Introduction Standard treatment for locally advanced cervical cancer (LACC) is chemoradiotherapy, in limited resource settings hypofractionated treatment might be an option. Objectives: Determine pathologic response to hypofracionated external concurrent chemoradiation followed by surgery in comparison to standard treatment in LACC.

Methods Fifty-nine patients with LACC, as part of a clinical trial, were evaluated after being allocated to standard treatment (45gy in 25 fractions) (29 patients) or Hypofraction treatment (37.5Gy in 15 fractions) (30 patients) followed by a type C1 radical hysterectomy and pelvic node dissection. Pathologic response to treatment was evaluated. Descriptive and inferential statistics, chi-square and multivariable analysis with logistic regression were performed.

Results In the standard external chemoradiotherapy group, complete pathology response was 22% (13 patients), partial response 5.1% (3 patients), microscopic disease 22% (13 patients). The hypofraction group, complete pathology response was 20.3% (12 patients), partial response 3.4% (2 patients), microscopic disease 27.1% (16 patients) (p= 0.834). Compared by histology, squamous cell carcinoma had complete response in 38% (19 patients), partial response 2% (1 patient), while adenocarcinoma with complete pathology response in 4% (2 patients), partial response 2% (1 patient) (p=0.296), independently to treatment arm. In the multivariable analysis, treatment was not an independent factor for pathologic response OR 0.954 (p=0.938).

Conclusion/Implications Hypofractionation seems to be as effective, in relation to pathologic response, as standard treatment and could be implemented where economic limitations are important or patients have to travel long distances. More prospective studies are needed.