Neoadjuvant Chemotherapy Followed by Interdigitated Brachytherapy versus Standard Chemoradiation in Locally Advanced...

To compare the clinical outcomes of neoadjuvant chemotherapy followed by interdigitated brachytherapy versus standard chemoradiation in locally advanced cervical cancer.

We enrolled 108 patients with histologically confirmed carcinoma of the cervix, at International Federation of Gynecology and Obstetrics (FIGO) stages IIB to IIIC1. They were then randomized into two groups. The study group received neoadjuvant chemotherapy with paclitaxel 175 mg/m ² and carboplatin (area under the curve [AUC]: 5) at every 3 weeks, followed by external beam radiotherapy (EBRT) 45 Gy/20 fractions and concurrent cisplatin with interdigitated high dose rate intracavitary brachytherapy (HDRICBT) 5 Gy/fraction weekly for a total of four fractions. Patients in the control group received EBRT 50 Gy/25 fractions and concurrent cisplatin with sequential HDRICBT 7 Gy/fraction weekly for a total of three fractions.

At the end of the study, the results of both groups were compared in terms of response to therapy and acute toxicities. A total of 108 patients were enrolled (54 in each two arms). Ninety-three patients who completed treatment were included in the analysis. The median follow-up duration was 10 months (range: 6-18 months). Complete response was observed in 24 (53.3%) and 26 (55.3%) patients, and partial response was in 12 (26.6%) and 12 (25.5%) patients in the study and control groups, respectively. Most of the acute and late toxicities were of grades 1 and 2 and comparable in both groups.

In a busy department where resources are limited, neoadjuvant chemotherapy (NACT) followed by EBRT with HDRICBT is an alternative option for current standard concurrent chemoradiation (CCRT) as its tolerance and toxicity are at par with CCRT.