brachytherapy for carcinoma cervix in terms of locoregional control DrSandeepM ID: 915712
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Slide1
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
Slide2BackgroundCarcinoma 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
Slide3In high volume centers for adequate use of resources, their were studies assessing HDR ICRT with reduce fractionation schedulesHama Y et al Radiology 2001 219;207-2126.8x 3f vs 9gy x2
Firuza
patel,pankaj
kumar
et
al
Brachytherapy
Volume 10, Issue 2
,
March–April 2011, Pages 147–153
Slide4Aims and Objectives To compare two different fractionation schedules in high dose brachytherapy for carcinoma cervix with respect to
locoregional
control of the disease
Slide5methodologyStudy setting :- Dept. of Radiotherapy Calicut medical college
Study design :- retrospective cohort
Study period :- 2010
jan
– 2011
jan
Slide6inclusion criteriaAll 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
Slide7Exclusion criteriaPerformance status – 3 & 4No proper follow upAge > 65 years
Stage IV disease
Non concurrent EBRT given cases
Slide8Materials & methods124 patients with carcinoma cervix with stage II & III were given concurrent chemo radiotherapy
cisplain
40 mg/m2 weekly
RT dose of 45Gy/23 #
Slide9Patients are divided in 2 arms7Gy given weekly in 3 sittings9Gy given weekly in 2 sittings
Slide10All patients are assessed clinically for residual disease after CCRTAll patients are followed up as per guidelines for one year for loco regional recurrence
acute complications
Recurrences are confirmed with biopsy
Slide11stage
Stage
Frequency
Percent
II
76
61.3%
III
48
32.7%
124
100%
Slide12ebrt
Frequency
Percent
45Gy/23#
124
100
Slide13Residual growth
Frequency
Percent
present
63
50.8
absent
61
49.2
Slide14brachytherapy
Frequency
Percent
9GY x 2
98
79
7GY x 3
26
21
124
100
Slide15statisticsData assessed using spss
version 16
Slide16results
Slide17No of recurrences in two arms
Slide18No of recurrences according to stage
Slide19No of recurrence in comparison with presence of residual disease
Slide20Slide21Slide22stage
NAD
recurrence
total
II
64 (84.2%)
12 (15.8%)
76
III
41 (85.4%)
7 (14.6%)
48
value
df
Asymp
. Sig
(2-sided)
Pearson chi square
1.231
4
.873
Slide23Slide24Residual growth
NAD
recurrence
total
present
52 (82.5%)
11 (17.5%)
63
absent
55 (90%)
6
(10%)
61
value
df
Asymp
. Sig.
(2-sided)
Pearson chi square test
0.832
1
0.362
Slide25toxicitiesBladder – 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
Slide26conclusionIn 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
Slide27limitationsNot a prospective studyOnly short term follow up
Slide28Thank u