KEY POINTS
- This randomized trial enrolled 75 patients with locally advanced cervical cancer receiving pelvic external-beam RT, weekly cisplatin and three HDR brachytherapy sessions. Seven patients were lost by long-term follow-up, leaving 68 evaluable patients.
- Both groups received the same number of brachytherapy fractions, but treatment was compressed into 1 week versus 3 weeks. This reduced median overall treatment time from 64.5 to 59 days (p=0.01).
- At three months, MRI showed no residual disease in 86.1% versus 56.3% (p=0.022) in the accelerated versus conventional groups. Table 1 also reports complete response rates of 77.8% versus 56.3% (p=0.041).
- Recurrence occurred in 13.9% versus 31.3%, although this difference did not reach statistical significance (p=0.085).
- There was no significant difference in overall survival (p=0.962) or disease-free survival (p=0.128). In multivariable analysis, treatment schedule itself was not associated with OS or DFS.
- Reported acute and late proctitis and cystitis did not significantly differ. Grade 3 acute cystitis occurred in 5.6% versus 0%, while grade 3 late cystitis occurred in 5.6% versus 3.1%; the study was too small to establish formal toxicity equivalence.
CLINICAL TAKEAWAY
Compressing HDR brachytherapy may be a practical way to keep definitive cervical cancer treatment closer to the desired overall treatment duration. The randomized signal for response is interesting, but the small cohort, lack of survival benefit and limited power for toxicity mean this is not yet sufficient to establish a new universal brachytherapy schedule.