However, the magnitude of its clinical benefit may vary according to local expertise, treatment workflow, and integration with brachytherapy [9][11][14].

In Africa, implementation of advanced radiotherapy techniques remains challenged by equipment shortages, limited brachytherapy capacity, and human resource constraints [2][15]. In Burkina Faso, published data on the use of VMAT for cervical cancer remain scarce. The present study therefore aimed to report the experience of the Radiotherapy Department of Bogodogo University Hospital in the management of cervical cancer with VMAT in a cohort of 52 patients.

A total of 52 patients irradiated for cervical cancer at the radiotherapy department of the Bogodogo University Hospital between March 2023 and October 2025 were included in the analysis. The mean age was 56.12 years, with a range of 30 to 83 years, and the median age was 55 years.

This study presents the initial experience of the Bogodogo Radiotherapy Department with VMAT in the treatment of cervical cancer and shows that most patients were managed for locally advanced disease. More than half of the cohort had FIGO 2018 stage IIIA or higher disease, and nearly one-third had nodal involvement. This pattern is consistent with reports from sub-Saharan Africa, where limited screening coverage, delayed diagnosis, and barriers to referral contribute to the predominance of advanced-stage presentation [2][17][18].

In sub-Saharan Africa, cervical cancer remains one of the leading reasons for gynecological radiotherapy, but its management is still heavily dependent on the availability of equipment, specialized personnel, and brachytherapy [2][19]. A recent systematic review showed that access to radiotherapy in sub-Saharan Africa remains limited by financial, geographic, logistical, and human constraints, with a direct impact on the quality and completeness of treatments [2]. In this context, the implementation of an advanced technique such as VMAT in a West African center represents a significant organizational and technological advancement [19].

The marked predominance of invasive squamous cell carcinoma in the present series is also consistent with regional and international data [19][20]. In addition, most patients had preserved performance status, which likely contributed to the feasibility of concurrent chemoradiotherapy in this cohort. All patients received radiotherapy and concurrent chemoradiotherapy, suggesting relative consistency of treatment delivery at the institutional level.

The treatment modalities observed in this study are consistent with contemporary standards. All patients received concurrent radiotherapy and chemoradiotherapy, while induction chemotherapy was used in only a portion of the cohort, and surgery remained a minority procedure [7][21]. This distribution is logical in a population dominated by locally advanced forms of the disease, for which chemoradiotherapy followed by brachytherapy is the standard treatment [6][7][21]. However, several African studies show that, beyond the recommendations, the actual implementation of this therapeutic standard remains inconsistent, particularly due to access delays, treatment interruptions, and the variable availability of brachytherapy [2][18][22].

The growing use of VMAT in radiation oncology is mainly supported by dosimetric and logistical advantages, including improved dose conformity, sparing of pelvic organs at risk, and shorter treatment times in selected settings [9][10][12][13]. The literature also suggests that VMAT can help reduce certain treatment times and improve logistical feasibility in high-volume departments [9][14]. However, the current study does not yet provide detailed dosimetric data, toxicity outcomes, brachytherapy information, or full time-to-event analyses, which limits the ability to draw strong conclusions regarding long-term oncologic benefit [7][23].

In this retrospective cohort, overall survival was prespecified as the primary endpoint, and our analysis remains essentially descriptive and hypothesisgenerating rather than designed to demonstrate definitive treatment benefit. The proportion of patients alive at last follow-up appears encouraging. Nevertheless, this result should be interpreted cautiously because the study did not provide a complete actuarial survival analysis, median follow-up duration, or detailed progression-related outcomes. For comparison, the experience of the National Radiotherapy Center in Accra, Ghana, involving 250 patients treated with external beam radiotherapy and brachytherapy, reported a 3-year overall survival rate of 86% with a median follow-up of 2.4 years [24]. This comparison suggests that the Bogodogo results are promising, but it also highlights the need for methodological refinement of the manuscript by adding data on survival, toxicities, brachytherapy, overall treatment time, and dosimetric parameters in order to more accurately assess the oncological and technical performance of this institutional experience [2][7][24].

Limits of the study: First, the retrospective design and our inclusion of only 52 of the 56 patients who initiated VMAT may have introduced selection bias, because four patients with incomplete baseline data or missing followup were excluded from the analysis. This restriction to patients with more complete records and documented followup may overestimate treatment completion and survival, and our results should therefore be interpreted as exploratory institutional observations rather than populationlevel estimates.

VMAT-based management of cervical cancer at the Bogodogo Radiotherapy Department mainly involved patients with locally advanced disease and relied primarily on concurrent chemoradiotherapy. The study supports the feasibility of implementing VMAT in a low‑resource African setting, but additional studies are required to better define toxicity, local control, and survival.