Comparing Toxicities between 18 Gy in 2 Fractions vs 21 Gy in 3 Fractions of Brachytherapy after Concurrent Chemoradiotherapy in Locally Advanced Carcinoma Cervix

Background: Cervical cancer remains a major global health issue, particularly in low- and middle-income countries, where late-stage diagnosis is a common phenomenon. For patients with locally advanced cervical carcinoma (LACC), concurrent chemoradiotherapy (CCRT) followed by high-dose-rate (HDR) brachytherapy is the standard treatment modality. Aim: This study aimed to compare early toxicity outcomes of two HDR brachytherapy regimens—18 Gy in 2 fractions versus 21 Gy in 3 fractions—administered after CCRT in patients with LACC. Methods: A quasi-experimental study was conducted at the National Institute of Cancer Research and Hospital (NICRH), Dhaka, between July 2023 and December 2024. A total of 66 histopathologically confirmed LACC patients were enrolled and divided equally into two arms: Arm A: 18 Gy in 2 fractions and Arm B: 21 Gy in 3 fractions. All patients received external beam radiation therapy (EBRT) at 50 Gy in 25 fractions over 5 weeks with concurrent weekly cisplatin (40 mg/m²), followed by HDR brachytherapy per their assigned arm. Early toxicities were assessed at 6-, 12- and 24-weeks post-treatment using CTCAE v5.0. Data analysis was performed using SPSS version 27, with statistical significance set at p < 0.05. Findings: Most patients were aged 30–50 years and from low socio-economic backgrounds, contributing to delayed diagnosis. Acute toxicity profiles were largely comparable between the two arms. At 12 weeks, anemia was absent in 96.9% of Arm A and 100% of Arm B; at 6 weeks, Grade II proctitis was reported in 9.1% (Arm A) and 6.0% (Arm B); at 12 weeks, skin toxicity occurred in 6.1% of patients in both arms and at 24 weeks, Grade I vaginal dryness was noted in 9.1% (Arm A) and 12.1% (Arm B). No statistically significant differences were found in hematological, gastrointestinal, genitourinary, dermatological, or vaginal toxicities between the two regimens. Conclusion: The 18 Gy in 2 fractions HDR brachytherapy regimen demonstrated comparable early toxicity outcomes to the 21 Gy in 3 fractions schedule, with the added advantage of shorter treatment duration. This makes it a viable, resource-efficient option for managing LACC in low-resource settings. Further large-scale studies with long-term follow-up are warranted to assess late toxicities, loco-regional control, and survival outcomes.