INTERSTITIAL BRACHYTHERAPY IN THE MANAGEMENT OF UTERINE CERVICAL CANCER- SINGLE INSTITUTIONAL STUDY
Journal Title: Journal of Evolution of Medical and Dental Sciences - Year 2018, Vol 7, Issue 50
Abstract
BACKGROUND The objective of this study is to report the clinical outcome of patients with carcinoma cervix treated by radiation therapy including brachytherapy (BT), using template based Interstitial Brachytherapy (ISBT), in whom conventional Intracavitary Application (ICA) is not possible and to determine the local control and the acute and late radiation induced toxicities. MATERIALS AND METHODS From Apr 2016 to Mar 2018, among histologically proven cervical cancer patients, 30-70 yrs. of age, stages from IB to IIIB, completed concurrent chemo-radiation (radical/adjuvant) and referred for High Dose Rate Brachytherapy (HDR BT), thirty patients, in whom conventional ICA is not possible are treated using template based, image guided ISBT. The dose prescribed per fraction of HDR-ISBT in our institute varied from 3-4 Gy/fraction to a total of 12-21 Gy in 4-6 fractions. D90 for HR-CTV of BT, cumulative EQD2 of HR-CTV and the cumulative D2cc for the bladder, rectum, and sigmoid, (Combined EBRT and BT) were analysed. Patients were evaluated for disease related parameters, treatment-related toxicities and tumour-response rates at 6 weeks, then every month for first 3 months and every 3 months thereafter. MRI is done at end of 3 months. RESULTS Among 735 patients referred for brachytherapy, 30 patients, who are not fit for conventional ICA, are treated by HDR ISBT.19 patients were using Syed-Neblett and 11 using Mupitz template. Median number of needles used was 15. The median BT Dose planned was 23.6 Gy and median HR-CTV D90 was 17.5 Gy. The median cumulative EQD2 for HR-CTV, D2cc for the bladder, rectum, and sigmoid were 67.5, 62.6, 64.36, 54.83 Gy respectively. The median V100 for HR-CTV was 70 ml. Local control (LC) rate at first follow up (3 months) is 43.3% and at 1 yr. is 41.38 %. The median Progression-free survival time for two year follow up was 19.92 months. One patient (3.33%) had distant metastasis, two patients (6.67%) experienced grade 2 rectal bleeding but none had bladder complications. CONCLUSION Treatment by image guided ISBT for carcinoma cervix patients in whom conventional application is not possible, results in good dose-volume histogram values and favourable local control with acceptable toxicities, is depicted through this prospective single institutional study with a lesser number of patients.
Authors and Affiliations
Thirukurungudi Narayanan Vijayasree, Subramanian Saravanan
Keywords
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- EP ID EP549313
- DOI 10.14260/jemds/2018/1188
- Views 89
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