Comparative Study of Local Control, Response and Toxicities between Accelerated Radiotherapy versus Concurrent Chemoradiation using Conventional Fractionation in the Treatment of Locally Advanced Cervical Cancer (Stage IB2, IIA2, IIB-IVA)

Abstract

Worldwide, cervical cancer is the leading cause of morbidity and mortality in women. Even though pelvic External Beam Radiotherapy (EBRT) in conventional fractionation with concurrent chemoradiotherapy followed by brachytherapy is the standard of care of locally advanced carcinoma cervix; accelerated radiotherapy can be a useful modality of treatment. Purpose of this study was to observe the efficacy of accelerated radiotherapy versus concurrent chemoradiotherapy using conventional fractionation as treatment for locally advanced carcinoma cervix (stage IB2, IIA2, IIB-IVA) in tertiary centers of Bangladesh. It was a prospective quasi experimental observational study. The study was conducted in department of Radiation Oncology, National Institute of Cancer Research and Hospital, from December 2016 to November 2017. The study subjects were patients of histologically & radiologically proven squamous cell carcinoma of locally advanced stages of uterine cervix, attending the department of Radiation Oncology, NICRH, Dhaka. Total sample size was 60. Sample was selected by purposive sampling technique. Median EBRT time was 30 days & 38 days in arm-A and arm-B respectively. Median gap during EBRT was 1 day & 3 days in arm-A and arm-B respectively. Median OTT was 55 days & 61 days in arm-A and arm-B respectively, a statistically significant delay in chemo radiation arm-B (p value<0.0001). Regarding treatment response, at the end of last follow up, in arm A, 23 patients (76.6%) showed complete response (CR), where in arm B complete response was noticed in 25 patients (83.3%). Partial response (PR) were in 4 patients (13.3%) and 5 patients (16.6%) in the two arms respectively. Progressive disease was found in 1 patient (3.33%) in arm A & 2 patients (6.66%) in arm B. No statistical significance was found between two arms. Locally advanced carcinoma cervix (stage IB2, IIA2, IIB-IVA) continues to be a healthcare problem in developing countries where effective screening programs, treatment facilities or economic condition are limited. Present study suggested that early responses to treatment with pure accelerated EBRT are non-inferior to concomitant chemoradiation and the acute toxicities are lesser.