High Dose Rate Brachytherapy in Two 9 Gy Fractions in the Treatment of Locally Advanced Cervical Cancer - a South Indian Institutional Experience

Background: Although 3D image based brachytherapy is currently the standard of treatment in cervicalcancer, most of the centres in developing countries still practice orthogonal intracavitary brachytherapy due tofinancial constraints. The quest for optimum dose and fractionation schedule in high dose rate (HDR) intracavitarybrachytherapy (ICBT) is still ongoing. While the American Brachytherapy Society recommends four to eightfractions of each less than 7.5 Gy, there are some studies demonstrating similar efficacy and comparable toxicitywith higher doses per fraction.
Objective: To assess the treatment efficacy and late complications of HDR ICBTwith 9 Gy per fraction in two fractions. Materials and
Methods: This is a prospective institutional study inSouthern India carried on from 1st June 2012 to 31st July 2014. In this period, 76 patients of cervical cancersatisfying our inclusion criteria were treated with concurrent chemo-radiation following ICBT with 9 Gy perfraction in two fractions, five to seven days apart.
Results: The median follow-up period in the study was 24months (range 10.6 - 31.2 months). The 2 year actuarial local control rate, disease-free survival and overallsurvival were 88.1%, 84.2% and 81.8% respectively. Although 38.2% patients suffered from late toxicity, only 3patients had grade III late toxicity.
Conclusions: In our experience, HDR brachytherapy with 9 Gy per fractionin two fractions is an effective dose fractionation for the treatment of cervical cancer with acceptable toxicity.