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Cervical CancerHYPOCx-iRexNCT07605507

Hypofractionated Whole Pelvic Chemoradiotherapy With iRex Optimization in Cervical Cancer

A study testing Hypofractionated Radiotherapy, Conventional Radiotherapy and Concurrent chemotherapy once a week in people with Cervical Cancer, run by Siriraj Hospital at 1 site in Thailand.

Active, not recruiting

Under way, not looking for participants. Everyone needed has enrolled. The study is still running.

Official record
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Trial summary

This study is a randomized controlled trial designed to compare hypofractionated whole pelvic radiotherapy with conventional radiotherapy in patients with cervical cancer undergoing concurrent chemoradiotherapy. Read more about this study

Who is it for?
Ages 18 years and older, women only
Conditions the study is for
Cervical Cancer
What is being tested?
Hypofractionated Radiotherapy, Conventional Radiotherapy and Concurrent chemotherapy once a week
Could I receive a placebo?
No, everyone receives an active treatment
How many people
40 participants
Where
1 siteThailand
Study dates
15 Jul 2021to 31 Jul 2028
Phase
Interventional
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • Women only
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Cancer of the uterine cervix considered suitable for curative treatment with definitive radio-(chemo)therapy including imaged-guided BT
  • Positive biopsy showing squamous-cell carcinoma, adenocarcinoma, or adeno-squamous cell carcinoma of the uterine cervix
  • Staging according to FIGO 2018 and TNM guidelines
  • MRI of the pelvis at diagnosis is performed
  • MRI, CT, or PET-CT of the retroperitoneal space and abdomen at diagnosis is performed
  • MRI with the applicator in place at the time of (first) BT will be performed
  • GFR ≥ 50 mL/min
  • Patient informed consent

Who cannot join

  • Other primary malignancies except carcinoma in situ of the cervix and basal cell carcinoma of the skin
  • Small cell neuroendocrine cancer, melanoma and other rare cancers in the cervix
  • Metastatic disease beyond intervertebral disc L2/3 level
  • Previous pelvic or abdominal radiotherapy
  • Previous total or subtotal hysterectomy
  • Combination of preoperative radiotherapy with surgery
Show all 11Show fewer
  • Patients receiving BT only
  • Patients receiving EBRT only
  • Patients receiving neo-adjuvant chemotherapy or other forms of antineoplastic treatment apart from weekly concomitant cisplatin (40 mg/m2).
  • Contra-indications to MRI
  • Contra-indications to BT

Trial locations and contacts

1 site in 1 country.

Thailand1 site
  • Siriraj Hospital

    Bangkok, Bangkok

Other trials in Thailand

About this study

Official title: HYPOfractionated Whole Pelvic Concurrent Chemoradiotherapy in Cervical (Cx) Cancer With "Indirect Excess Dose Volume Ratio (iRex)" - Optimized Image Guided Adaptive Brachytherapy (HYPOCx-iRex Trial) : A Phase II Non-inferiority Randomized Controlled Trial

This study is a randomized controlled trial designed to compare hypofractionated whole pelvic radiotherapy with conventional radiotherapy in patients with cervical cancer undergoing concurrent chemoradiotherapy.

Hypofractionated radiotherapy delivers a higher dose per treatment over a shorter overall treatment time, which may reduce the number of hospital visits and improve treatment convenience for patients. Conventional radiotherapy requires more treatment sessions over a longer period.

Read more

The purpose of this study is to evaluate whether hypofractionated radiotherapy is as safe and effective as conventional radiotherapy. The primary outcomes focus on treatment-related toxicity, while secondary outcomes include tumor response, survival outcomes, quality of life, and treatment-related factors.

In addition, this study will evaluate a novel planning approach called the indirect excess dose volume ratio (iRex) to optimize brachytherapy planning and potentially reduce radiation-related side effects.

Read the detailed description

Cervical cancer remains a significant global health burden, particularly in low- and middle-income countries. Standard treatment for locally advanced cervical cancer consists of conventional fractionated radiotherapy combined with concurrent chemotherapy, followed by brachytherapy. However, conventional radiotherapy requires prolonged treatment duration, which may negatively impact patient compliance, healthcare resource utilization, and treatment outcomes.

Hypofractionated radiotherapy delivers a higher dose per fraction while maintaining a comparable total biological dose, thereby reducing the overall treatment time. Shortening treatment duration may improve tumor control based on radiobiological principles and reduce patient burden, including travel and treatment-related costs.

Previous studies suggest that hypofractionated radiotherapy may provide comparable oncologic outcomes to conventional radiotherapy, with acceptable toxicity profiles. However, high-quality randomized evidence remains limited, particularly using modern radiotherapy techniques such as intensity-modulated radiotherapy (IMRT) and image-guided adaptive brachytherapy (IGABT).

This study is a Phase II randomized controlled trial designed to evaluate the safety and feasibility of hypofractionated whole pelvic radiotherapy compared with conventional fractionation. Patients will be randomized to receive either hypofractionated or conventional external beam radiotherapy, both combined with concurrent chemotherapy and followed by brachytherapy.

In addition, this study incorporates a novel dosimetric parameter, the indirect excess dose volume ratio (iRex), to optimize brachytherapy planning. The use of iRex in combination with standard dose constraints may improve spatial dose control and reduce radiation-induced toxicity.

The primary objective is to assess treatment-related toxicity, while secondary objectives include tumor response, survival outcomes, quality of life, dosimetric parameters, and cost-effectiveness. This study aims to provide evidence supporting a shorter, more efficient radiotherapy regimen without compromising safety or efficacy.

Conditions
Cervical Cancer
Being tested
Hypofractionated Radiotherapy, Conventional Radiotherapy, Concurrent chemotherapy once a week, Image-guided Adaptive Brachytherapy, iReX Optimization
Keywords
Cervical Cancer, Hypofractionated Radiotherapy, Conventional Radiotherapy, Whole Pelvic Radiotherapy, Chemoradiotherapy, Brachytherapy
Medical subject headings
Uterine Cervical Neoplasms

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Hypofractionated RadiotherapyRadiation

    Whole pelvic radiotherapy delivered using hypofractionation (2.2 Gy per fraction over 20 fractions) with IMRT.

  • Conventional RadiotherapyRadiation

    Whole pelvic radiotherapy delivered using conventional fractionation (1.8 Gy per fraction over 25 fractions) with IMRT.

  • Concurrent chemotherapy once a weekDrug

    Cisplatin-based concurrent chemotherapy administered intravenously at a dose of 40 mg/m² once weekly during external beam radiotherapy for 5 to 6 cycles.

  • Image-guided Adaptive BrachytherapyProcedure or surgery

    Image-guided adaptive brachytherapy delivered following external beam radiotherapy.

  • iReX OptimizationProcedure or surgery

    Brachytherapy treatment planning optimized using iReX in addition to standard D2cc constraints.

  • Standard D2cc PlanningProcedure or surgery

    Conventional brachytherapy treatment planning using standard D2cc constraints without iReX optimization.

Study groups in NCT07605507
Study groupRoleWhat they receive
HYPO + iREXExperimentalParticipants receive hypofractionated whole pelvic radiotherapy with concurrent chemotherapy followed by image-guided adaptive brachytherapy optimized using iRex in addition to standard D2cc constraints.
Receives: Radiation: Hypofractionated Radiotherapy; Drug: Concurrent chemotherapy once a week; Procedure: Image-guided Adaptive Brachytherapy; Procedure: iReX Optimization
HYPO + Standard PlanningExperimentalParticipants receive hypofractionated whole pelvic radiotherapy with concurrent chemotherapy followed by image-guided adaptive brachytherapy using standard D2cc constraints without iRex optimization.
Receives: Radiation: Hypofractionated Radiotherapy; Drug: Concurrent chemotherapy once a week; Procedure: Image-guided Adaptive Brachytherapy; Procedure: Standard D2cc Planning
CVRT + iREXActive comparatorParticipants receive conventional fractionated whole pelvic radiotherapy with concurrent chemotherapy followed by image-guided adaptive brachytherapy optimized using iRex.
Receives: Radiation: Conventional Radiotherapy; Drug: Concurrent chemotherapy once a week; Procedure: Image-guided Adaptive Brachytherapy; Procedure: iReX Optimization
CVRT + Standard PlanningActive comparatorParticipants receive conventional fractionated whole pelvic radiotherapy with concurrent chemotherapy followed by image-guided adaptive brachytherapy using standard planning without iRex.
Receives: Radiation: Conventional Radiotherapy; Drug: Concurrent chemotherapy once a week; Procedure: Image-guided Adaptive Brachytherapy; Procedure: Standard D2cc Planning

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Incidence of Acute Treatment-Related Toxicity

    Incidence of acute treatment-related toxicity during radiotherapy and at 1- and 3-month follow-up after treatment, assessed using CTCAE version 5.0.

    Measured: During treatment and up to 3 months after completion of radiotherapy

  2. Incidence of Late (Chronic) Treatment-Related Toxicity

    Incidence of late (chronic) treatment-related toxicity assessed at 6 and 12 months, and at 3 and 5 years after treatment using CTCAE version 5.0.

    Measured: From 6 months up to 5 years after completion of radiotherapy

Secondary outcomes (12)
  1. Tumor Response Rate

    Tumor response rate assessed after external beam radiotherapy and at 3-, 6-, and 12-month follow-up.

    Measured: Up to 12 months after completion of radiotherapy

  2. Quality of Life Assessed by EQ-5D-5L

    Patient-reported quality of life assessed using the EuroQol 5-Dimension 5-Level questionnaire (EQ-5D-5L) during treatment and at 1-, 3-, 6-, and 12-month, and 3- and 5-year follow-up.

    The EQ-5D-5L descriptive system assesses mobility, self-care, usual activities, pain/discomfort, and anxiety/depression across 5 levels of severity. The EQ Visual Analog Scale (EQ-VAS) ranges from 0 to 100, with higher scores indicating better perceived health status.

    Measured: During treatment and up to 5 years after completion of radiotherapy

  3. Local Recurrence-free Survival

    Time from completion of radiotherapy to local tumor recurrence.

    Measured: At 3 and 5 years after completion of radiotherapy

  4. Nodal Recurrence-free Survival

    Time from completion of radiotherapy to nodal recurrence.

    Measured: At 3 and 5 years after completion of radiotherapy.

  5. Distant Metastasis-free Survival

    Time from completion of radiotherapy to distant metastasis.

    Measured: At 3 and 5 years after completion of radiotherapy.

  6. Disease-specific Survival

    Time from completion of radiotherapy to death due to cervical cancer.

    Measured: At 3 and 5 years after completion of radiotherapy.

  7. Overall Survival

    Time from completion of radiotherapy to death from any cause.

    Measured: At 3 and 5 years after completion of radiotherapy.

  8. Correlation of Dosimetric Parameters With Tumor Control and Toxicity

    Exploratory analyses will assess the correlation between dosimetric parameters from brachytherapy treatment planning, including dose-volume histogram (DVH) metrics and iRex optimization values, and clinical outcomes, including local tumor control and incidence of treatment-related gastrointestinal and genitourinary toxicities assessed using Common Terminology Criteria for Adverse Events (CTCAE) version 5.0.

    Measured: During treatment and follow-up up to 5 years after completion of radiotherapy.

  9. High-risk Clinical Target Volume D90 Comparison Between iRex-oriented and Conventional Brachytherapy Planning

    Comparison of high-risk clinical target volume (HR-CTV) D90 dose between iRex-oriented optimization and conventional brachytherapy planning.

    Measured: From treatment initiation through completion of brachytherapy treatment, an average of 4 weeks.

  10. Number of Brachytherapy Fractions Achieving Successful iRex Optimization

    Number and percentage of brachytherapy fractions achieving successful iRex-oriented dose optimization according to predefined planning objectives.

    Measured: From treatment initiation through completion of brachytherapy treatment, an average of 4 weeks.

  11. Dose-Response Relationship Between iRex and Toxicity

    Evaluation of the relationship between iRex values and treatment-related toxicity.

    Measured: During follow-up up to 5 years

  12. Incremental Cost-effectiveness Ratio per Quality-adjusted Life Year Between Hypofractionated and Conventional Radiotherapy

    Cost and utility data will be used to evaluate cost-effectiveness by calculating the incremental cost-effectiveness ratio (ICER) between hypofractionated and conventional radiotherapy. Uncertainty analyses will be performed using oneway sensitivity analysis, probabilistic sensitivity analysis, and threshold analysis.

    Measured: During treatment and follow-up up to 5 years after completion of radiotherapy.

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted26 May 2026
  2. Study start15 Jul 2021
  3. Primary completion31 Jul 2028 (estimated)
  4. Study completion31 Jul 2028 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
None (open label)
Enrolment
40 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT07605507
Sponsor's protocol ID
Si 149/2564(IRB3)
Acronym
HYPOCx-iRex
Status last verified
May 2026
First submitted
16 Apr 2026
Last updated
26 May 2026
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Undecided

Questions about this trial

What is this clinical trial studying?

A study testing Hypofractionated Radiotherapy, Conventional Radiotherapy and Concurrent chemotherapy once a week in people with Cervical Cancer, run by Siriraj Hospital at 1 site in Thailand.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 8 inclusion and 11 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: under way, not looking for participants, as of the sponsor's last update on 26 May 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Thailand. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Incidence of Acute Treatment-Related Toxicity (time frame: During treatment and up to 3 months after completion of radiotherapy). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 26 May 2026.

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