Dr.Sandeep.M Junior resident Dr.Ajaykumar Prof & HOD
Background Carcinoma cervix is one of the commonest malignancies in females. Locally advanced carcinoma cervix is managed with concurrent chemoradiation. Brachytherapy is usually delivered by either HDR or LDR machines. ABS(American Brachytherapy Society recommeneds maximum 7.5Gy/fr and min 4 fr)1 1 ref:Nag s etal Int J Radiat oncol Biol Phy 2000,48,201
In high volume centers for adequate use of resources, their were studies assessing HDR ICRT with reduce fractionation schedules Hama Y et al Radiology ; 6.8x 3f vs 9gy x2 Firuza patel,pankaj kumar et alBrachytherapyBrachytherapy Volume 10, Issue 2, March–April 2011, Pages 147–153 Volume 10, Issue 2
Aims and Objectives To compare two different fractionation schedules in high dose brachytherapy for carcinoma cervix with respect to locoregional control of the disease
methodology Study setting :- Dept. of Radiotherapy Calicut medical college Study design :- retrospective cohort Study period : jan – 2011 jan
inclusion criteria All patients with ca cervix, stage II & III who took treatment from our college Performance status – 1 & 2 Age between – 35 – 65 years Squamous cell carcinoma histology
Exclusion criteria Performance status – 3 & 4 No proper follow up Age > 65 years Stage IV disease Non concurrent EBRT given cases
Materials & methods 124 patients with carcinoma cervix with stage II & III were given concurrent chemo radiotherapy cisplain 40 mg/m2 weekly RT dose of 45Gy/23 #
Patients are divided in 2 arms 7Gy given weekly in 3 sittings 9Gy given weekly in 2 sittings
All patients are assessed clinically for residual disease after CCRT All patients are followed up as per guidelines for one year for loco regional recurrence acute complications Recurrences are confirmed with biopsy
stage StageFrequencyPercent II7661.3% III4832.7% %
ebrt FrequencyPercent 45Gy/23#124100
Residual growth FrequencyPercent present absent6149.2
brachytherapy FrequencyPercent 9GY x GY x
statistics Data assessed using spss version 16
results
No of recurrences in two arms
No of recurrences according to stage
No of recurrence in comparison with presence of residual disease
stageNADrecurrencetotal II64 (84.2%)12 (15.8%)76 III41 (85.4%)7 (14.6%)48 valuedfAsymp. Sig (2-sided) Pearson chi square
Residual growthNADrecurrencetotal present52 (82.5%)11 (17.5%)63 absent55 (90%)6 (10%)61 valuedfAsymp. Sig. (2-sided) Pearson chi square test
toxicities Bladder – grade I- 9Gy – 15% 7 Gy- 20% None of the pts needed intervention for heamatologic toxicities Bleeding PR one patient from both arms reported bleeding PR was managed conservatively
conclusion In carcinoma cervix CCRT followed by HDR ICRT with 9Gy wkly in two fraction is equaly effective in local control as 7GYin three fractions in a follow up period of one year These patients should be followed up for late toxicities
limitations Not a prospective study Only short term follow up
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