Is Moderately Hypofractionated Radiotherapy a Safe and Effective Strategy for Cervical Cancer?—A Review of Current Evidence

TL;DR

Moderately hypofractionated radiotherapy may offer a shorter treatment option for cervical cancer but needs more research to confirm its long-term safety and effectiveness.

Contribution

This review evaluates the potential of moderately hypofractionated radiotherapy as a treatment option for cervical cancer in resource-limited settings.

Findings

MHRT may improve patient adherence and reduce healthcare burdens in low-resource settings.

Current evidence for MHRT is limited to small studies with short follow-up periods.

Larger trials are needed to confirm the long-term safety and efficacy of MHRT.

Abstract

Cervical cancer remains a significant public health burden, especially in low- and middle-income countries where access to treatment is constrained. Conventional fractionated radiotherapy (CFRT) entails protracted treatment schedules and places considerable demands on both patients and healthcare systems. In contrast, moderately hypofractionated radiotherapy (MHRT) offers a shorter course and has shown promising short- to mid-term efficacy. This approach may improve patient adherence and reduce resource utilization in settings with limited resources. However, given that the current evidence predominantly originates from small or early-phase studies, the long-term efficacy and safety of this approach remain unproven. Consequently, MHRT cannot yet supplant CFRT as the standard of care. Larger, high-quality trials with prolonged follow-up periods, encompassing diverse populations and technologies, are essential.

Cervical cancer (CC) remains a leading cause of cancer-related mortality, particularly in low- and middle-income countries (LMICs), despite advancements in HPV vaccination and screening. Radiotherapy (RT) plays a critical role in managing CC, but conventional fractionated radiotherapy (CFRT) is limited by long treatment durations, which reduce patient adherence, increase the risk of treatment interruptions, and impair healthcare access in LMICs. Moderately hypofractionated radiotherapy (MHRT) may offer a promising alternative, delivering higher doses per fraction with fewer total fractions, thus shortening treatment duration and alleviating the burden on both patients and healthcare systems. Early clinical data suggest that MHRT achieve acceptable short- to medium-term tumor control with manageable toxicity. However, the small sample sizes and limited follow-up in published studies preclude definitive conclusions about long-term efficacy and safety. This review synthesizes the existing clinical evidence to outline the potential benefits and inherent limitations of MHRT in CC management and highlight the need for future large-scale, long-term randomized controlled trials with rigorous quality assurance protocols. These findings also have implications for the potential implementation of MHRT in LMICs.