PROSPECTIVE RANDOMIZED STUDY ON TWO DOSE FRACTIONATION REGIMENS OF HIGH DOSE RATE BRACHYTHERAPY FOR CARCINOMA CERVIX: COMPARISON OF CLINICAL RESPONSE AND COMPLICATIONS IN ORGANS AT RISK
Abstract
Introduction: Cancer Cervix is treated with a combination of external beam radiotherapy and
intracavitary brachytherapy. With the recent American Brachytherapy Society consensus
guidelines for locally advanced carcinoma of the cervix, atleast Equivalent Dose 2 > 80 Gy for
patients with complete response or partial response with residual disease less than 4cm is
recommended. For non responders or those with tumors larger than 4cm at the time of
brachytherapy, tumor dose escalation to an Equivalent Dose 2 of 85-90 Gy is recommended to
point A. Present study was designed to see the feasibility of these guidelines in terms of local
tumor control and toxicities to rectum and bladder in our group of patients.
Material and Methods: Fifty patients of biopsy proven cancer cervix were enrolled. After
pre-treatment evaluation all patients were delivered external beam radiotherapy 50 Gy in 25
fractions at 200 cGy/day with concurrent cisplatin on weekly basis. Patients were then
randomized into three applications (Group A), four applications (Group B) of HDR
Brachytherapy of 6 Gy each so that total treatment time does not exceed 8 weeks. BED and
LQED were calculated and assessment of response and complications were assessed.
Statistical analysis was done using Chi square test.
Results: Mean age of the patients was 50 years. No significant hematological toxicities and
radiation reactions were seen during external beam radiotherapy. The mean BED of group A
for tumor, rectum & bladder was 137.3 Gy, 112.53 Gy & 103.23 Gy respectively and of group
B was 155.3 Gy, 120.98 Gy and 111.95 Gy respectively. The mean EQD2 in group A at tumor,
rectum & bladder was 74 Gy, 54.08 Gy and 61.94 Gy respectively and in group B was 82 Gy,
59.18 Gy and 66.60 Gy respectively. There was no statistically significant difference in local
response and early & late bladder reactions in both the groups.
Conclusion: In a follow-up of six months we did not find any significant difference in
toxicities of rectum and bladder. Long-term follow-up is needed to see for late rectal and
bladder toxicities.
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