A Relative Investigation among Hypofractionated Radiotherapy and Conventional Fractionated Radiotherapy in the Locoregional Control of Carcinoma of the Cervix

Abstract

This study was undertaken to know the effect of hypofractionated radiotherapy by comparing this with the effect of conventionally fractionated radiotherapy in the locoregional control of carcinoma of cervix stage IIa, IIb, IIIa, and IIIb along with the screening the early complication of radiation therapy. A total number of 60 patients of squamous cell carcinoma of the cervix were elected to host the experiment, divided into two groups with an equal number named Control group and Case group. The Control group was treated with conventional therapy of 60 Gy in 30 fractions in 6 weeks. The case group was treated by hypofractionated therapy of 60 Gy in 18 fractions in 6 weeks. The objectives of the study were to observe the local response and early complication of radiation toxicities in both groups of patients. In the control group, p/v findings were (observed after 6wks from the completion of radiation treatment), where complete response 16(53.3%) and partial response were followed by stage IIa 10(33.3%) and stage IIb 04(13.3%). In the case group, complete responses were 11(36.7%) partial response were followed by stage IIa 11(36.7%) and stage IIb 8(26.7%). But statistically, the difference in outcome was not significant. (X=1.077, df=01, p=0.299). No significant differences were observed between control and case groups, regarding the adverse effects of radiotherapy (P>0.05). Regarding locoregional control of carcinoma cervix, statistically, the difference of outcome was not significant between control and case population (P>0.05). Considering all the parameters, it is concluded that – Effects of radiotherapy in terms of locoregional control and adverse effects in patients treated with hypo fractionated radiotherapy appears comparable to that of conventional fractionation.

Introduction

This study compares hypofractionated radiotherapy with conventionally fractionated radiotherapy for treating locally advanced cervical cancer (Stages IIA–IIIB) in a resource-limited setting in Bangladesh.

Background

Cervical cancer is one of the leading causes of cancer-related deaths among women in developing countries, including Bangladesh and India. High mortality rates are linked to limited awareness, inadequate screening, and insufficient treatment facilities. Although cervical cancer is highly treatable in its early stages, advanced-stage disease is primarily managed with radiotherapy.

In Bangladesh, the shortage of radiotherapy centers creates long waiting times for treatment. Since conventional radiotherapy requires many treatment sessions, the study explored whether hypofractionated radiotherapy (larger doses given in fewer sessions) could provide similar outcomes while allowing more patients to receive treatment.

Objective

To evaluate the effectiveness and early side effects of hypofractionated radiotherapy compared with conventional radiotherapy in patients with cervical cancer stages IIA, IIB, IIIA, and IIIB.

Methods

• Study design: Prospective study lasting 18 months.
• Location: Department of Radiotherapy, Rajshahi Medical College Hospital, Bangladesh.
• Participants: 60 patients with histologically confirmed squamous cell carcinoma of the cervix.
• Groups:
  • Control group (30 patients): Conventional radiotherapy (200 cGy per fraction, 5 days/week for 6 weeks).
  • Case group (30 patients): Hypofractionated radiotherapy (333 cGy per fraction, 3 days/week for 6 weeks).
• All patients were treated using Cobalt-60 teletherapy.

Data Collection and Assessment

Patients underwent:

• Clinical examination,
• FIGO staging,
• Laboratory investigations,
• Weekly monitoring during treatment.

The study assessed:

• Vaginal (P/V) bleeding,
• Vaginal discharge,
• Weakness,
• Lower abdominal pain,
• Tumor response after treatment.

Results

Patient Characteristics

• Mean age:
  • Control group: 46.5 years
  • Case group: 47 years
• Most patients had Stage IIB cervical cancer:
  • Control: 66.7%
  • Case: 73.3%

Treatment Side Effects

No statistically significant differences were found between the two groups regarding:

• Vaginal bleeding,
• Vaginal discharge,
• Weakness,
• Lower abdominal pain.

(P > 0.05 for all comparisons)

Treatment Response After 6 Weeks

Control Group

• Complete response: 53.3%
• Partial response (Stage IIA): 33.3%
• Partial response (Stage IIB): 13.3%

Hypofractionated Group

• Complete response: 36.7%
• Partial response (Stage IIA): 36.7%
• Partial response (Stage IIB): 26.7%

Although the conventional group showed a higher complete response rate, the difference was not statistically significant (p = 0.299).

Discussion

The study found that:

• Hypofractionated radiotherapy produced treatment outcomes comparable to conventional radiotherapy.
• Early radiation-related complications were similar in both groups.
• No significant differences were observed in local disease control or treatment toxicity.

These findings are consistent with previous studies showing that hypofractionated radiotherapy can achieve similar tumor control while reducing the number of treatment sessions.

Significance

Hypofractionated radiotherapy may be particularly valuable in regions with:

• Limited radiotherapy facilities,
• High patient volume,
• Resource constraints.

Because it requires fewer hospital visits and machine time, it can increase treatment capacity without significantly compromising outcomes.

Limitation

The follow-up period was only 6 weeks, which was insufficient to evaluate:

• Long-term survival,
• Late radiation side effects,
• Long-term disease control.

Conclusion

This study was initiated to know the effect of hypofractionated radiotherapy by comparing this with the effect of conventionally fractionated radiotherapy in the locoregional control of carcinoma of cervix stage IIa, IIb, IIIa and IIIb to see the early complication of radiation therapy. There were 60 patients of squamous cell carcinoma of the cervix. The patients were divided into two groups, 30 patients in each group- The Control group was treated with conventional therapy of 60 Gy in 30 fractions in 6 weeks. The case group was treated by hypofractionated therapy of 60 Gy in 18 fractions in 6 weeks. In summary, No significant difference was observed between control and case groups, regarding the adverse effects of radiotherapy (P>0.05). Regarding locoregional control of carcinoma cervix, statistically, the difference of outcome was not significant between control and case population (P>0.05). The effects of radiotherapy in terms of adverse effects in patients treated hypofractionated radiotherapy appears comparable to that of standard fractionation.

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Copyright

Copyright © 2026 Dr. Rawshan Ara Khatun, Dr. Julekha Khatun. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.