Hypofractionated Two Week Short-Course Radiotherapy vs. Monthly Single Fraction Palliative Pelvic Radiation in Advanced Gynecologic Cancers

Purpose/Objective(s)

This prospective study compares the effectiveness of hypo fractionated two-week short course radiotherapy versus monthly single fraction radiotherapy, as palliative radiotherapy in advanced gynecologic cancers. The primary end point was subjective response in symptoms and secondary end points were the impact on quality of life, objective response rate and treatment related toxicity.

Materials/Methods

Fifty patients with advanced or metastatic cancer of the cervix, endometrium, vulva and vagina with significant pelvic symptoms and unfit for curative treatment were enrolled in the study. Palliative radiotherapy was planned using conventional fluoroscopic simulator with standard pelvic radiation portals. Radiotherapy was delivered using a Co-60 unit or Linear Accelerator with 6MV photons. Patients randomized to two-week radiotherapy arm received a dose of 30Gy in 10 fractions over two weeks and those in the single fraction arm received 8 Gy single fraction, up to 3 fractions at monthly interval. The decision of second and third fraction was based on symptom relief and tumor response. Disease symptoms and Quality of life were assessed using the ESAS-r and FACT questionnaires respectively. Toxicity was assessed using the CTCAE (version 5) and WHO subjective treatment response assessment was done.

Results

Of the 25 patients recruited in each arm, all patients completed treatment in the 30Gy/10 fractions arm. In the single fraction arm, 6 (24%) had good symptom control after one fraction, and 8 (32%) required 2 fractions and 11 patients (44%) required three fractions. The median follow- up period was 7.5 months. Compared to baseline, there was a significant improvement in the symptom scores at 1, 3 and 6 months in both the arms. There was no significant difference in the symptom scores between the two treatment arms. The overall symptomatic response rates in the 30Gy/10# and SFRT arm were more than 80%for pelvic pain, 96% for vaginal bleeding and more than 80%for vaginal discharge. When compared with baseline, Quality of life scores at 1, 3 and 6 months showed significant improvement in all domains in both the arms. The emotional and physical well-being scores at 3 months were significantly better (p=0.02 and 0.04) in the 30Gy/10# arm compared to the SFRT arm. There was no difference in the treatment toxicities between both the arms. At last follow-up, 50% had stable disease, 26% had progressive disease and 24% had partial response to treatment. There was no difference in the response rates between both the arms

Conclusion

Palliative Pelvic Radiation provides significant symptomatic relief and improves the Quality of life of patients with Advanced Gynecologic cancers. Single fraction palliative radiation is comparable to two-week hypo-fractionated radiotherapy with comparable symptom control, toxicities, and improvement in quality of life. The improved emotional and physical wellbeing scores in the two-week radiotherapy arm could be due to the psychological effect of a longer treatment.