Altered fractionation radiation therapy for gynecologic cancers

Altered fractionation radiation therapy is one of the attempts to improve the therapeutic ratio in the hope of controlling locally advanced tumors by radiation therapy alone. This includes hypofractionation, split course fractionation, hyperfractionation, accelerated hyperfractionation, and others. Various fractionation schemes are reviewed in terms of dose and time modification for the management of various gynecologic malignancies. Of these, accelerated hyperfractionation with 10% to 15% dose reduction from conventional or traditional once daily radiation therapy appears to hold the most promise. One and one half Grays per fraction, two fractions per day were used for whole pelvis irradiation and 1.0 Gy per fraction, two fractions per day were used for whole abdomen irradiation with 4 hours between fractions, 5 days a week. Various gynecologic malignancies have been treated with these programs since 1982. Gray for Gray, tumors tend to regress more rapidly than, and the acute and late effects were quite similar to conventional once-daily radiation therapy with 1.8 Gy to 2.0 Gy per fraction. The accelerated hyperfractionation programs were generally well tolerated and deserve a randomized trial.