Comparison of Outcome and Toxicities of Treatment with Six Fractions per Week Versus Five Fractions per Week Concurrent Chemo-radiation in Locally Advanced Cervical Carcinoma

Background: Cervical cancer remains a leading cause of female mortality worldwide. Optimizing chemoradiation fractionation schedules may improve tumor control while minimizing toxicities and reducing treatment duration. Objective: This study aimed to compare treatment efficacy, overall response rate, and acute toxicities between five-fractions-per-week conventional concurrent chemoradiation (CCRT) and six-fractions-per-week accelerated CCRT in locally advanced cervical carcinoma. Methods: A quasi-experimental study was conducted at Rajshahi Medical College Hospital (January 2021–July 2022) with 68 biopsy-proven squamous cell carcinoma patients, randomized into two arms (Arm A: 5 fractions/week, Arm B: 6 fractions/week). Both groups received concurrent weekly cisplatin and HDR brachytherapy. Patients were evaluated pre-, during, and post-treatment at 4, 8, and 12 weeks for response and toxicities. Results: A total number of 68 patients, 64 completed treatments (Arm A: n=32, Arm B: n=32). Mean age was 49.11 ± 10.9 years (range 28–69). Median EBRT duration was significantly shorter in Arm B (29.7 ± 1.9 days) compared to Arm A (36.1 ± 2.3 days; p<0.0001). Complete response was 65.6% in Arm A and 59.4% in Arm B, with partial response 25% vs. 18.8% respectively; overall response rates were 90.6% vs. 78.1% (p=0.168). Grade 1–2 hematological toxicities occurred in 53.1% (Arm A) vs. 46.9% (Arm B; p=0.472). Gastrointestinal toxicity (Grade ≥2) was slightly higher in Arm B (31.2% vs. 28.1%, p=0.623). No progressive disease was observed. Kaplan–Meier estimates showed improved treatment completion probability in Arm B due to shorter schedules. Conclusion: Accelerated CCRT significantly reduced treatment time with comparable response and toxicity outcomes to conventional CCRT. Although overall response favored conventional CCRT, statistical superiority was not established. Larger trials are recommended.