Abstract
Background: ABS (American Brachytherapy Society) necessitates use of BT (Brachytherapy) for successful completion of management of locally advanced cervical cancer. Multiple dose fractionation schedules are available but none is currently standardized.
Objective: To analyze two different concurrent HDR-ICBT (Intracavitary BT) schedules, their disease response, acute and late toxicities.
Materials and Methods: 50 cases of histologically proven stage II cervical cancer were randomized into two arms, Arm A and Arm B. Patients in both arms received 50 Gy (Gray) (2 Gy/ fraction, 25 fractions, Monday to Friday) of EBRT (External Beam Radiotherapy) to whole pelvis with weekly cisplatin (40 mg/m2) on every Sunday. Patients in Arm A received HDR-ICBT regime of 7.5 Gy/fraction for 3 fractions, in Arm B patients received 6 Gy/fraction for 4 fractions on every Saturday.
Results: Median follow up period of study was 14 months (range 7 – 20 months). There is no significant difference in local control and late toxicities in both arms.
Conclusion: Both regimes of concurrent HDR- ICBT were tolerated well and were safe to use. Results of disease response and toxicity profile were also similar in both regimes.
Keywords: cervical cancer, HDR intracavitary brachytherapy, dose fractionation, acute toxicity, late toxicity.
References
- Maheshwari A, et al. Gynecological cancers: A summary of published Indian data. South Asian J Cancer. 2016 Jul-Sep; 5(3): 112–120.
- Burden of HPV related cancers. Human Papillomavirus and Related Diseases Report India. http://www.hpvcentre.net.
- GLOBOCON 2018. http://gco.iarc.fr/today/data/factsheets/populations/356-india-fact-sheets.pdf
- GLOBOCON 2018. http://gco.iarc.fr/today/data/factsheets/populations/900-world-fact-sheets.pdf
- Jain A, Ganesh B, Bobdey SC et al. Sociodemographic and clinical profile of cervical cancer patients visiting in a TCH in India. Indian Journal of Medical and Paediatric Oncology 2017 jul – sep;38(3): 291 – 295.
- Nag S, et al. The American Brachytherapy Society recommendations for High-dose-rate brachytherapy for carcinoma of the cervix. Int. J. Radiation Oncology Biol. Phys., Vol. 48, No. 1, pp. 201–211, 2000.
- American Brachytherapy Society consensus guidelines for locally advanced carcinoma of the cervix. Part I: General principles, https://www.americanbrachytherapy.org/ABS/document-server/?cfp=ABS/assets/file/public/guidelines/Guidelines_Carcinoma_Cervix_Part1.pdf
- Petereit DG, Sarkaria JN, et al. The adverse effect of treatment prolongation in cervical carcinoma. Int J Radiat Oncol Biol Phys 1995; 32:1301–1307.
- Saptarshi Ghosh, Pamidimukalabra-mhananda Rao High-Dose-Rate Orthogonal Intracavitary Brachytherapy with 9 Gy/Fraction in Locally Advanced Cervical Cancer: Is it Feasible? Journal of Obstetrics and Gynecology of India 2015;66(Suppl 1):1-7.
- Toita T, Kakinohana Y, Ogawa K, et al. Combination external beam radiotherapy and high-dose-rate intracavitary brachytherapy for uterine cervical cancer: Analysis of dose and fractionation schedule. Int J Radiat Oncol Biol Phys. 2003;56(5):1344–1353.
- Oken M, Creech R, Tormey D, et al. Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol. 1982; 5:649-655.
- RTOG FOUNDATION INC. RTOG/ EORTC Late Radiation Morbidity Scoring Schema. 2018 Available from: https://www.rtog.org/researchassociates/adverseeventreporting/rtogeortclateradiationmorbidityscoringschema.aspx
- Tanderup R, Eifel PJ, et al. Curative Radiation Therapy for Locally Advanced Cervical Cancer: Brachytherapy Is NOT Optional. Int J Radiation Oncol Biol Phys, Vol. 88, No. 3, 2014 pp. 537-539.
- Gaur R, Singh OP, et al. Comparison of Low- and High-dose Rate Brachytherapy in Carcinoma Cervix: Results from a Randomized Study. Indian Journal of Clinical Practice, Vol. 23, No. 4, September 2012.
- Kaled MA. Can intensity-modulated radiation therapy replace brachytherapy in the management of cervical cancer? Brachytherapy 1 (2002) 191–194
- Sethi RA, Jozsef G, Grew D, et al. Is there a role for an external beam boost in cervical cancer radiotherapy? Front Oncol 201333.
- Hsieh CH, Wei MC, Hsu YP, et al. Should helical tomotherapy replace brachytherapy for cervical cancer? Case Report. BMC Cancer. 2010; 10:637.
- Marnitz S, Kohler C, Budach V, et al. Robotic radiosurgery: Emulating brachytherapy in patients with locally advanced cervical carcinoma. Technique, feasibility and acute toxicity. Radiat Oncol. 2013;8(1):109.
- Haas JA, Witten MR, Clancey O, Episcopia K, Accordino D, Chalas E. CyberKnife boost for patients with cervical cancer unable to undergo brachytherapy. Front Oncol. 2012; 2:25.
- Perez CA, Grigsby PW, Castro-Vita H, et al: Carcinoma of the uterine cervix. I. Impact of prolongation of overall treatment time and timing of brachytherapy on outcome of radiation therapy. Int J Radiat Oncol Biol Phys 32:1275-1288, 1995.
- Lanciano RM, Pajak TF, Martz K, et al: The influence of treatment time on outcome for squamous cell cancer of the uterine cervix treated with radiation: A patterns-of-care study. Int J Radiat Oncol Biol Phys 25:391-397, 1993.
- Grinsky T, Rey A, Roche B, et al: Overall treatment time in advanced cervical carcinoma: A critical parameter in treatment outcome. Int J Radiat Oncol Biol Phys 27:1051-1056, 1993.
- Huang EY, Sun LM, Lin H, et al. A prospective cohort study to compare treatment results between 2 fractionation schedules of high-dose-rate intracavitary brachytherapy (HDR-ICBT) in patients with cervical cancer. Int J Radiat Oncol Biol Phys. 2013;85(1):123–128.
- Saptarshi Ghosh, Pamidimukalabra-mhananda Rao High-Dose-Rate Orthogonal Intracavitary Brachytherapy with 9 Gy/Fraction in Locally Advanced Cervical Cancer: Is it Feasible? Journal of Obstetrics and Gynecology of India 2015;66(Suppl 1):1-7.
- American Brachytherapy Society consensus guidelines for locally advanced carcinoma of the cervix. Part I: General principles, https://www.americanbrachytherapy.org/ABS/document-server/?cfp=ABS/assets/file/public/guidelines/Guidelines_Carcinoma_Cervix_Part1.pdf
- Petereit DG, Sarkaria JN, et al. The adverse effect of treatment prolongation in cervical carcinoma. Int J Radiat Oncol Biol Phys 1995; 32:1301–1307.
Corresponding Author
Dr Neeti Sharma
Professor, Department of Radiation Oncology, Acharya Tulsi Regional Cancer Treatment and Research Institute, S.P. Medical Collage, Bikaner, Rajasthan, India, 334001
DOI: https://dx.doi.org/10.18535/jmscr/v6i12.129
