Comparison of Weekly versus Biweekly High-Dose Rate (HDR) Intracavitary Brachytherapy After Concomitant Chemoradiation for Cervical Cancer: A Prospective Study

Abstract

Background: Cervical cancer is a leading cause of death among women in developing countries. High-dose rate (HDR) intracavitary brachytherapy, delivered either concurrently or sequentially with external beam radiotherapy (EBRT), is an integral component of cervical cancer treatment. In recent years, HDR brachytherapy in combination with EBRT has gained popularity in the management of cervical cancer. 

Objectives: This study aimed to evaluate the treatment response at 3 and 6 months after treatment completion, as well as treatment-related toxicities during weekly versus biweekly HDR intracavitary brachytherapy (HDR-ICBT) after concomitant chemoradiation in patients with squamous cell carcinoma of the cervix.

Methods:  A total of 60 cervical cancer patients meeting the inclusion criteria were randomly assigned to either the weekly or biweekly HDR-ICBT groups using a chit-box method with replacement. In Arm A (Study Arm), 30 patients received concurrent EBRT (50 Gy in 25 fractions with 2 Gy per fraction) with weekly cisplatin (35 mg/m²) followed by HDR-ICBT (5 Gy in 5 fractions biweekly) after completion of EBRT. In Arm B (Control Arm), 30 patients received concurrent EBRT (50 Gy in 25 fractions with 2 Gy per fraction) with weekly cisplatin (35 mg/m²) followed by HDR-ICBT (7.5 Gy in 3 fractions weekly) after completion of EBRT.

Results: Patients were assessed at 3 and 6 months to determine local disease response and the incidence of any toxicities during treatment. All responses were graded as either complete response (CR), partial response (PR), stable disease (SD), or progressive disease (PD). Thirty patients were assessed for therapy response using WHO criteria. At 3 months, Arm A showed an 86% CR rate, and Arm B showed a 90% CR rate. Two patients in Arm A and one patient in Arm B had PR. Both arms had two patients with progressive disease. At 6 months, one patient in each arm who had progressive disease converted to partial response after receiving post-RT chemotherapy.

Conclusions: Brachytherapy is a vital aspect of cervical cancer treatment. Many centers have experimented with various doses and fractionation regimens. Patients in the current trial did not report any safety concerns or intolerability issues across either treatment protocol. Arm A completed treatment earlier than Arm B with comparable disease response and toxicities. Ultimately, the choice of treatment plan depends on individual patient circumstances and institutional preferences. However, longer follow-ups and a larger patient sample are needed for a robust evaluation of disease response and toxicity.