Abstract
Introduction: Carcinoma of the uterine cervix has traditionally been treated by combination of external radiotherapy and brachytherapy. Besides the conventional low dose rate (LDR), now medium dose rate (MDR) and high dose rate (HDR) brachytherapy are being used in management of this disease. Fractionation has decreased the late complications of HDR as compared to LDR. We aimed to see whether fractionation in MDR would also decrease the late complication rate while keeping the local control rates same. Material and Methods: After completion of external radiotherapy (46Gy/23#/4.5weeks) to the pelvis, those patients who were suitable for PGI afterloading intracavitary applicator were randomized into two groups of fifty patients each. The study group (Group A) was given two sessions of 14 Gy each, 1 week apart, to point A on MDR selectron. The control group (Group B) was given a single session of 28 Gy to point A. Results: Both groups were comparable in most of the patient characteristics. There was no statistically significant difference in the local control rate and disease free survival in two groups. The local control rate in group A was 23/25(92%) and 22/25(88%) in group B. (p>0.1). The overall disease free survival at 2 years was 22/25(88%) in group A and 20/25(80%) in group B. (p>0.1). Two patients (8%) developed vulvovaginal morbidity in group A compared to six (16%) in group B. One patient (4%) developed rectal morbidity in group A compared to eight (32%) in group B. One patient (4%) developed bladder complication in group A compared to three (12%) in group B. The difference in overall number of morbidity events in group A 4(16%) Vs 17(68%) in group B was statistically significant. (p<0.001) Conclusion: Fractionation in MDR brachytherapy decreases the late morbidity compared to morbidity observed with single fraction as observed in our study. Also fractionation does not appear to affect local control. Further trials and a longer follow up are needed to confirm our findings.
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