dr.sandeep.m
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Dr.Sandeep.M Junior resident Dr.Ajaykumar Prof & HOD. - PowerPoint PPT PresentationTRANSCRIPT
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