High dose rate (HDR) intracavitary brachytherapy (ICBT) plays a crucial role in cervix cancer treatment, with variations in fractionation schedules across different radiation societies. This study aims to assess the effectiveness and tolerability of a 7 Gy per fraction twice daily schedule over two successive weeks versus an 8 Gy per fraction once weekly schedule over three successive weeks.

From 2020 to 2022, 87 patients with uterine cervix cancer (Stages II and III) underwent concomitant external beam radiotherapy (EBRT) and chemotherapy, followed by HDR-ICBT. Patients were randomised into two arms: Arm A (8 Gy per fraction once weekly for 3 fractions) and Arm B (7 Gy per fraction twice daily once a week for 4 fractions). Local control is defined as any patient free from local progression (CR + PR + SD) in the first year after ending brachytherapy (BTH).

The median follow-up was 16·5 months. Local control at 1 year was 78·7% in Arm A and 89·2% in Arm B (p = 0·24). No clinically significant differences in rectal and bladder toxicities were observed between the two arms (p = 0·40).

There were limited treatment machines and other BTH challenges in Egypt, and the HDR BTH schedule of 7 Gy per fraction twice daily over 2 successive weeks presents an acceptable alternative to the current national standard of 8 Gy per fraction once weekly over 3 weeks. Both schedules demonstrate comparable local control, late toxicity and progression-free survival. Notably, the 7 Gy per fraction twice daily per week for 4 fractions offers the advantage of a reduced total treatment time.