Concomitant Chemoradiation versus Accelerated Radiotherapy in Selected Cases of Locally Advanced Carcinoma Cervix – A Prospective Study

Introduction : Although concomitant chemoradiation (CTRT) is the standard of care for locally advanced cervical cancer (LACaCx), it cannot be administered safely in elderly patients or those with certain comorbidities. Aims: To evaluate the feasibility and efficacy of six fractions per week of pure accelerated external beam radiotherapy (EBRT) with standard CTRT, for selected patients with LACaCx. Materials and Methods: From January – September 2010, 45 patients with LACaCx (FIGO stage II B – III B) were administered EBRT 50 Gy / 25 fractions as: 21 in Arm A Six fractions per week pure accelerated EBRT without chemotherapy and 24 in Arm B Five fractions per week of conventional CTRT. Patients in both arms received identical brachytherapy. Continuous variables, means-medians were compared with unpaired ‘t’ test and categorical data were compared with ‘chi square’ test. Disease Free Survival (DFS) was assessed using Kaplan Meier curves. Results: Treatment Time was significantly lesser in Arm A (p< 0.0001) with lesser gaps during radiation (p = 0.0156). Overall responses were comparable at the end of treatment and last follow up (median 37 months). Acute toxicities were higher in Arm B with significantly lesser average number of adverse events (AEs) in Arm A (All Grades: p = 0.0178 and Grade ≥ 3 : p = 0.0314). Late toxicities, 3 year locoregional response and median DFS were similar. Conclusion: The results of our study indicate that pure accelerated EBRT alone may be an effective and feasible alternative to CTRT in certain patients with LACaCx.