Assessing Clinical Outcomes between 18 Gy in 2 Fractions vs 21 Gy in 3 Fractions of Brachytherapy after Concurrent Chemoradiotherapy in Locally Advanced Carcinoma Cervix

Abstract

Background: There is a multitude of problems encountered during the management of critical conditions in low-resource settings. Reducing the administration of brachytherapy from 3 to 2 fractions will assist cervical cancer patients by decreasing the treatment costs and as well as repeated attendances in the hospitals. Objective: The research was carried out to compare the clinical outcomes following treatment of locally advanced carcinoma cervix with two fractions of high dose-rate brachytherapy following conventional concurrent chemoradiation. Method: A quasi-experimental approach was employed. The study took place in National Institute of Cancer Research & Hospital, Dhaka, Bangladesh from July 2023 to December 2024. A sum of 66 locally advanced cervical cancer patients were divided into 2 arms; Arm A receiving 18 Gy in 2 fractions of brachytherapy and Arm B getting 21 Gy in 3 fractions of brachytherapy. Findings: We discovered that, 51.5% vs. 48.5% were illiterate, 90.9% vs. 87.9% had early marriages; 51.5% vs. 60.6% patients had 2 or more children. Most of the patients, 54.5% vs 57.6% were in stage IIB of FIGO staging. No statistically significant association was determined between per vaginal findings after completion of treatment regimen as well as during the follow-up sessions. Besides, 66.7% vs. 72.7% had abnormal vaginal bleeding, 54.6% vs 63.6% had unusual per vaginal discharges and 75.8% vs 63.6% had pain in pelvic region before the treatment had started. However, during the follow-ups, all the complaints had reduced grossly in both the arms; for instance, during the 3rd follow-up, 1 patient in Arm B had mild bleeding; 9.1% vs 3.1% cases had unusual discharges and 3.1% vs. 6.1% mentioned pelvic pain. No statistically significant association was established between the 2 groups in this context. Lastly, 100.0% vs 94.7% stage IIB participants demonstrated complete response. Stable disease was found in 1 patient of stage IVA in Arm B. Conclusion: Therapeutic regimens of reduced duration may offer better patient compliance and reduced burden on healthcare facilities in low-resource zones provided clinical outcomes are not compromised. The implementation of 18 Gy in 2 fraction regimen will aid in overcoming various challenges on both patient’s and hospital’s end.