Pilot Study on Continuous Hyperfractionated Accelerated Radiotherapy(CHART) and High Dose Rate Brachytherapy in Locally Advanced Cervical Cancer

Background: Fractionated external beam radiotherapy followed by intracavitary brachytherapy is the mainstay of treatment in cervical cancer. Due to long radiotherapy course, patients in developing countries default effective radiotherapy. Treatment break or discontinuance leads to treatment failure. Continuous hyperfractionated accelerated radiotherapy (CHART) is an altered fractionation scheme used to reduce overall treatment time, overcome tumor repopulation thus could be an option in cervical carcinoma. Methods: Twenty-five histopathological documented locally advanced cervical carcinoma (FIGO stage IB2- IVA) were treated with 42Gy/30fractions external radiotherapy over 10-day period at an inter-fraction interval of 6 hours using CHART technique. Following CHART, patients were subjected to high dose rate brachytherapy to a dose schedule of 9Gyx2 at weekly interval. The response to above radiotherapy protocol and morbidity pattern was evaluated. Results: All patients completed planned CHART external radiotherapy. The median follow-up was 32-months with a pelvic control rate of 68% and 24-month overall survival was 72%. The most common acute toxicity in CHART technique was fatigue (64%) and diarrhea (52%), the late effects being rectal bleeding (2-cases), subcutaneous fibrosis (1-case), spinal pain (1-case). Conclusion: CHART technique is an effective and well tolerated technique in locally advanced cervical cancer at a cost of manageable fatigue and diarrhea. Further investigation involving large number of patients is warranted to evaluate this technique.