Hypofractionated pelvic RT (37.5Gy/15fx) + weekly cisplatin shows similar pCR vs standard 50Gy/25fx in LACC surgery cohort

Phase II randomized trial (NCT03750539) in FIGO IB3–IIIC1 locally advanced cervical cancer tested concurrent weekly cisplatin with either standard-fractionation EBRT (50Gy/25fx) or hypofractionated EBRT (37.5Gy/15fx), followed by radical hysterectomy + bilateral pelvic lymphadenectomy (n=93; 50 vs 43). Complete pathologic response was 48% with standard vs 35% with hypofractionation, with residual microscopic disease in 38% vs 44% (p=0.46); additional post-op treatment for partial response/high-risk pathology was needed in 14% vs 21%. Nodal yield was similar (mean 14 vs 15 nodes; p=0.291) and node positivity was rare on final pathology (0.85% of 1,399 nodes), but the key caveat is that this “chemoRT → hysterectomy” approach is not the dominant SOC in the US, where definitive chemoRT typically uses ~45–50.4Gy pelvic EBRT (similar to the control arm dose) plus brachytherapy rather than planned hysterectomy.