dr.sandeep.m

A COMPARISON OF TWO DIFFERENT FRACTIONATION SCHEDULES IN HIGH DOSE RATE BRACHYTHERAPY FOR CARCINOMA CERVIX IN TERMS OF LOCOREGIONAL CONTROL

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 2001 219;207-212 6.8x 3f vs 9gy x2 Firuza patel,pankaj kumar et alBrachytherapy Volume 10, Issue 2, March–April 2011, Pages 147–153

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 :- 2010 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

Stage Frequency Percent

II 76 61.3%

III 48 32.7%

124 100%

ebrt

Frequency Percent

45Gy/23# 124 100

Residual growth

Frequency Percent

present 63 50.8

absent 61 49.2

brachytherapy

Frequency Percent

9GY x 2 98 79

7GY x 3 26 21

124 100

statistics

Data assessed using spss version 16

results

No of recurrences in two arms

9 gy x 2 7gy x 30

10

20

30

40

50

60

70

80

total norecurrences

No of recurrences according to stage

IIB IIIB05

101520253035404550

TOTAL RECCURENCE

No of recurrence in comparison with presence of residual disease

RESIDUAL NO RESIDUAL05

1015202530354045

TOTAL NORECCURENCE

stage NAD recurrence total

II 64 (84.2%) 12 (15.8%) 76III 41 (85.4%) 7 (14.6%) 48

value df Asymp. Sig(2-sided)

Pearson chi square

1.231 4 .873

Residual growth

NAD recurrence total

present 52 (82.5%) 11 (17.5%) 63absent 55 (90%) 6 (10%) 61

value df Asymp. Sig.(2-sided)

Pearson chi square test

0.832 1 0.362

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

Thank u