Top Line: Hypofractionation is an attractive means to shorten overall treatment time for locally-advanced cervical cancer.
The Study: An Indian single-arm phase 2 trial! enrolled 50 women with stage IB3–IIIC cervical squamous cell carcinoma. It delivered 3D-conformal 4-field whole pelvis radiation to 40 Gy in 16 daily fractions followed by a sequential boost of 10 Gy in 4 fractions to any gross nodal disease all with concurrent weekly cisplatin topped off with HDR brachytherapy 28 Gy in 4 fractions. Median overall treatment time was 7 weeks. Acute grade 3+ GI toxicity was higher than expected at 20%, but rates of acute grade 3+ GU (6%) and heme (20%) toxicity were on par with historical controls. Late grade 3+ GI, GU, and vaginal toxicities were 10%, 2%, and 6%. Overall survival at 5 years was 78% and comparable to modern EMBRACE-era benchmarks despite 42% of enrollees having stage III disease.
TBL: Moderately hypofractionated pelvic radiation with concurrent cisplatin preceding brachytherapy for locally-advanced cervical cancer delivers solid 5-year disease control at the expense of worse GI toxicity, with IMRT-based hypofractionation potentially poised to lessen the trade-off. | Gandhi, Int J Radiat Oncol Biol Phys 2025
The Study: An Indian single-arm phase 2 trial! enrolled 50 women with stage IB3–IIIC cervical squamous cell carcinoma. It delivered 3D-conformal 4-field whole pelvis radiation to 40 Gy in 16 daily fractions followed by a sequential boost of 10 Gy in 4 fractions to any gross nodal disease all with concurrent weekly cisplatin topped off with HDR brachytherapy 28 Gy in 4 fractions. Median overall treatment time was 7 weeks. Acute grade 3+ GI toxicity was higher than expected at 20%, but rates of acute grade 3+ GU (6%) and heme (20%) toxicity were on par with historical controls. Late grade 3+ GI, GU, and vaginal toxicities were 10%, 2%, and 6%. Overall survival at 5 years was 78% and comparable to modern EMBRACE-era benchmarks despite 42% of enrollees having stage III disease.
TBL: Moderately hypofractionated pelvic radiation with concurrent cisplatin preceding brachytherapy for locally-advanced cervical cancer delivers solid 5-year disease control at the expense of worse GI toxicity, with IMRT-based hypofractionation potentially poised to lessen the trade-off. | Gandhi, Int J Radiat Oncol Biol Phys 2025