High-Dose-Rate Orthogonal Intracavitary Brachytherapy with 9 Gy/Fraction in Locally Advanced Cervical Cancer: Is it Feasible??

Introduction: Though high dose rate (HDR) intracavitary brachytherapy (ICBT) is now an integral part in the treatment of cervical cancer, the quest for optimum dose and fractionation schedule is still ongoing. While the American Brachytherapy Society recommends individual fraction size of <7.5 Gy, there are few studies where the authors obtained similar results with higher dose per fraction. Objective: To compare and analyse two high-dose-rate intracavitary brachytherapy schedules—7 Gy per fraction for three fractions with 9 Gy per fraction for two fractions. Materials and Methods: This is a prospective institutional study in Southern India carried on from 1 June 2012 to 31 March 2013. In this period, 124 patients of cervical cancer satisfying our inclusion criteria were treated with concurrent chemo-radiation, following which patients were randomized to one of the treatment arms, with 62 patients in each arm. The ICBT dose in Control Arm A was 7 Gy per fraction in three fractions, 1 week apart. While in Study Arm B, the ICBT dose was 9 Gy per fraction in two fractions, again 1 week apart. One patient in Arm A and three patients in Arm B discontinued the treatment even after repeated counselling and hence were excluded from the study analysis. Results: The median follow-up period in the study was 25.2 months. In the Control Arm A, the 2-year actuarial local control rate, disease-free survival and overall survival were 88.5, 86.9 and 92.6 %, respectively, while in the Study Arm B, the 2-year actuarial local control rate, disease-free survival and overall survival were 91.5, 88.1 and 86.4 %, respectively. Conclusion: In our experience, HDR brachytherapy with 9 Gy per fraction in two fractions is an effective dose fractionation when compared to 7 Gy per fraction in three fractions. © 2015, Federation of Obstetric & Gynecological Societies of India.