Does modification of intracavitary brachytherapy procedure by extended loading technique confer maximum vaginal coverage and affect treatment response?

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Background: Standard loading technique was seen to result in incomplete coverage of the primary disease extending to the vagina. Modification of loading technique with extended loading aims to deliver higher dose to vaginal extent of disease with acceptable toxicity. Objectives: This study was conducted to determine the feasibility of extended loading technique in intracavitary brachytherapy in cervical cancer patients with primary disease involving vagina in terms of dosimetry, response rates of primary disease, and associated toxicities. Methods: Twenty patients were selected who were registered and treated during January 2020 to December 2021. All patients (100%) completed the treatment with minimum of two follow-ups. Results: Overall, the response rate of 90% in primary disease was observed in patients treated, and interestingly, 50% of the patients had complete response. Moreover, 100% of patients reported improvement in at least one symptom. Only one patient had a static disease. As defined by the RTOG criteria for toxicity assessment, Grade I rectal toxicity (70%) and genitourinary toxicity (50%) were seen in most patients. Grade III toxicity was reported in five patients. No Grade IV toxicity was seen. Conclusion: Extended loading technique was an excellent method to adequately cover the vaginal disease in a setting where interstitial brachytherapy and intensity-modulated radiation therapy boost techniques are not available, with acceptable toxicity.