Role of Twice Weekly HDR- Brachytherapy in Management of Carcinoma of Uterine Cervix a Experience of Rural Centre in India

Abstract

Aim and Objective : Study of safety and efficacy of twice weekly HDR brachytherapy, in management of cervical carcinoma. Background and purpose : HDR brachytherapy (HDR-ICBT) is integral part of treatment in cervical cancer treated with curative intent.HDRICBT should always fractionated, if brchytherapy started after external radiotherapy and once in a week application was done then there is prolongation of overall treatment time (OTT) which leads to of tumour repopulation leading to poor tumour control. To reduce repopulation, OTT should be shortened either by increasing dose per fraction or administering more fractions per week, first approach has more complications. So to decreases OTT twice weekly regimen should be prefer. This study aims to evaluate the effectiveness and safety of twice weekly HDR-ICBT Materials and Methods : Hundred patients with locally advanced (stages IIB to IVA according to FIGO classification) carcinoma of uterine cervix were enrolled, radiotherapy was conventionally administered: 50.4 Gy/28 fractions by external beam (whole pelvis) followed by HDR-ICBT, 4 fractions of 7 Gy each. Paclitaxel was administered on weekly basis at dose of 40 mg∕m2 during entire course of external beam radiotherapy as a radio sensitizer. Overall treatment time 50 days. Results : Treatment response was evaluated three months after the end of radiotherapy by means of clinical examination and ultrasonography. Complete Regression (CR) in 83%, partial response (PR) 14% and progressive disease 3%. At 26 months of median follow up 73 patients alive, 58 patients are disease free. Conclusion : The twice weekly HDRICBT regimen may improve the local control rate with low complications as well as reduced overall treatment time.