Key result
HDR brachytherapy 7 Gy x 3 yields comparable GI and GU toxicities to 6 Gy x 4.
Why the study?
The optimum dose and fractionation schedule in HDR ICBT remains uncertain without uniform consensus, prompting an evaluation of acute toxicities between two regimens.
Does an HDR brachytherapy schedule of 7 Gy x 3 fractions compared to 6 Gy x 4 fractions affect acute GI and GU toxicities in patients with cervical cancer?
RCT (n=66)
randomized
No
Does an HDR brachytherapy schedule of 7 Gy x 3 fractions compared to 6 Gy x 4 fractions affect acute GI and GU toxicities in patients with cervical cancer?
A shorter HDR brachytherapy schedule of 7 Gy x 3 fractions is preferable to 6 Gy x 4 fractions due to comparable acute toxicities and reduced hospital burden for locally advanced cervical cancer.
Supports shorter 7 Gy × 3 HDR brachytherapy to reduce hospital burden in cervical cancer; confirms comparable acute GI/GU toxicity versus 6 Gy × 4.
INTRODUCTION: High dose rate (HDR) intracavitary brachytherapy (ICBT) is an integral element in the treatment of carcinoma uterine cervix. The main objective of brachytherapy in carcinoma cervix is to deliver a lethal dose to tumor cells without inducing unacceptable damage to the surrounding normal tissue. Because the absorbed dose falls off rapidly, higher doses can be safely delivered to the targeted tissue over a short time. The quest for optimum dose and fractionation schedule in HDR ICBT is still ongoing, and there is no uniform consensus. This study aimed to assess the acute dose-related toxicities of HDR brachytherapy schedule of 7 Gy x 3 fractions over 6 Gy x 4 fractions in the treatment of cervical cancer. OBJECTIVE: The aim of this study was to study the acute treatment-related gastrointestinal (GI) and genitourinary (GU) toxicities between two HDR brachytherapy regimens. MATERIAL AND METHODS: This is a prospective institutional study carried out from May 2018 to September 2018. In this time period, 66 patients of cervical cancers fulfilling our inclusion criteria were treated with concurrent chemoradiation (CCRT) following brachytherapy. During treatment, patients were randomized to arm A-7 Gy per fraction for three fractions and arm B-6 Gy per fraction for four fractions. Acute GI and GU toxicities were assessed using Common Terminology Criteria for Adverse Events (CTCAE) Version 4.03. All patients were kept for follow-up for 3 months in this study. RESULTS: There is no statistically significant difference between the two arms for acute GI and GU toxicities, and the results were comparable. CONCLUSIONS: Considering the increased hospital burden of locally advanced cervical cancer patients in the Indian context, the HDR brachytherapy schedule of 7 Gy per fraction is preferable to 6 Gy per fraction for a lesser fractionation schedule.
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Gagrani et al. (2024) conducted an RCT in cervical cancer stages IIB-IIIC1 (n=66). Cobalt-60-based HDR intracavitary brachytherapy vs. 6 Gy per fraction for four fractions was evaluated on acute treatment-related gastrointestinal (GI) and genitourinary (GU) toxicities. HDR brachytherapy at 7 Gy x 3 fractions resulted in comparable acute gastrointestinal and genitourinary toxicities compared to 6 Gy x 4 fractions, with no statistically significant difference.
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