A comparative analysis of hypofractionated versus conventional radiotherapy for cervical cancer in a resource-limited setting: a prospective study
IntroductionHypofractionation has potential benefits for cancer patients in low-income countries by reducing treatment duration and resource demands. However, few studies have examined the potential for higher toxicity due to the increased radiation dose per session, particularly in patients with ex...
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Frontiers Media S.A.
2025-06-01
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| Series: | Frontiers in Oncology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fonc.2025.1552346/full |
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| author | Abba Mallum Abba Mallum Abba Mallum Maureen Bilinga Tendwa Rakiya Saidu William Swanson Paul Phan Heng Li Twalib Ngoma Stephen Avery M. Saiful Huq John M. Akudugu Wilfred Ngwa Wilfred Ngwa Luca Incrocci Mariza Vorster Mariza Vorster |
| author_facet | Abba Mallum Abba Mallum Abba Mallum Maureen Bilinga Tendwa Rakiya Saidu William Swanson Paul Phan Heng Li Twalib Ngoma Stephen Avery M. Saiful Huq John M. Akudugu Wilfred Ngwa Wilfred Ngwa Luca Incrocci Mariza Vorster Mariza Vorster |
| author_sort | Abba Mallum |
| collection | DOAJ |
| description | IntroductionHypofractionation has potential benefits for cancer patients in low-income countries by reducing treatment duration and resource demands. However, few studies have examined the potential for higher toxicity due to the increased radiation dose per session, particularly in patients with existing health burdens like HIV. This study aimed to evaluate and compare the toxicity profiles of conventionally fractionated radiotherapy (CFRT) and hypofractionated radiotherapy (HFRT) in cervical cancer patients in a low-income setting, facilitating a better understanding of the associated risks and benefits to ensure safe and effective treatment options.MethodsA prospective cohort study was conducted at Inkosi Albert Luthuli Central Hospital (IALCH) in South Africa from March 2022 to March 2023. A total of 107 patients with confirmed cervical cancer were recruited and randomly assigned to either CFRT (n = 54; 50.50 Gy in 25 fractions) with weekly chemotherapy or HFRT (n = 53; 42.72 Gy in 16 fractions). Additionally, both groups received high-dose-rate (HDR) intracavitary brachytherapy, with doses of 18.00-, 21.00-, or 10.00-Gy boost. Clinical data and adverse events were recorded and analyzed, with statistical significance set at p < 0.05.ResultsThe median age at diagnosis was 36.4 (28.2–62.9) years, with 85.0% of patients under 40 years and 86.0% HIV-positive. Most patients in both groups presented with stage IIB and grade II disease. HFRT patients completed radiotherapy significantly faster (median, 35 days) than CFRT patients (median, 62 days) (p < 0.001). Both groups experienced similar rates of gastrointestinal (GI), genitourinary (GU), and skin toxicity, although significant differences were found in GI (p = 0.005) and GU (p = 0.01) side effects. Vaginal stenosis was more common in the CFRT group (51.9%) than in the HFRT group (43.4%). Both groups showed comparable clinical responses, recurrence-free survival, and absence of residual disease within 12 months.ConclusionHFRT (42.72 Gy in 16 fractions) offers comparable outcomes to CFRT (50.50 Gy in 25 fractions) with a shorter treatment duration, making it a feasible option in resource-limited settings. |
| format | Article |
| id | doaj-art-bda0d75b5d9249c2b7828bfef8759b30 |
| institution | DOAJ |
| issn | 2234-943X |
| language | English |
| publishDate | 2025-06-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Oncology |
| spelling | doaj-art-bda0d75b5d9249c2b7828bfef8759b302025-08-20T03:07:28ZengFrontiers Media S.A.Frontiers in Oncology2234-943X2025-06-011510.3389/fonc.2025.15523461552346A comparative analysis of hypofractionated versus conventional radiotherapy for cervical cancer in a resource-limited setting: a prospective studyAbba Mallum0Abba Mallum1Abba Mallum2Maureen Bilinga Tendwa3Rakiya Saidu4William Swanson5Paul Phan6Heng Li7Twalib Ngoma8Stephen Avery9M. Saiful Huq10John M. Akudugu11Wilfred Ngwa12Wilfred Ngwa13Luca Incrocci14Mariza Vorster15Mariza Vorster16Department of Radiotherapy and Oncology, College of Health Sciences, University of KwaZulu Natal, Durban, South AfricaDepartment of Radiotherapy and Oncology, Inkosi Albert Luthuli Central Hospital, Durban, South AfricaFaculty of Medicine and Health Sciences, Walter Susilu University, Mthatha, South AfricaDepartment of Complementary Medicine, South Africa Health Product Regulatory Authority (SAHPRA), Pretoria, South AfricaDepartment Obstetrics and Gynaecology, Faculty of Health Sciences, University of Cape Town, Cape Town, South AfricaDepartment of Radiation Oncology, Emory University, Atlanta, GA, United StatesDepartment of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, MD, United StatesDepartment of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, MD, United StatesDepartment of Clinical Oncology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, TanzaniaDepartment of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, United States0Department of Radiation Oncology, University of Pittsburgh School of Medicine and University of Pittsburgh Medical Center (UPMC) Hillman Cancer Center, Pittsburgh, PA, United States1Division of Radiobiology, Department of Medical Imaging and Clinical Oncology, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South AfricaDepartment of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, MD, United States2Brigham and Women’s Hospital Dana-Farmer Cancer Institute, Harvard Medical School, Boston, MA, United States3Department of Radiotherapy, Erasmus MC Cancer Institute, Rotterdam, NetherlandsDepartment of Radiotherapy and Oncology, College of Health Sciences, University of KwaZulu Natal, Durban, South Africa4Department of Nuclear Medicine, College of Health Sciences, University of KwaZulu Natal, Durban, South AfricaIntroductionHypofractionation has potential benefits for cancer patients in low-income countries by reducing treatment duration and resource demands. However, few studies have examined the potential for higher toxicity due to the increased radiation dose per session, particularly in patients with existing health burdens like HIV. This study aimed to evaluate and compare the toxicity profiles of conventionally fractionated radiotherapy (CFRT) and hypofractionated radiotherapy (HFRT) in cervical cancer patients in a low-income setting, facilitating a better understanding of the associated risks and benefits to ensure safe and effective treatment options.MethodsA prospective cohort study was conducted at Inkosi Albert Luthuli Central Hospital (IALCH) in South Africa from March 2022 to March 2023. A total of 107 patients with confirmed cervical cancer were recruited and randomly assigned to either CFRT (n = 54; 50.50 Gy in 25 fractions) with weekly chemotherapy or HFRT (n = 53; 42.72 Gy in 16 fractions). Additionally, both groups received high-dose-rate (HDR) intracavitary brachytherapy, with doses of 18.00-, 21.00-, or 10.00-Gy boost. Clinical data and adverse events were recorded and analyzed, with statistical significance set at p < 0.05.ResultsThe median age at diagnosis was 36.4 (28.2–62.9) years, with 85.0% of patients under 40 years and 86.0% HIV-positive. Most patients in both groups presented with stage IIB and grade II disease. HFRT patients completed radiotherapy significantly faster (median, 35 days) than CFRT patients (median, 62 days) (p < 0.001). Both groups experienced similar rates of gastrointestinal (GI), genitourinary (GU), and skin toxicity, although significant differences were found in GI (p = 0.005) and GU (p = 0.01) side effects. Vaginal stenosis was more common in the CFRT group (51.9%) than in the HFRT group (43.4%). Both groups showed comparable clinical responses, recurrence-free survival, and absence of residual disease within 12 months.ConclusionHFRT (42.72 Gy in 16 fractions) offers comparable outcomes to CFRT (50.50 Gy in 25 fractions) with a shorter treatment duration, making it a feasible option in resource-limited settings.https://www.frontiersin.org/articles/10.3389/fonc.2025.1552346/fullcervical cancerconventional radiotherapyhypofractionated radiotherapyadverse reactionsoverall survival |
| spellingShingle | Abba Mallum Abba Mallum Abba Mallum Maureen Bilinga Tendwa Rakiya Saidu William Swanson Paul Phan Heng Li Twalib Ngoma Stephen Avery M. Saiful Huq John M. Akudugu Wilfred Ngwa Wilfred Ngwa Luca Incrocci Mariza Vorster Mariza Vorster A comparative analysis of hypofractionated versus conventional radiotherapy for cervical cancer in a resource-limited setting: a prospective study Frontiers in Oncology cervical cancer conventional radiotherapy hypofractionated radiotherapy adverse reactions overall survival |
| title | A comparative analysis of hypofractionated versus conventional radiotherapy for cervical cancer in a resource-limited setting: a prospective study |
| title_full | A comparative analysis of hypofractionated versus conventional radiotherapy for cervical cancer in a resource-limited setting: a prospective study |
| title_fullStr | A comparative analysis of hypofractionated versus conventional radiotherapy for cervical cancer in a resource-limited setting: a prospective study |
| title_full_unstemmed | A comparative analysis of hypofractionated versus conventional radiotherapy for cervical cancer in a resource-limited setting: a prospective study |
| title_short | A comparative analysis of hypofractionated versus conventional radiotherapy for cervical cancer in a resource-limited setting: a prospective study |
| title_sort | comparative analysis of hypofractionated versus conventional radiotherapy for cervical cancer in a resource limited setting a prospective study |
| topic | cervical cancer conventional radiotherapy hypofractionated radiotherapy adverse reactions overall survival |
| url | https://www.frontiersin.org/articles/10.3389/fonc.2025.1552346/full |
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