6. To investigate the acute toxicity of 3D conformal concurrent chemo RT (Keeping PTV Dmax <=105%) in carcinoma cervix patients.

7. observational descriptive study N= 22 (an ongoing study – total 30) Cisplatin 40 mg/m 2 weekly 4-5 weeks (maximum of 5 doses )

8. Acute RTOG toxicity – during EBRT(weekly once) and 1 week post EBRT

11. Version 10 AAA ALGORITHM Eclipse

12. 120 LEAF MLC - 6MV/15MV

14. WEIGHTAGES MLC LEAF POSITION SUBFIELDS

15. PARAMETEROBSERVATION OCTOBER 2011 – ONGOING MEDIAN AGE47 COMPLETE LOCAL RESPONSE AFTER 2 MONTH100% DOSE46GY/23# HDR BRACHYTHERAPY9 GY/2#

16. Results

25. VAGINAL MUCOSA

27. Studies similar to our study using conventional RT

31. PITFALLS NON-RANDOMISED (NO COMPARATIVE ARM) CONTOURING UNCERTAINTIES/MOTION SETUP ERRORS TIME CONSUMING LATE LONG TERM OUTCOME UNKNOWN SUBJECTIVE ANORECTAL DISCOMFORT SKIN TOXICITY MORE THAN EXPECTED EXPENSIVE

32. Conclusion

34. STRUCTURES CONTOURED

35. GTV CTV PTV GTV CTV PTV 5mm 1cm 8mm 5mm

36. Brachytherapy

37. NO OF CYCLES CHEMO 5 CYCLES

38. Of the ten trials only 3 used similar methodology as this study.

41. ICRU 83

43. Tolerance doses Rectum, 75 Gy (mean 68 Gy, <80% of the dose at point A) – V50 < 60 – V60 < 50 Bladder, 80 Gy 2/3 RD (mean 70 Gy, 85% of the dose at point A) – FULL BLADDER 65 Gy Vagina, 120–140 Gy (mean 125 Gy)

44. FEMORAL HEADS = V50 < 50% SMALL BOWEL = 45 Gy TOTAL DOSE (250 CM3) Skin : PTV-V107% (>28.6%) more toxicity