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A comparative study between conventional high-dose-rate brachytherapy and once a week and twice a week concurrent brachytherapy in treatment of carcinoma of uterine cervix with external beam radiation therapy

Tapas Kumar Das, Phalguni Gupta, Samaresh Malo, Sharmistha Ganguly, Pabitra Das, Aloke Ghosh Dastidar.

Background: Carcinoma of uterine cervix is the most common cancer in women in many developing countries such as India and is a significant health-care problem worldwide.

Objectives: To compare effectiveness, safety, and toxicity profile of conventional high-dose-rate brachytherapy (HDR-BT) and once a week and twice a week HDR-BT study concurrent with external beam radiation therapy (EBRT), that is, 7 Gy/3 fraction of concurrent EBRT and 4.5 Gy/6 fractions of concurrent EBRT to be compared with conventional HDR-BT schedule.

Materials and Methods: In this open prospective randomized pilot comparative study, total 82 patients of cancer cervix were categorized into three treatment groups. (1) Group A (n = 27): Those received 3 weeks EBRT followed by concurrent once a week high-dose-rate brachytherapy (HDR-BT) along with EBRT from 4th week onward. The total dose of HDR-BT was 21 Gy in 3 fractions. (2) Group B (n = 28): Those received 3 weeks EBRT followed by concurrent twice a week HDR-BT and EBRT from 4th week onward. The total dose of HDR-BT was 27 Gy in 6 fractions (4.5 Gy in each fraction). (3) Group C (n = 27): Those received conventional brachytherapy, which was started 2 weeks after the completion of EBRT.

Results: It was observed that the fractionation schedule and dose in study Group B (4.5 Gy/6 fraction of concurrent EBRT) had produced most satisfactory results regarding response rate, local control, failure rate, and less acute and late toxicities of bladder, rectum, vagina, and skin compared to study Group A and control Group C.

Conclusion: HDR intracavitary brachytherapy using 4.5 Gy/6 fraction of concurrent EBRT twice in a week in locally advanced carcinoma cervix may be a good option as it has better local control and less toxicity. Continuing this study for prolonged period and recruiting more patients will help in arriving at more conclusive results.

Key words: Carcinoma cervix, external beam radiation therapy, high-dose-rate brachytherapy, different brachytherapy fractionations

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American Journal of Preventive Medicine and Public Health


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