1. Dr.Sandeep.M Junior resident Dr.Ajaykumar Prof & HOD

2. 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

3.  In high volume centers for adequate use of resources, their were studies assessing HDR ICRT with reduce fractionation schedules  Hama Y et al Radiology 2001 219;207-212  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

4. Aims and Objectives  To compare two different fractionation schedules in high dose brachytherapy for carcinoma cervix with respect to locoregional control of the disease

5. methodology  Study setting :- Dept. of Radiotherapy Calicut medical college  Study design :- retrospective cohort  Study period :- 2010 jan – 2011 jan

6. 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

7. Exclusion criteria  Performance status – 3 & 4  No proper follow up  Age > 65 years  Stage IV disease  Non concurrent EBRT given cases

8. 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 #

9.  Patients are divided in 2 arms  7Gy given weekly in 3 sittings  9Gy given weekly in 2 sittings

10.  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

11. stage StageFrequencyPercent II7661.3% III4832.7% 124100%

12. ebrt FrequencyPercent 45Gy/23#124100

13. Residual growth FrequencyPercent present6350.8 absent6149.2

14. brachytherapy FrequencyPercent 9GY x 29879 7GY x 32621 124100

15. statistics  Data assessed using spss version 16

16. results

17. No of recurrences in two arms

18. No of recurrences according to stage

19. No of recurrence in comparison with presence of residual disease

22. stageNADrecurrencetotal II64 (84.2%)12 (15.8%)76 III41 (85.4%)7 (14.6%)48 valuedfAsymp. Sig (2-sided) Pearson chi square 1.2314.873

24. Residual growthNADrecurrencetotal present52 (82.5%)11 (17.5%)63 absent55 (90%)6 (10%)61 valuedfAsymp. Sig. (2-sided) Pearson chi square test 0.83210.362

25. 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

26. 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

27. limitations  Not a prospective study  Only short term follow up

28. Thank u