Comparative Outcomes of Survival and Relapse After High-Dose-Rate Brachytherapy Versus External-Beam Radiotherapy Boost Following Concurrent Chemoradiation in Locally Advanced Cervical Cancer in Algeria

PURPOSE Brachytherapy remains an integral component of definitive chemoradiation for locally advanced cervical cancer (LACC). However, when unavailable, an external-beam radiotherapy (EBRT) boost is sometimes used as an alternative. This study aimed to compare clinical outcomes and identify prognostic factors of relapse in patients treated with concurrent chemoradiation followed by either high-dose-rate (HDR) brachytherapy or EBRT boost. MATERIALS AND METHODS We retrospectively analyzed 317 patients with LACC treated between 2014 and 2020. All patients received pelvic irradiation (46 Gy in 23 fractions) with once weekly cisplatin (40 mg/m 2 ), followed by either HDR brachytherapy boost (n = 148) or EBRT boost (n = 169). Completion surgery was performed in selected cases (50% in the HDR group and 25% in the EBRT group). Survival outcomes were assessed using Kaplan-Meier and Cox regression analyses. RESULTS After a median follow-up of 33 months, 62 patients (19.5%) experienced relapse 35 local and 33 distant, with some patients presenting both. The 3-year local relapse-free survival (LRFS), disease-free survival (DFS), and overall survival (OS) rates were significantly higher in the HDR group compared with EBRT (LRFS: 92.4% v 81.7%; DFS: 79.9% v 59.2%; OS: 86% v 62%; all P < .01). On multivariate analysis, both completion surgery (hazard ratio HR = 0.424; P = .037) and boost modality (HR = 0.422; P = .031) independently influenced LRFS. Acute toxicities were more frequent in the EBRT group, while late events were generally comparable. A relative increase in late digestive and urinary toxicity was noted among operated patients. CONCLUSION HDR brachytherapy boost remains the most effective modality for improving local control and survival in LACC. When brachytherapy is unavailable, completion surgery after EBRT boost may serve as a reasonable alternative, offering acceptable oncologic and toxicity outcomes.