Title: Weekly versus Biweekly High Dose Rate Brachytherapy Schedules in Carcinoma Cervix Following Concomitant Chemoradiation with Cisplatin
Authors: Dr Avni Kachhwaha, Dr H. S. Kumar, Dr M. R. Baradia, Dr Neeti Sharma, Dr Shankar Lal Jakhar, Dr Kamlesh Kumar Harsh
DOI: https://dx.doi.org/10.18535/jmscr/v8i1.02
Abstract
Objective: The main objective of brachytherapy in carcinoma cervix is to deliver a lethal dose to tumour cells without inducing unacceptable damage to the surrounding normal tissue. Because the absorbed dose falls off rapidly, higher doses can be delivered safely to the targeted tissue over a short time. The aim of this study is to compare disease response, acute and late treatment related toxicities between two HDR brachytherapy regimens.
Material and Methods: 50 biopsy proven and registered FIGO stage IB2-IIIB cases of carcinoma cervix treated with concurrent CT (Inj. cisplatin 40 mg/m2 weekly) + EBRT up to 50Gy are included and randomised into two arms. In Arm A (control), HDR of 7.5Gy x 3# (weekly) is delivered to patients. In Arm B (study), HDR of 5.5Gy x 5# (biweekly) is delivered to patients. Disease response is evaluated by WHO criteria at the end of treatment, then at 1, 3 and 6 months to complete their 1 year follow up. Treatment related toxicities are also evaluated by RTOG guidelines at 1, 3 and 6 months up to 1 year.
Results: At 1st month, 96% in Arm A and 92% in Arm B, at 3rd and 6th month 84% in Arm A and 76% in Arm B shows complete response. At 1 year DFS is 84% in Arm A and 68% in Arm B. In late toxicity, Grade III and IV vaginal fibrosis and rectal complications were seen in 16% and 4% respectively in both arms. Grade III and IV bladder complications were observed in 0% in Arm A and 8% in Arm B.
Conclusion: This study suggests that both HDR fractionation schedules proved safe and well tolerated by patients. So, any of the regimens can be used depending upon patient factors and work-load of the institute.
Keywords: Ca cervix, HDR brachytherapy, disease response, late treatment toxicity, disease free survival.
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