A Retrospective Study of Definitive Radiotherapy in Locally Advanced Carcinoma of Uterine Cervix Treated Initially with Hypofractionation: A G.C.R.I. Experience

Locally advanced carcinoma cervix represents a heterogeneous group of patients.Those considered unsuitable for curative treatment at the time of presentation are generally treated with hypofractionated radiotherapy.This study evaluates locoregional outcome, early and late toxicities of bladder, rectum and vagina in locally advanced carcinoma cervix patients treated with initial short course of palliative hypofractionated radiotherapy and subsequently followed by curative radiotherapy.Between 2013 and 2016, a total of 254 patients of locally advanced cervical carcinoma were initially treated to a dose of 30Gy in 10 fractions over 2 weeks.Fifty two out of 254 patients (20.5%) were identified who were subsequently treated with curative radiotherapy after being initially treated with palliative hypo-fractionated radiotherapy.Forty three of 52 patients (82.7%) were suitable for complete course of pelvic irradiation.Out of 43, 28 patients received brachytherapy boost and 15 patients received external beam radiotherapy boost.With a median follow-up of 19 months, 19 patients out of 40 (47.5%) had complete response, 10 (25%) had subjective symptomatic response initially and 11 (27.5%) had progressive disease.Patients receiving brachytherapy had disease free survival (15 months vs. 19 months; p>0.05) as compared to those received pelvic boost by external radiotherapy.In our study, 20.5% patients of locally advanced cervical carcinoma patients treated with initial short course hypofractionated palliative external beam radiotherapy became eligible for curative radiotherapy.These patients show a reasonably good survival and acceptable delayed toxicities and use of brachytherapy boost in selected subset of patients is encouraged.The data of this study correlates well with studies of similar nature done in the past.