IMPACT OF PHYSICAL DOSE RATE EFFECT ON THE LONG TERM RESULTS OF THE CF-252 BRACHYTHERAPY OF CERVIX CARCINOMA E. Janulionis; K.P.Valuckas; V.Atkocius; V.Samerdokiene.

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Presentation transcript:

IMPACT OF PHYSICAL DOSE RATE EFFECT ON THE LONG TERM RESULTS OF THE CF-252 BRACHYTHERAPY OF CERVIX CARCINOMA E. Janulionis; K.P.Valuckas; V.Atkocius; V.Samerdokiene Institute of Oncology, Vilnius University, Lithuania , Porto Alegre, Brazil

PURPOSE EVALUATE EFFECT OF Cf-252 DOSE RATE ON THE LONG TERM CLINICAL RESULTS AFTER COMBINED RADIATION THERAPY FOR STAGE IIB AND IIIB OF CERVIX UTERI CARCINOMA

PATIENTS Ca cervicis uteri, IIB and IIIB 342 PTS TREATED BY EBRT ( 60 Co) Cf BRACHYTHERAPY No chemotherapy

CALCULATION OF THE DOSES FROM 252Cf SOURCES (J.S. Rjabukin, 1985)

MOST FREQUENTLY USED 252Cf BRACHY REGIMEN 5 x 8 iGy=40iGy 5 x (1,32÷1,44) neutron Gy + 5 x (0,88÷0,96) gamma Gy 6,6÷7,2 neutron Gy + 4,4÷4,8 gamma Gy

PATIENTS BY YEAR AND STAGE Year FIGO Total IIBIIIB Total

252 Cf BRACHYTHERAPY BY FRACTIONATION FIGO Total IIBIIIB 5-6 x 8 iGy x 9 iGy x 10 iGy415 Total

IRRADIATION TIME AND PHYSICAL DOSE RATE YEAR FRACTION DOSE, iGy PHYSICAL DOSE neutron+gamma, Gy IRRADIATION TIME, h PHYSICAL DOSE RATE AT POINT A, Gy/h iGy 2,2-2,4 0,5-0,73,7-4, iGy12, iGy1,6-2,01,2-1,4

LATE COMPLICATIONS, IIB + IIIB, % (GRADE 2-3) IIBIIIBIIB + IIIB CYSTITIS PROCTITIS TOTAL

LATE COMPLICATIONS (CYSTITIS + PROCTITIS), IIB + IIIB, vs =306+0=6 14,4%5,2% Statisticaly significant higher late complications rate in Exact Sig. (2 sided) Fisher's Exact Test0.010

SIGNIFICANCE OF SURVIVAL IIB 1994, 1995, 1996, 1997, 1998, 1999 no significance Sig. Log Rank (Mantel-Cox)0.518 Breslow (Generalized Wilcoxon) Tarone-Ware vs no significance Sig. Log Rank (Mantel-Cox)0.921 Breslow (Generalized Wilcoxon) Tarone-Ware0.914 yr months yr months

SIGNIFICANCE OF SURVIVAL IIIB 1994, 1995, 1996, 1997, 1998, 1999 no significance Sig. Log Rank (Mantel-Cox)0.086 Breslow (Generalized Wilcoxon) Tarone-Ware vs statisticaly significant higher survival in Sig. Log Rank (Mantel-Cox)0.035 Breslow (Generalized Wilcoxon) Tarone-Ware0.042 yr months yr months

CONCLUSIONS  During period pts with Ca cervicis uteri received combined RT: EBRT( 60 Co) + Brachytherapy ( 252 Cf)  The brachytherapy physical dose rate (or irradiation time) changed about 4-fold  The overall survival rate was the same for each year of treatment  The statistically significant difference was found for survival of stage IIIB and late complications ( vs )  There was not found clinical proof of the Cf-252 dose rate effect on overall survival

Thank you for attention