Modified partial hyperfractionation in radiotherapy for bulky uterine cervical cancer: reduction of overall treatment time

Purpose: The purpose of this study was to assess the feasibility and toxicity of modified fractionation of external beam radiation with the intention of reducing the overall treatment time (OT) by 1 week in cervical cancer. Methods and Materials: Thirty-one patients (Group 1, n = 31) with bulky cervical cancer (≥ 4 cm with Stage II and III, ≥ 5 cm with Stage IB2) were entered into the twice a day (b.i.d.) protocol (18 Gy/10 fx in 2 weeks followed by 18 Gy/12 fx, b.i.d. in 6 days, then midline block at 36 Gy with 45 Gy to the whole pelvis and 51–59 Gy to the parametrium). These patients underwent high-dose-rate brachytherapy with 4 Gy/fx × 7 to point A, biweekly. During the same period, patients with non-bulky tumors (Group 2, n = 31) received conventional treatment and similar brachytherapy. Results: The OT of Group 1 was 7 weeks or less in 61.3%, 7.1–8 weeks in 29%, and more than 8 weeks in 9.7% (19.4%, 51.6%, and 29% in Group 2, respectively, p = 0.003). Incidences of acute complications and treatment breaks were similar in both groups. Late complication (rectal bleeding) occurred only in Group 1 (13%, 4/31), but was self-limited. Locoregional failures occurred within 2 years after completion of radiation therapy in both groups (16% and 13% in Group 1 and 2, respectively, with minimum and median follow-ups of 2 years and 34 months). Conclusion: Partial hyperfractionation on the third week of radiation permitted patients to finish their treatment with shorter OT without excessive acute complications and with acceptable grade 2 late rectal bleeding complications. This treatment scheme may be an effective method for the improvement of local control of bulky cervical cancer.