Hypofractionated Radiotherapy Not Inferior for HRQOL in Cervical Cancer

Hypofractionated radiotherapy does not compromise health-related quality of life (HRQOL) or functional outcomes compared with standard fractionation in patients with locally advanced cervical cancer. Data presented from a randomized phase 2 trial (NCT03750539) at the 2026 American Society of Clinical Oncology Annual Meeting indicate that although patients experienced a decline in QOL during the perioperative period, recovery toward baseline levels was typically achieved within 3 months of treatment completion.

Among 93 patients included in the trial, significant differences were noted across various areas, including global health status/QOL, selected functional domains, and symptom scales. Conversely, social functioning, dyspnea, insomnia, financial difficulties, and cervical cancer–specific outcomes were similar between the group of patients who received fractionated therapy and the group who received standard treatment.

Key Efficacy and Quality-of-Life Outcomes

For the global health status/QOL domain, the standard fractionation group moved from a baseline of 66.9 to 65.7 during treatment, eventually recovering to 79.1. The hypofractionation group moved from 65.8 at baseline to 64.6, with a recovery to 74.4 (P = .001). Physical functioning also showed resilience; the hypofractionation arm moved from a baseline of 88.0 to 79.0 before recovering to 86.8, which was comparable to the standard arm’s recovery from a baseline of 81.6 to 86.4 (P = .001).

Role functioning scores followed this pattern of decline and subsequent recovery. Patients in the hypofractionated arm reported a baseline of 85.0, a midtreatment dip to 69.4, and a recovery to 81.1; in the standard fractionation arm, the values were 80.8, 69.7, and 82.0, respectively (P = .001).

Adverse Event Data and Symptom Scales

Although global outcomes were comparable, the trial tracked specific symptom scales to identify treatment-related toxicities. Significant differences were noted in fatigue, diarrhea, and appetite loss across the treatment timeline (P = .001 for all).

• Fatigue: Both groups experienced an increase in fatigue during treatment. The hypofractionated group moved from a baseline score of 27.9 to 67.4, later improving to 57.0, and the standard fractionation group moved from 29.0 to 67.0, then eventually to 57.2.
• Diarrhea: The hypofractionated group’s score shifted from 86.6 at baseline to 67.7 before recovering to 91.1; the standard fractionated group went from 90.1 to 77.7, then to 92.5.
• Appetite loss: Scores for the hypofractionated arm moved from 78.8 to 66.6, eventually reaching 83.3; the standard fractionated arm went from 78.2 to 66.6, then to 89.7.

David Francisco Cantu De León, of Instituto Nacional de Cancerología in Mexico City, Mexico, lead study author of the presentation, and coauthors wrote, “Although hypofractionated radiotherapy is not currently a standard approach for cervical cancer treatment, these findings suggest that this strategy does not compromise outcomes compared with conventional fractionation.”

Trial Design and Patient Population

The study evaluated the impact of radiotherapy fractionation schedules on patient-reported outcomes. The study population consisted of 93 patients diagnosed with International Federation of Gynecology and Obstetrics stage IB3 to IIIC1 cervical cancer. Participants were randomly assigned to 1 of 2 treatment arms:

• Standard fractionation: 50 Gy delivered in 25 fractions (n = 50)
• Hypofractionation: 37.5 Gy delivered in 15 fractions (n = 43)

Both cohorts received concurrent chemoradiotherapy followed by surgical intervention. Quality of life was assessed longitudinally using the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ) Core 30 (version 3.0) and the cervical cancer–specific QLQ-CX24 questionnaires. Scores were standardized according to established EORTC procedures and analyzed using repeated-measures analysis of variance with a significance threshold of P < .05. Baseline clinical and tumor characteristics were reported as well-balanced between the 2 groups.

The finding that hypofractionated radiotherapy does not negatively affect HRQOL represents feasibility for a modality that may be beneficial to settings with limited radiotherapy resources. However, investigators noted, “Larger studies with longer follow-up are warranted to further define its long-term efficacy, safety, and patient-reported outcomes.”

Reference

Cantu De Leon DF, Gallardo Alvarado LN, Moreno-Flores G, et al. Quality of life outcomes following hypofractionated radiotherapy in locally advanced cervical cancer. J Clin Oncol. 2026;44(suppl 16):5534. doi:10.1200/JCO.2026.44.16_suppl.5534