S448
Clinical - Gynaecological
ESTRO 2026
chemotherapy; had good performance status; and presented with FIGO 2018 stage IB–IIB or IIIC1 disease ( ≤ 2 pelvic lymph nodes). Participants were randomized to one of two treatment arms: (1) HypoRT with 40 Gy in 15 fractions, or (2) conventional fractionation with 45 Gy in 25 fractions. All external beam RT (EBRT) was delivered using volumetric-modulated arc therapy (VMAT) with daily cone beam computed tomography (CBCT) guidance. Magnetic resonance (MR)- guided 3D brachytherapy was administered in 3-4 fractions as a boost. Patients were followed regularly post-treatment, and quality-of-life (QOL) data were collected using validated questionnaires. Descriptive statistics were stratified by treatment arm, QOL domains were compared using the Wilcoxon rank sum test, and linear mixed models were used to evaluate longitudinal QOL changes. Results: The HEROICC trial did not achieve its planned accrual of 48 patients, enrolling and randomizing 17 participants. Median follow- up was 2.9 years (minimum 1.5 year). Baseline characteristics were comparable between arms (Table 1). Median overall treatment time (EBRT + brachytherapy) was 35 days (IQR: 30–40) in Arm 1 and 46 days (IQR: 44–48) in Arm 2. Patients in Arm 1 experienced significantly greater declines in EPIC bowel domains over time, with regression coefficients ± SE of -8.8 ± 2.0 (p < 0.001) for bowel function (Figure 1) and - 21.4 ± 6.5 (p=0.005) for bowel bother. No consistent differences were observed in urinary or sexual function. No local disease progression occurred in both arms; three patients developed metastases (1 in Arm 1 and 2 in Arm 2). Grade ≥ 3 gastrointestinal toxicity was more frequent in Arm 1 (two cases of grade 3 diarrhea and one grade 4 colonic stenosis), although not reaching statistically significance (p=0.082).
Conclusion: In this feasibility trial, hypofractionated chemoradiotherapy (40 Gy/15 fractions with cisplatin) was associated with greater bowel
toxicity compared to conventionally fractionated RT, despite the use of contemporary RT techniques. References:
Mendez LC, Raziee H, Davidson M, Velker V, D'Souza D, Barnes E, Leung E. Should we embrace hypofractionated radiotherapy for cervical cancer? A technical note on management during the COVID-19 pandemic. Radiother Oncol. 2020 Jul;148:270-273. doi: 10.1016/j.radonc.2020.05.032. Epub 2020 May 28. PMID: 32474128; PMCID: PMC7255703. Keywords: Cervical Cancer, hypofractionated RT, QOL
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