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Category: Volume 08 Issue 03 March 2020
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Title: A Prospective randomized study to compare the outcome and tolerability of Hypofractionated chemoradiotherapy versus conventional chemoradiotherapy in Advance Carcinoma of Cervix

Authors: Nitin Kumar, S N Prasad, J K Verma, P K Singh

 DOI: https://dx.doi.org/10.18535/jmscr/v8i3.31

Abstract

   

Background: Cervical cancer is the second most common cancer in India in women accounting for 22.86% of all cancer cases in women. Aim of this study is to investigate tumor response and toxicities in Advance Carcinoma of Cervix treated by hypofractionated radiotherapy compared with conventional fractionation radiotherapy.

Materials and Methods: We conducted a Prospective study done between September 2017 to September 2019.40 untreated patients of squamous cell carcinoma of cervix (FIGO stage II –IVA) with histologically confirmed diagnosis and no evidence of distant metastasis & chronic medical condition were randomised to Arm A (CRT) and Arm B ( HRT), 20 patients in each  arm. Arm A received EBRT 46 Gy in 23 #, 5# per week for 4.5 week while Arm B received 39 Gy in 13 # at 5 # per week  with standard pelvic AP/PA or four field box technique. Both arm received concurrent cisplatin 40mg/m2 weekly. EBRT was followed by 2 sesssion of Intracavitory brachytherepy at a week interval to a dose of 9Gy per session to point A by HDR. 3 patients in HRT arm and 2 patients in CRT arm defaulted treatment and hence excluded from study.  End point of the study were tumor response, acute and late toxicities.

Results: Complete response was achieved by 64.70 % in HRT arm as compared to 66.67% in CRT arm. Partial response was achieved by 35.30% as compared to 33.33 but the differences was statistically not significant at two month. (p value= 0.2589) Grade 3/4 skin toxicity was significantly higher in the HRT (17.3 %) arm as compared to conventional. Acute toxicities (Grade 1, II) are statistically non-significant & managed conservatively.

Conclusion: Tumor response in patients treated with hypofractionated radiotherapy appears comparable to that of standard fractionation with manageable toxicity profile.

Keywords: Hypofractionation, carcinoma cervix, concurrent chemoradiation.

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Corresponding Author

Nitin Kumar

Junior Resident, Department of Radiotherapy, J K Cancer Institute, G.S.V.M. Medical College, Kanpur, Uttar Pradesh, India