Vol 9, No 1 (2024)
Original article
Published online: 2024-02-02

open access

Page views 151
Article views/downloads 123
Get Citation

Connect on Social Media

Connect on Social Media

Aftereffects of delayed intracavitary brachytherapy in cancer cervix patients during COVID-19 lockdown — a tertiary care centre review

Nabila Anjum1, Abhishek Pratap Singh1, Desh Deepak Ladia1, Ayushi Chaturvedi1
Medical Research Journal 2024;9(1):53-57.


Introduction: To evaluate the impact of the COVID outbreak on the extension of overall treatment time
(OTT) in diagnosed cases of non-metastatic Carcinoma Cervix patients.

Material and methods: A retro-prospective analysis of all patients with non-metastatic biopsy-confirmed
Carcinoma Cervix who received radical radiotherapy including intracavitary brachytherapy (ICBT) between
20th March 2020 to 1st June 2020 and 1st April 2021 to 1st June 2021 respectively. All patients were re-staged
prior to 1st fraction brachytherapy with clinical examination supplemented with MRI pelvis for patients with
a treatment gap of more than 30 days. Follow-up was done with clinical examination at 3-month intervals
post-completion of treatment for 2 years. Imaging was done annually in the form of an MRI abdomen and pelvis.

Results: A total of 51 patients were reviewed by the Department of Radiation Oncology during the aforementioned
period out of which 41 patients completed their treatment. The median age of the patient was 52
years. The median time interval between completion of external beam radiotherapy (EBRT) and 1st fraction
ICBT was 22 days (range: 7–52 days). The median time interval between two consecutive fractions of ICBT
was 11 days (range 7 days to 25 days). The median OTT defined from the start of EBRT to the completion
of brachytherapy was 82 days. The median follow-up interval was 15 months (range 6–24 months). There
was a statistically significant relationship between the time interval between EBRT and ICBT and disease
outcome (p-value = 0.002). Also, patients with longer OTT had poorer outcomes (p-value = 0.003), as
did patients with poor response to EBRT (p-value = 0.001)

Conclusions: In the era of COVID-19, long treatment gaps, extended OTT and poor response to external
beam treatment have significantly altered the outcome of treatment in cancer cervix patients. Longer
follow-up is required to understand the long-standing implications of the same in the Indian setting.

Article available in PDF format

View PDF Download PDF file


  1. Shankar A, Saini D, Goyal N, et al. Cancer care delivery challenges in India during the COVID-19 era: are we prepared for the postpandemic shock? Asia Pac J Oncol Nurs. 2021; 8(1): 1–4.
  2. Ranganathan P, Sengar M, Chinnaswamy G, et al. Impact of COVID-19 on cancer care in India: a cohort study. Lancet Oncol. 2021; 22(7): 970–976.
  3. Cancer Today. Global Cancer Observatory. https://gco.iarc.fr/today/fact-sheets-populations (no date).
  4. Hong JC, Foote J, Broadwater G, et al. Total treatment duration for cervical cancer: is 55 days still the goal in the era of concurrent chemotherapy? Int J Radiat Oncol Biol Phys. 2016; 96(2): S15.
  5. Chatterjee A, Grover S, Gurram L, et al. Patterns of cervical cancer brachytherapy in India: results of an online survey supported by the Indian Brachytherapy Society. J Contemp Brachytherapy. 2019; 11(6): 527–533.
  6. Petereit D, Sarkaria J, Chappell R, et al. The adverse effect of treatment prolongation in cervical carcinoma. Int J Radiat Oncol Biol Phys. 1995; 32(5): 1301–1307.
  7. Ghosh S, Rao PB, Kotne S. High dose rate brachytherapy in two 9 Gy fractions in the treatment of locally advanced cervical cancer — a South Indian institutional experience. Asian Pac J Cancer Prev. 2015; 16(16): 7167–7170.
  8. Thakur P, Dogra E, Gupta M, et al. Comparison of ISO-effective and cost-effective high-dose-rate brachytherapy treatment schedules in cervical cancer — regional cancer center experience. J Contemp Brachytherapy. 2019; 11(5): 428–435.
  9. Rose PG, Ali S, Watkins E, et al. Thigpen, J.T. “Long-term follow-up of a randomized trial comparing concurrent single agent cisplatin, cisplatin-based combination chemotherapy, or hydroxyurea during pelvic irradiation for locally advanced cervical cancer: a Gynecologic Oncology Group Study. Yearbook of Oncology. 2007; 25(19): 2804–2810.
  10. Stehman FB, Ali S, Keys HM, et al. Radiation therapy with or without weekly cisplatin for bulky stage 1B cervical carcinoma: follow-up of a Gynecologic Oncology Group trial. Am J Obstet Gynecol. 2007; 197(5): 503.e1–503.e6.
  11. Toita T, Kato S, Ishikura S, et al. Radiotherapy quality assurance of the Japanese Gynecologic Oncology Group study (JGOG1066): a cooperative phase II study of concurrent chemoradiotherapy for uterine cervical cancer. Int J Clin Oncol. 2011; 16(4): 379–386.
  12. Bandyopadhyay A, Mukherjee U, Ghosh S, et al. Pattern of failure with locally advanced cervical cancer — a retrospective audit and analysis of contributory factors. Asian Pac J Cancer Prev. 2018; 19(1): 73–79.