A Comparative Study to Evaluate the Role of Hypofractionated Radiotherapy With Concurrent Weekly CisplatinVs Conventional Radiotherapy with Concurrent Weekly Cisplatin in Advanced Carcinoma Cervix
Journal Title: Scholars Journal of Applied Medical Sciences - Year 2017, Vol 5, Issue 7
Abstract
Abstract:Carcinoma cervix is still the most common carcinoma in females in rural area. External beam radiotherapy along with concurrent weekly cisplatin followed by brachytherapy is the standard practice for managing advanced carcinoma cervix. Hypofractionation involves giving a smaller number of larger doses per fraction. There are very few studies on the hypofractionation for cancer cervix. In the coming days, the burden of cervical cancer might even becomegreater, stretching the limited resources available in developing countries even further. Thus, it is important to evaluate hypofractionated radiotherapy protocols and their potential. The Aim of the present study is to evaluate the response rate of hypofractionated radiotherapy with concurrent weekly cisplatin vs. conventional radiotherapy with concurrent weekly cisplatin in advanced carcinoma cervix and to evaluate and compare the toxicities between the two arms. Forty eligible patients of locally advanced carcinoma cervix who presented a Regional Cancer Centre, and satisfied the eligibility criteria were included in this study. They were divided into two Arms (Arm A (n=19) and Arm B(n=21)) to receive concurrent chemoradiation. Patients in Arm A received EBRT in hypofractionated radiotherapy schedule of 45Gy in 18 fractions @ 250cGy per fraction along with concurrent weekly cisplatin in a dose of 40 mg/m2 followed by brachytherapy. Patients in Arm B received EBRT in conventional schedule of 50Gy in 25 fractions @200cGy per fraction with concurrent weekly cisplatin followed by brachytherapy. Toxicities were assessed on weekly basis according to RTOG toxicity criteria. Response was assessed clinically after 6weeks, 3months and 6months of completion of treatment. The mean age of presentation in our study was 46yrs at stage IIIB. Upper GI toxicity of Grade-2 was found to be 79% in Arm A and 52.4% in Arm B. Lower GI toxicity of Grade-2 was found in 42.1% in Arm A and 23.8% in Arm B which was statistically not significant. During 1st follow-up that is at 6weeks after treatment completion, it was observed that 84.2% patients in Arm-A had CR while 81% patients had CR in Arm B. The PR was comparable (15.8%) in Arm- A and 19% in Arm-B and was not statistically significant (p- 0.787).With a median duration of follow up of 6 month 79% patients in Arm A survived without disease, 10.5% patients survived with disease and 10.5% patient lost for follow up; whereas in Arm B 71.5% patients survived without disease, 19% patients surviving with disease and 9.5% patients lost for follow up.No significant difference in response with respect toloco regional control as well as toxicity in both arms were seen. Hence It can be helpful for patients in better compliance, shorter hospital stay and for hospital in more number of patient coverage in a fixed timeperiod. Keywords:Carcinoma Cervix, Hypofractionated Radiotherapy, Cisplatin.
Authors and Affiliations
Subhasis Mishra, Niharika Panda
Keywords
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