A comparative study of hyperfractionated radiotherapy versus conventional radiotherapy with concurrent chemotherapy for the treatment of locally advanced squamous cell carcinoma of the cervix

Abstract

Aim: The aim of the study was to see the feasibility of hyperfractionated radiotherapy with concurrent chemotherapy in the treatment of locally advanced carcinoma cervix and to evaluate the result in terms of locoregional control, acute toxicities, weekly tumor regression rate, and radiation dose required for 50% and 80% reduction of previous tumor volume and to compare results with standard protocol in a retrospective manner. Materials and Methods: A pilot study of patients of carcinoma uterine cervix FIGO Stage IIB to IVA was undertaken. The study group consisted of 11 patients, treated by hyperfractionated schedule of 60 Gy/50 fractions/5 days/week over 5 weeks. Two fractions of 120 cGy per fraction per day were given at interval of 6 h. Injection cisplatin (50 mg/m2) I/V was administered on day 1, followed by injection 5-fluorouracil (750 mg/m2) I/V for 5 days, and the same regimen was repeated in the last week of external radiotherapy. After observing encouraging results, we compared our study with standard protocol in a retrospective manner which included 11 patients as a control group, who were treated by conventional fractionation of 50 Gy/25 fractions, 2 Gy/fraction/5 days/week for 5 weeks with injection cisplatin 50 mg I/V weekly. Results: The observed complete response was 72% and 81.8% in the control and study groups, respectively. Acute toxicities such as nausea, vomiting, and anemia were observed slightly higher in the study group, but all were well managed. The weekly tumor regression rate was much better in the study arm. Treatment-resistant depression (TRD) 50 and TRD80were also in favor of the study arm. Conclusion: Hyperfractionated radiotherapy along with concurrent chemotherapy has produced a promising local control of locally advanced cervical cancer with an acceptable complication rate as compared to standard protocol.