Concurrent Taxol-Based Doublet Chemotherapy as an Alternative for Intracavitary Brachytherapy Boost in Locally Advanced Carcinoma Cervix- Retrospective Analysis From a Tertiary Care Center

Objective In light of the dogma that brachytherapy is irreplaceable for the successful treatment of cervical cancer, and the limited availability of brachytherapy facilities in developing countries, we sought to evaluate the toxicity and efficacy of taxol- and platinum-based doublet chemotherapy delivered concurrently with external beam radiotherapy (EBRT) in locally advanced cervical cancer as an alternative to brachytherapy, which is mandated as the standard of care according to current guidelines. Methods The records from our institution were reviewed to identify patients who underwent chemoradiation with two doses of tri-weekly docetaxel (80mg/m2) and carboplatin (AUC 5) concurrent with EBRT between January 2017 and 2019 for locally advanced cervical carcinoma. Here, 48 cases were analysed, with a median follow-up period of two years. Results The two groups were homogenously matched, and the patients who received EBRT boost and brachytherapy boost achieved complete pathological response rates of 68% and 83%, respectively (p=0.243). The odds ratio was 0.45 (95% confidence interval, 0.09-2.08), indicative of non-significance and non-inferiority based on the analysis using the chi-squared test (with Pearson’s correlation) and Student's t-test. The disease-free survival durations calculated using Kaplan-Meier estimates were 22 and 24 months, two-year disease-free survival rates were 83% and 91.3%, and two-year overall survival (OS) were 85.6% and 94% for the EBRT boost and brachytherapy boost groups, respectively (p=0.657). Conclusion In this retrospective analysis, we concluded that EBRT boost was non-inferior to brachytherapy boost and could be considered as a reasonable alternative in locally advanced cervical cancer when used concurrently with more dose-intense chemotherapy.