Session Item

To evaluate feasibility and tolerability of hypofractionated external beam radiation therapy (EBRT) schedule with concurrent chemotherapy (weekly cisplatin 40mg/m2) in high volume and node positive cervical cancer (CC).

From March 2018 to July 2020, 15 consecutive patients, median age 59 (47-80) with locally advanced (IIB-IVa) high volume CC received exclusive chemoradiation. Hypofractionated EBRT was delivered using VMAT and a simoultaneous integrated boost. EBRT schedule was 66.08 Gy to primary, 59.92 Gy to positive nodes, 54.4 Gy to negative pelvic nodes and 50.4 Gy to lomboaortic nodes, when required, in 28 daily fractions. Pelvic RM was performed during the last week of EBRT to evaluate tumor response. Four patients received image guided brachytherapy boost (BRTb) (14 Gy in 2 weekly fractions), in 3 patients BRTb was technically not feasible, 2 patients were unfit to continue treatment, in 4 elderly patients BRTb was not planned. In 2 non responders patients, systemic therapy followed chemoradiation. Cone beam CT was acquired daily.
Acute and late toxicity were registered using RTOG scales.

Median follow-up is 18.7 months (0.33-38). The oldest patient of the series (80 years) died early for a cardiovascular event. Other 3 patients died after 17, 45 and 50 months respectively. Eleven patients are alive, 10 without evident disease and one is lost at follow-up. Overall survival is shown in fig.1.
Acute genitourinary (GU) and gastroenteric (GI) toxicity was ≤ G2 and all patients completed treatment in 8 weeks.
Late GU toxicity ≥ G3 was reported in patients who received BRT boost (in 2 patients G3 and in 1 patient G4, requiring temporary colostomy). No patients presented > G2 late GI toxicity.

Fig.1 Overall survival

At state of art, brachytherapy is mandatory within cervical cancer radiation strategies. A dose escalation with EBRT could provide to a tumor downsizing useful when only endocavitary without combined interstitial brachytherapy is available but insufficient to cover high volume residual primary.
Unfortunately, in our series, hypofractionated EBRT plus BRT it's more toxic than standard treatment.
Moreover, in elderly patients or in patients with technical impossibility to receive BRT, external dose escalation could represent an alternative and this schedule seems to be useful in local control.
More trials including higher number of patients are necessary to define the real role of hypofractionation in cervical cancer.