A Comparative Analysis of Hypofractionated versus Conventional Radiotherapy for Cervical Cancer in a Resource-Limited Setting: A Prospective Study

Abba Aji Mallum^1,2,3*Maureen Bilinga Tendwa⁴Rakiya Saidu⁵Rakiya Saidu⁵William Swanson⁶Paul Phan⁷Heng Li⁷Twalib Ngoma⁸Stephen Avery⁹M Saiful Huq¹⁰John M Akudugu¹¹Wilfred Ngwa⁷Luca Incrocci¹²Mariza Vorster³

• ¹Inkosi Albert Luthuli Central Hospital (IALCH), Durban, South Africa
• ²Walter Sisulu University, Mthatha, South Africa
• ³College of Health Sciences, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
• ⁴South African Health Products Regulatory Authority, Pretoria, South Africa
• ⁵University of Cape Town, Cape Town, South Africa
• ⁶Emory University, Atlanta, Georgia, United States
• ⁷Johns Hopkins Medicine, Johns Hopkins University, Baltimore, Maryland, United States
• ⁸Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
• ⁹University of Pennsylvania, Philadelphia, Pennsylvania, United States
• ¹⁰School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
• ¹¹Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
• ¹²Erasmus Medical Center, Rotterdam, Netherlands

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 either 18.00 Gy, 21.00 Gy or 10.00 Gy boost. Clinical data and adverse events were recorded and analyzed, with statistical significance set at p < 0.05.The 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, though 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 the HFRT group (43.4%). Both groups showed comparable clinical responses, recurrence-free survival, and absence of residual disease within 12 months. HFRT (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.