Accelerated hyperfractionated radiotherapy for locally advanced cervix cancer

Purpose: A phase II trial was designed to evaluate the toxicity and outcome of patients with locally advanced cervix cancer treated with accelerated h yperfractionated radiotherapy (AHFX). Methods and Materials: In this prospective trial, AHFX doses of 1.25 Gy wer e administered twice daily at least 6 hours apart to a total pelvic dose of 57.5 Gy, A booster dose was then administered via either low-dose rate bra chytherapy or external beam therapy to a smaller volume. All patients were accrued and treated at Peter MacCallum Cancer Institute (PMCI) between 1986 until April 1991. Results: Sixty-one eligible patients were enrolled in this protocol; 2 (3.2 %) had Stage IIB; 42 (68.9%) had Stage III; 8 (13.1%) had Stage IV and 9 (1 4.8%) had recurrent cervical cancer, Fifty-two patients (85%) completed the planned external beam without a treatment break. Thirty patients had acute toxicity that required regular medication. One patient died of acute treat ment related toxicity. Fifty-five patients received booster therapy: 45 wit h intrauterine brachytherapy, 6 with interstitial brachtherapy, and 4 with external beam. The median follow-up of surviving patients was 6 years. Over all 5-year survival is 27% and 5-year relapse free survival is 36%, Ninetee n patients died with pelvic disease and the actuarial local control rate wa s 66%, There were 8 severe late complications observed in 7 patients. Seven required surgical intervention (an actuarial rate of 27%), Five patients a lso required total hip replacement. Conclusions: The local control rate was favorable compared with other serie s that have used standard fractionation, although overall survival remained similar. The severe late complication rate was high for this protocol and higher than similar protocols reported in the literature.