Inter-institutional comparison of treatment practice for cervical cancer with special emphasis on brachytherapy

PURPOSE: To compare the cervical cancer treatment outcome and toxicities between two different institutions. MATERIAL AND METHODS: We analysed the clinical outcome of cervical cancer patients treated at two different centres from January 2015 to December 2016. Centre A treated 72 patients by external beam radiotherapy (EBRT) to a dose of 45 Gy in 25 fractions followed by intracavitary brachytherapy (ICBT) 6.5 Gy × 4 fractions and centre B treated 89 patients by EBRT to a dose of 50.4 Gy in 28 fractions followed by ICBT 9 Gy × 2 fractions. The local control, distant metastases and treatment toxicities were compared. RESULTS: The median follow-up in centre A was 12 months and in centre B was 18 months. The median overall treatment time in centre A was 52 days and in centre B was 61 days. The mean equieffective doses in 2 Gy (EQD(2)) for high risk target volume (CTV(HR)) and point A in centre A were 84.59 and 64.5 Gy, respectively. The mean EQD(2) for point A in centre B was 78.5 Gy. One patient out of 72 (1.38%) had local recurrence in centre A and five patients out of 89 (5.6%) had local recurrence in centre B. Local control in centre A was 98.6% and in centre B was 94.3%. The local recurrence rate was higher in centre B but it was not statistically significant (p = 0.15). One patient developed brain metastasis in centre B. One patient developed grade 3 proctitis in centre A. CONCLUSIONS: A high dose rate brachytherapy fractionation schedule of 6.5 Gy × 4 fractions over 2 days for CTV(HR) is associated with reduced overall treatment time, a slightly higher local control rate and lesser dose to OARs compared to 9 Gy × 2 fractions given one week apart to point A.