Early report on abbreviated brachytherapy schema for cervical cancer during the COVID-19 pandemic

Purpose:
This study evaluated the efficacy and safety of a high-dose-rate (HDR) brachytherapy regimen with an abbreviated schema for patients with cervical cancer during the COVID-19 pandemic.

Material and methods:
Patients underwent external beam radiation therapy combined with cisplatin-based chemotherapy. Subsequently, brachytherapy (7 × 4 Gy) was administered for 10 days using an abbreviated schema. The treatment plan aimed to deliver a cumulative dose of at least 85 Gy EQD₂ for α/β = 10 Gy to high-risk clinical target volume (HR-CTV), while minimizing exposure to the bladder, rectum, and sigmoid colon.

Results:
Sixty-nine patients with cervical cancer received definitive chemoradiation therapy, with a median overall treatment time of 56.2 days. The incidence of acute grade 3 hematological toxicity was 62.3%, and grade 4 toxicity was 11.6%. Grade 3 or higher gastrointestinal and genitourinary toxicity rates were 5.8%, 2.9%, 2.8%, and 4.3%, respectively. Late gastrointestinal toxicities of grade ≥ 2 and grade ≥ 3 occurred in 14 (20.3%) and 3 (4.3%) patients, respectively. Late genitourinary toxicities of grade ≥ 2 and grade ≥ 3 occurred in 8 (11.6%) and 3 (4.3%) patients, respectively. As of December 2023, with a median follow-up of 40 months, 1-year PFS and OS rates were 81.2% and 94.2%, respectively, while 3-year PFS and OS rates were 71.0% and 85.5%, respectively.

Conclusions:
The abbreviated HDR brachytherapy regimen offered a viable alternative for patients with cervical cancer during the COVID-19 pandemic, suggesting that this treatment schedule maintains therapeutic efficacy and safety, and avoids prolonged treatment duration.