Treatment For Carcinoma Of Cervix Research Articles

Comparison of Thermoplastic Cast Versus Knee Wedge/Foot Rest Immobilization Technique in the Treatment of Carcinoma Cervix with Conformal Radiation Therapy

A total of 58 patients who underwent concurrent chemo-radiation for carcinoma cervix were analyzed for magnitude of variation in daily treatment position with two immobilization methods, and its impact on the dose delivered to the organs at risk. Assessment was done with the help electronic portal imaging devices (EPID). The main endpoints of the study were to quantify and compare the total isocentric displacement among the knee rest foot rest and thermoplastic cast groups, and to correlate the effect of isocentric displacement with dose volume changes. The EPIDs were compared with the DRR and set-up errors were noted in X (medio-lateral) Y (antero- posterior) and Z (cranio-caudal) axes. Any variations above the prescribed limits were corrected accordingly before treatment and variations were noted. The root mean square variation in thermoplastic cast group ranged from 0.93 mm to 4.61 mm in X axis, 1.28 mm to 8.07 mm in Y axis, 1.19 mm to 9.49 mm in Z axis. In knee rest foot rest arm these variations are 1.27 mm to 6.05 mm in X axis, 0.91 mm to 4.8 mm in Y axis and 1.09 mm to 5.3 mm in Z axis respectively. P value was significant in Y direction. The total vector error in thermoplastic cast group is 6.308 ± 2.17, and for the knee rest foot rest group was 4.67 ± 1.48. The p value obtained was 0.002, which was statistically significant in favor of knee rest foot rest arm. The bladder, rectum, bowel dose mean differences after isocenter displacement were not statistically significant in both arms.

Dosimetric analysis of intensity-modulated radiation therapy and volumetric-modulated arc therapy in comparison with conventional box technique in the treatment of carcinoma cervix: An impact of prosthetic implant.

The number of patients for carcinoma cervix with implanted hip prostheses has been increasing worldwide during the past several decades. Technological advancements are useful for delivering higher doses, i.e., dose escalation to the target, but the presence of high-density implanted hip prosthesis creates challenges for the planner. A population of 25 patients was selected for the study. Plans were generated using the MONACO treatment planning system keeping the isocenter same. The parameters evaluated for planning target volume (PTV) were D98%, D50%, D2%, Dmax, Dmean, V107%, and V110%. Similarly, the parameters Dmax, Dmean, and D2cc were evaluated for the delineated critical organs. Average monitor units (TMUmean) were also assessed. D98% of PTV was 44.51 (standard deviation [SD]: 0.13) Gy, 44.41 (SD: 0.38) Gy, 44.58 (SD: 0.14) Gy, 44.08 (SD: 0.41) Gy and 44.46 (SD: 0.32) Gy for 4F, intensity-modulated radiation therapy (IMRT), IMRT_WP, volumetric-modulated arc therapy (VMAT), and VMAT_WP techniques, respectively, where WP stands for "without prosthesis". Volume of bowel receiving 45 Gy was 86.82 (SD: 66.38) cm3, 6.97 (SD: 5.77) cm3, 14.11 (SD: 14.29) cm3, 13.31 (SD: 6.57) cm3, and 10.31 (SD: 10.94) cm3 for 4F, IMRT, IMRT_WP, VMAT and VMAT_WP techniques, respectively. Radiotherapy is standard care of practice for known cases of cervical malignancies. As per our investigations, VMAT has generated comparable plans in terms of target coverage (D98%) as compared to IMRT and 4F techniques (P = 0.015 and P = 0.002) and with prosthesis also (P = 0.024). The mean dose to the bladder was significantly lesser with IMRT and VMAT. Our results highlight that VMAT has reduced the mean dose to the rectum (P = 0.001) in presence of high-density implant. The mean dose to femoral heads was also reduced when compared with the 4-field technique. VMAT has an edge over other techniques in terms of target coverage and sparing of critical organs in the presence of metallic prosthesis. Information about the geometry and density of prosthesis will be beneficial for treatment planning.

A prospective comparative study of concurrent chemoradiation in advanced carcinoma cervix patients with weekly cisplatin vs. weekly cisplatin and paclitaxel

Background: Cisplatin-based concurrent chemoradiation is the standard treatment for carcinoma cervix. However, there is a need to explore alternative chemotherapeutic agents to further improve the treatment outcome. In this study, weekly paclitaxel and cisplatin-based chemoradiation was compared with weekly cisplatin-based chemoradiation in terms of disease control and toxicity profile. Materials and Methods: Sixty-four patients with FIGO stage IB2-IIIB squamous cell carcinoma of the uterine cervix were divided (by simple random sampling) into two groups: control arm patients who received radiotherapy (50 Gy in 25 fractions over 5 weeks) with concurrent weekly cisplatin (40 mg/m2) and study arm patients received same radiation dose with weekly cisplatin (30 mg/m2) and paclitaxel (40 mg/m2). After that, all patients received brachytherapy 21 Gy/three fractions, one fraction/week. All patients were followed up weekly during treatment, then 4–6 weeks after treatment completion, and thereafter monthly for at least 6 months. Results: The overall treatment response (complete+ partial response) was numerically higher in the cisplatin-containing control arm, but not significant (93% vs. 80%, P-value = 0.406). High-grade early rectal (60% vs. 25%, P-value = 0.014) and acute gastrointestinal toxicity (66% vs. 6%, P-value <0.001) were significantly higher in the cisplatin and paclitaxel-containing arm. Hematological, renal, late rectal, and bladder toxicities were also numerically higher in the study arm, but not statistically significant. Conclusion: There was no significant benefit of weekly paclitaxel and cisplatin as an alternative to weekly cisplatin-based chemoradiation in the treatment of carcinoma cervix.

A prospective randomized study to compare weekly versus tri-weekly cisplatin-based concurrent chemoradiation in the treatment of locally advanced carcinoma cervix

Background: Concurrent chemoradiotherapy with cisplatin is the standard treatment for locally advanced carcinoma cervix. Cisplatin can be given either as weekly or a tri-weekly regimen with radiotherapy. However, there were few studies comparing both, so our study aimed at comparing weekly versus tri-weekly cisplatin-based chemoradiation in terms of loco-regional control and acute toxicity profile. Aims and Objectives: To compare the treatment response and acute toxicity profile of thse two concurrent chemotherapy schedule. Materials and Methods: Patients with non-metastatic, squamous cell carcinoma of uterine cervix International Federation of Gynecology and Obstetrics stage IB2-IVA were randomized into two arms-control arm patients received external beam radiotherapy (50Gy in 25 fractions over 5 weeks) with concurrent weekly cisplatin (40mg/m2), and study arm patients received radiotherapy with same dose, along with tri-weekly concurrent cisplatin (75 mg/m2) for two cycles. After that, all patients received brachytherapy 21 Gee/3 fractions, one fraction/week. All patients were followed up weekly during treatment and then monthly for at least a period of 6 months for evaluation of toxicity and treatment response. Results: Six weeks after treatment completion, complete treatment response was comparable in both the arms(43.33% vs. 46.67%, P=0.35). Incidences of leucopenia were significantly high in weekly cisplatin arm (P=0.002).Nephrotoxicity of higher grade was also numerically more in control arm (P=0.654). However, treatment compliance was better in tri-weekly cisplatin arm, reflected by reduced treatment interruptions (46.67% vs. 53%). Conclusion: Tri-weekly cisplatin-based concurrent chemoradiation is equally effective as weekly cisplatin-based approach with comparable acute toxicity in treatment of carcinoma cervix.

14P A prospective study of comparision of two HDR brachytherapy regimens in treatment of cervical cancer

Cervical cancer is the 4th most common cancer in women in the world, and the 9th overall. External beam radiotherapy (EBRT) with concurrent cisplatin followed by brachytherapy forms the standard of care for advanced cervical carcinoma. High dose-rate (HDR) intracavitary brachytherapy (ICBT) for cervical cancer is now well established because of its numerous advantages. This study aimed to assess and compare the local control and toxicities between HDR ICBT with 7.5 Gy per fraction in three fractions (Control Arm) and 9 Gy per fraction in two fractions (Study Arm) after EBRT in treatment of carcinoma cervix.

Liposome-Loaded Targeted Theranostic Fluorescent Nano-Probes for Diagnosis and Treatment of Cervix Carcinoma

Near-infrared fluorescence imaging, with its high sensitivity, non-invasiveness, and superior real-time feedback properties, has become a powerful skill for accurate diagnosis in the clinic. Nanoparticle-assisted chemotherapy is an effective cure for cancer. Specifically, the combination of near-infrared fluorescence imaging with chemotherapy represents a promising method for precise diagnosis and treatment of cervical cancer. To realize this approach, it is necessary to design and synthesize therapeutic nano-probes with detection abilities. In this work, an organic NIRF emissive heptamethine cyanine dye, IR783, was utilized and encapsulated in biocompatible drug-carrier liposomes). Then, the anticancer drug doxorubicin was loaded, to form LP-IR783-DOX nanoparticles. The LP-IR783-DOX nanoparticles had spherical shapes and were smoothly dispersed in aqueous solutions. Favorable absorption (a peak of 800 nm) and fluorescence (a peak of 896 nm) features were obtained from LP-IR783-DOX nanoparticles in the near-infrared region. Moreover, the specific detection abilities of nanoparticles were confirmed in different cell lines, and nanoparticles exhibited strong detection abilities in human cervix carcinoma cells in particular. To analyze the chemotherapeutic properties of LP-IR783-DOX nanoparticles, live HeLa cells were studied in detail, and the application of these NPs resulted in a chemotherapeutic efficiency of 56.75% based on fluorescein isothiocyanate staining and flow cytometry. The results indicate that nanoparticles have great potential for theranostic application of fluorescence imaging and chemotherapy in cases of cervical cancer.

To evaluate the use of tandem and cylinder as an intracavitary brachytherapy device for carcinoma of the cervix with regard to local control and toxicities.

Brachytherapy always remains a keystone in the treatment of gynecological carcinoma for both definitive and adjuvant treatments. Due to the rapid fall-off nature of brachytherapy, the target gets a high dose with a low dose to the normal organs nearby and thereby increasing the tumor control probability. This study aims at the evaluation of local control and toxicities in the carcinoma of the cervix using tandem and cylinder as brachytherapy applicator. The study was conducted between January 2014 and December 2018 in a tertiary care hospital. Thirty-one patients who fulfilled our set criterion of Clinical stage IB3-IVA, Performance status Eastern Cooperative Oncology Group 0-2 were selected. All patients were treated initially with external beam radiotherapy and later by high dose rate intracavitary brachytherapy after completion of external beam radiation therapy (EBRT). A dose of 18-21 Gy was delivered to the residual disease in three sessions with a 1-week interval between each session. The dose was optimized in such a way that the organs at risk (OAR), namely bladder and rectum received doses within their tolerance levels. The patients were continuously monitored using Common Terminology Criteria for Adverse Events version 5.0 for both acute and late toxicities and by imaging for local control. Statistical analysis using SPSS Version 20.0 (SPSS Inc., Chicago, Illinois, USA) was used to evaluate the results. Continuous variables were expressed as mean ± standard deviation, and categorical variables were summarized as frequencies and percentages. Out of the 31 patients, 5 (16.1%) experienced radiation-induced Grade 1 skin changes which were due to EBRT, 1 (3.2%) had Grade 1 G. I. T toxicity, 1 (3.2%) had Grade 1 radiation-induced vaginal mucositis after brachytherapy. At 6-8-week follow-up, all the patients showed no evidence of disease on radiological imaging. At 3 months of follow-up, 1 (3.2%) patient had radiation-induced proctitis of Grades 2 and 3 (9.7%) had radiation-induced cystitis of Grades 1 and 1 (3.2%) had Grade 2 cystitis. At 6 months of follow-up, 1 (3.2%) had Grade 1, 1 (3.2%) had Grade 2, and 1 (3.2%) had Grade 3 radiation-induced proctitis. At 3 months of follow-up, 29 (93.5%) patients had no evidence of disease, while 2 (6.5%) were having residual disease on imaging. At 6 months of follow-up, all the patients were disease-free. At 12 months of follow-up, 26 (83.9%) patients were disease-free, 1 (3.2%) had local recurrence, 2 (6.5%) had distant metastasis, and 2 (6.5%) had expired. At 24 months of follow-up, 26 patients were disease-free. Acute and late toxicities were similar to those used in the treatment of carcinoma cervix by standard brachytherapy applicators. Local control was achieved in 83.87% of cases. Two-year survival was 93.5%. We observed that the tandem and cylinder applicator is an acceptable applicator to be used for intracavitary brachytherapy. It is safe and simple besides this; the toxicities and local control are similar to the other standard applicators used in brachytherapy in carcinoma cervix. However, the required dose prescription to point A was not possible in all the patients due to limitations of OARs. Furthermore, long-term follow-up is needed to see the patterns of failure, recurrence-free survival, overall survival, and long-term toxicities in the treated patients.

793P Comparison of two high-dose rate (HDR) brachytherapy regimens in treatment of cervical cancer

Chemoradiation with external beam radiation therapy (EBRT) followed by high dose-rate (HDR) intracavitary brachytherapy (ICBT) is the standard treatment for locally advanced cervical cancer. HDR ICBT for cervical cancer is now well established because of its numerous advantages. Although there are decades of published literature and research on the efficacy of HDR brachytherapy, optimum treatment time, dose, and fractionation still need to be defined. The aim of this study was to assess and compare the local control and toxicities between HDR ICBT with 7.5 Gy per fraction in three fractions (Control Arm) and 9 Gy per fraction in two fractions (Study Arm) after EBRT in treatment of carcinoma cervix.

Dosimetric impact of contrast medium on different photon energies using conformal & IMRT techniques in the treatment of carcinoma cervix and its validation with indigenous phantom

Introduction Considering the unwanted exposure to organs in path of the beam, 4-field (4F) and subsequently, Intensity-modulated-radiation-therapy (IMRT), is known as standard mode of treatment of carcinoma cervix. It is routine practice to inject intravenous contrast during simulation scan which elopes after that from patient body. Therefore, the impact of contrast media should be investigated for radiation dose calculations.Material & MethodsAn indigenously made phantom, named as ‘original contrast (OC)’, was used with dimensions 15 x 15 x 30 cm3. A sleeve was given to place the ionization chamber at the isocentre of the planning target volume (PTV) inside the cylindrical vial of iodinized contrast. Similarly, a virtual phantom was created with similar dimensions in presence and absence of contrast media, called as ‘virtual contrast (VC)’ and ‘virtual without contrast (VWC)’ phantom. Plans were generated with photon energies (6MV/10MV/15MV/6FFF/10FFF) using 4F and IMRT technique. Plans were evaluated for PTV (D99%, D10%, Dmean) and Bladder & Rectum (V30Gy, V10Gy). Normal-tissue-integral-dose (NTID) and total-monitor-units (TMU) were also evaluated.Results D99% of the PTV was comparable in VC and VWC phantoms but was decreased for OC phantom. Similarly, D10% was reportedly higher as 54.03 Gy (4F, 6 MV), 54.71 Gy (4F, 15 MV), 55.78 Gy (4F, 6 FFF) and 57.64 Gy (4F, 10 FFF) for OC phantom. D30% of the bladder and also the NTID was lesser for IMRT cases in all the selected phantoms. Additionally, 4F has shown lesser spillage with 6MV/15 MV photon beam energies in OC phantom. The ‘total monitor units (TMU)’ required for IMRT plans were significantly higher.ConclusionThe contrast material under-estimate the planned dose yet has insignificant influence on the dose calculation. Therefore, unnecessary exposure of dual scans should be avoided and use of 6MV and IMRT technique should be continued in the clinics.

Retrospective Dosimetric analysis of Bone marrow sparing vs non bone marrow sparing Image Guided Volumetric Modulated Arc Therapy in intact Carcinoma Cervix patients

ABSTRACT Aim: Aim of this study was to compare dosimetric parameters of bone marrow (BM) and non bone marrow sparing with state of the art technique image guided volumetric modulated arc therapy in the treatment of Carcinoma Cervix. Methods and Materials: The retrospective Dosimetric study was conducted on 10 consecutive patients of biopsy-proven invasive cervical cancer attending the outpatient department of Geetanjali cancer centre. For treatment planning, patients were scanned on a GE Optima-520, 16 slice fan-beam CT (FBCT) scanner with 2.5 mm slice thickness in the supine position on a customized vacuum cushion with simulation tattoos and alignment lasers. All the simulation scans were taken after following a bladder and bowel preparation protocol, aimed at an empty rectum and full bladder, starting prior to the initial planning scan and continuing throughout the treatment. The prescribed dose to PTV was 50Gy in 25 fractions (2Gy/fraction) and from second week of radiotherapy 50mg/m2/week cisplatin chemotherapy was administered for five weeks. Two sets of plans were generated for all the 10 patients using Volumetric Arc Radiotherapy (VMAT) in Monaco v 5.11.02(Elekta, Crawley, UK) treatment planning system. Keeping all constraints in mind planning optimization was performed with no compromise in coverage of PTV. Results: In the present study V5, V10, V20, V30 were all significantly lower in BMS-IG/VMAT plan . Maximum significance was noted at V20. Value of V40 is lower in BM-IG/VMAT plan, but statistically not significant. Conclusion: Treatment of carcinoma cervix is restricted as a result of toxicity of the surrounding normal structures and HT. HT could be significantly reduced by bone marrow sparing, which could be aided by IGRT/VMAT. This modality could allow completion of treatment with prescribed dose and concurrent chemotherapy in allotted stipulated time. More prospective randomized control trials are needed, to prove its efficacy. key words: bone marrow sparing, hematological toxicity, Image Guidance/Volumetric Modulated Arc Therapy

Impact of volumetric imaging (CBCT) in defining PTV margins in the treatment of carcinoma cervix

Impact of volumetric imaging (CBCT) in defining PTV margins in the treatment of carcinoma cervix

Clinical dosimetric impact of AAA and Acuros XB on high-density metallic implants in case of carcinoma cervix

Background: Metallic implant in radiotherapy leads to difficulty in tumor target and critical organ delineation. Four-field box technique is conventional approach to treat pelvic malignancies. Aim of the Study: The aim of study is to evaluate the dosimetric impact of calculation algorithms in the treatment of carcinoma cervix with metallic implants. Materials and Methods: A paraffin wax-coated iron rod was used to evaluate the beam characteristics under the influence of metallic implant. Beam characteristics such as tissue phantom ratio (TPR20,10) were measured and analyzed. 15 patients with and without metallic prosthesis of carcinoma cervix were compared in the study. Planning was done for the prescription dose of 45 Gy/25 fractions. Plans were calculated using AAA algorithm and recalculated using Acuros XB (AXB) and pencil beam convolution algorithms for the same monitor units. RTOG and Quantec Protocol were used for plan evaluation. Results: Transmission and TPR20,10increases with field size and beam energy. Surface dose Dsalso increases with field size. D98%and D2%of planning target volume showed a significant difference for AAA versus AXB. 4FN (AAA) are significantly better for all the 4F plans, calculated by three algorithms in case of V15Gyof small bowel. Analyzed data indicated the significant attenuation caused by high-Z material. Analyzed value of conformity index showed that value of index comes >1 in all the cases. Conclusion: The results indicate that when creating treatment plans for cervical cancer lesions with metallic prosthesis, the AAA algorithm would be a more appropriate choice.

Prospective Randomized Study Comparing Concomitant Chemoradiotherapy Using Three Weekly Cisplatin and Biweekly 5-Fluorouracil versus Weekly Paclitaxel in Locally Advanced Carcinoma Cervix

India being the second most populous country in the world accounted for 25% of cervical cancer death according to GLOBOCAN 2012. Although there are many agents available, the need for a model chemotherapy regimen that is effective and at the same time less toxic and has easy affordability is the current unmet need. We devised a study with the most commonly available and affordable drugs such as Cisplatin, 5-Fluorouracil (5FU), and Paclitaxel. The main objective was to study the efficacy of concurrent chemoradiotherapy in treatment of carcinoma cervix, using two different regimens in terms of clinical response evidenced clinically as well as on imaging. Secondary objectives were to assess the progression-free and overall survival. It was clearly evident that the response rate could be appreciated clinically in arm B over A; however, this difference could not be justified by statistical methods. Toxicities observed in both the arms was comparable, and in terms of progression-free and overall survival, the differences were not significant suggesting that the both the options could be considered in the treatment. Although the outcome looks promising prompting exploration of more such combinations that are easily available in the rural hospitals, but because of smaller sample size and smaller follow-up, a multi-institutional study with a larger sample size and a longer follow-up is definitely required to set the ball rolling in favor of combination chemotherapy, including cisplatin and 5FU.

Novel NGR anchored pullulan micelles for controlled and targeted delivery of doxorubicin to HeLa cancerous cells

Doxorubicin (DOX) is used to treat different kinds of cancers, including cervix carcinoma. However, it has various side effects such as cardiotoxicity. Nano-sized controlled releasing carriers such as polymeric micelles are of interesting approaches to overcome these side effects of doxorubicin in cancer chemotherapy. Regarding the up-regulation of CD13/APN receptors on the cervix carcinoma cells, which can bind to peptide sequences specially NGR (asparagine–glycine–arginine) with high affinity, peptide sequence (NGR) targeted micelles would lead to effective treatment of this carcinoma. In this study, the NGR peptide sequence was synthesized using the solution-phase strategy from asparagine, glycine, and arginine residues. The pullulan–retinoic acid conjugate and pullulan–retinoic acid–NGR conjugate were prepared by the amide and ester bond formation between the hydroxyl groups of pullulan and carboxylic acid groups of retinoic acid and peptide sequence. Pullulan–retinoic acid–NGR micelles were prepared by the direct dissolution method. The optimized micelles, according to their particle size (124.5 nm), zeta potential (− 3.65 mV), entrapment efficiency (85%), and release of DOX (70%, within 72 h) were assessed for their cytotoxicity on HeLa cells using MTT assay. NGR-targeted pullulan/retinoic acid micelles had higher cytotoxicity than the free DOX in cell culture studies on the HeLa cell line, and this can be a promising result in the treatment of cervix carcinoma.

Dosimetric influence of photon beam energy and number of arcs on volumetric modulated arc therapy in carcinoma cervix: A planning study

AimAim of the present study was to compare the dosimetric impact of different photon beam energies and number of arcs in the treatment of carcinoma cervix. BackgroundCarcinoma cervix is a common cancer in women worldwide with a high morbidity rate. Radiotherapy is used to treat such tumours. Volumetric Modulated Arc Therapy (VMAT) is considered superior to other techniques with multiple arcs and energies. Materials and methodsTwenty patients with carcinoma cervix underwent radiotherapy in a prospective observation study conducted at our institute. Volumetric modulated arc plans with 6MV, 10MV and 15MV photon energies using single arc (SA) and dual arc (DA) were generated. Several physical indices for planning target volume (PTV) like V95%, V100%, V110%, D98%, D50%, D2% and total number of MUs were compared. Normal Tissue Integral Dose (NTID) and dose to a shell structure PHY2.5 and PHY5.0 were analyzed. ResultsComparable dose coverage to PTV was observed for all the energies and arcs. CI for DA6MV (1.095) was better than SA6MV (1.127), SA10MV (1.116) and SA15MV (1.116). Evaluated parameters showed significant reduction in OAR doses. Mean bladder dose for DA6MV (41.90Gy) was better than SA6MV (42.48Gy), SA10MV (42.08Gy) and SA15MV (41.93Gy). Similarly, p-value for the mean rectal dose calculated was 0.001 (SA6 vs 15), 0.013 (DA6 vs 10) and 0.003 (DA6 vs 15) and subsequently favoured DA6MV. Difference in NTID was very small. ConclusionsThe study showed no greater advantage of higher energy, and DA VMAT plan with 6MV photon energy was a good choice of treatment for carcinoma cervix as it delivered a highly homogeneous and conformal plan with superior target coverage and better OAR sparing.

Radical hysterectomy – its trend and role in treatment of carcinoma cervix

Radical hysterectomy – its trend and role in treatment of carcinoma cervix

Comparison of manual and inverse optimisation techniques in high dose rate intracavitary brachytherapy of cervical cancer: A dosimetric study

Aims and objectivesTo compare dosimetrically the manual optimisation with IPSA using dose volume histograms (DVH) among patients treated for carcinoma of cervix with intracavitary brachytherapy. BackgroundWith the advent of advanced imaging modalities, there has been a shift from conventional X-ray based planning to three-dimensional planning. Manual optimisation is widely used across various institutions but it is time consuming and operator dependant. Inverse planning simulated annealing (IPSA) is now available in various brachytherapy planning systems. But there is a paucity of studies comparing manual optimisation and IPSA in treatment of carcinoma cervix with intracavitary brachytherapy and hence this study. Materials and methodsFifteen consecutive patients treated between December 2013 and March 2014 with intracavitary brachytherapy for carcinoma of cervix were selected for this study. All patients were initially treated with external beam radiotherapy followed by intracavitary brachytherapy. The DVH was evaluated and compared between manually optimised plans and IPSA in the same set of patients. ResultsThere was a significant improvement in the HRCTV coverage, mean V100 of 87.75% and 82.37% (p=0.001) and conformity index 0.67 and 0.6 (p=0.007) for plans generated using IPSA and manual optimisation, respectively. Homogeneity index and dose to the OARs remained similar between the two groups. ConclusionThe use of inverse planning in intracavitary brachytherapy of cervix has shown a significant improvement in the target volume coverage when compared with manual planning.

Does Change in the Effect of Source Strength of the High Dose Rate <sup>192</sup>Iridium Radio-Isotope on Local Control and Late Normal Tissue Toxicity (Bladder and Rectum) in the Treatment of Carcinoma Cervix

Aim: To analyse and assess the effect of dose rate of 192ir-source strength on late complications and local control rate during treatment of carcinoma cervix. Materials and Methods: One hundred and two cases of carcinoma cervix were included in the study. All patients were treated with a curative intent with radical dose of radiation as per the department protocol. All patients were treated with both EBRT plus Brachytherapy with Inj. Cisplatin 40 mg/m2 weekly. Patients were divided into 2 groups based on activity i.e. group A (10-6Ci) and group B (5-2Ci). After brachytherapy, point doses were analysed based on ICRU 38 recommendations. During follow up, morbidities were evaluated using RTOG grading system. Results: There was no difference in local control and distant metastasis in both groups after six months of follow up. Late Complications were comparable in both groups irrespective of source strength. Bladder complications were minimal with no significant difference in both study groups. Further Patients were divided into four groups i.e. BED of ICRU rectal point (3 and ≥100 Gy3) and source strength (10-6Ci and 5-2Ci), when BED was >100 Gy3 resulted in higher late rectal complication rate (P 3. Conclusion: This study suggests that change in source activity did not make a difference in local control, late rectal and bladder morbidities at 6 months of follow up. Longer follow up is required to assess long term results and morbidities.

Dose verification in carcinoma of uterine cervix patients undergoing 3D conformal radiotherapy with Farmer type ion chamber.

External beam radiotherapy (EBRT) for carcinoma of uterine cervix is a basic line of treatment with three dimensional conformal radiotherapy (3DCRT) in large number of patients. There is need for an established method for verification dosimetry. We tried to document absorbed doses in a group of carcinoma cervix patients by inserting a 0.6 cc Farmer type ion chamber in the vaginal cavity. A special long perspex sleeve cap is designed to cover the chamber for using in the patient's body. Response of ionization chamber is checked earlier in water phantom with and without cap. Treatment planning was carried out with X-ray computed tomography (CT) scan and with the chamber along with cap in inserted position, and with the images Xio treatment planning system. Three measurements on 3 days at 5-6 fraction intervals were recorded in 12 patients. Electrometer measured charges are converted to absorbed dose at the chamber center, in vivo. Our results show good agreement with planned dose within 3% against prescribed dose. This study, is a refinement over our previous studies with transmission dosimetry and chemicals in ampules. This preliminary work shows promise that this can be followed as a routine dose check with special relevance to new protocols in the treatment of carcinoma cervix with EBRT.

Analysis on the Incidence, Staging and Treatment of Carcinoma Cervix at Delta Medical College and Hospital of Bangladesh

Background: Cervical cancer remains the most common cancer among women in this part of the world. Bangladesh has the highest level of incidence and mortality rates due to cervical cancer among women. Cervical cancer is a preventable disease by screening and treatment of pre-invasive condition. Unfortunately, there is no effective screening program in Bangladesh. Objective: The objective was to analyze the clinico-pathologic characteristics and, subsequently the therapy delivered to the patients. Materials and method: This cross sectional study was done from January to December 2011 in oncology division of Delta Medical College and Hospital, Dhaka, Bangladesh. During this period a total of 2264 female carcinoma patients were registered. Out of them 523 patients were with the diagnosis of carcinoma of cervix. Evaluation and characterization of patients with carcinoma cervix were done according to the age group, clinical stages and surgical status. External beam radiotherapy (EBRT) and doses, brachytherapy doses and fractions, time interval between EBRT and brachytherapy, neo-adjuvant and concurrent chemotherapy status were the factors taken into consideration for the analysis of treatment of these patients. Results: The study revealed that the incidence of carcinoma cervix was 23% and highest incidence was between 40-50 years of age group, most of the patients were in Stage IIB (34%) and IIIB (28%) and 31% with unknown stage. About 44% patients were referred postoperatively and most of them with unknown stage. Almost 90% patients received EBRT, 24% patients received concurrent chemo-radiation, 46% of them completed 5 cycles of concurrent chemotherapy and 8.6% patients received neo-adjuvant chemotherapy. About 69% patients received brachytherapy with HDR Co-60 sources and 23% of patients received their brachytherapy treatment after 12 weeks of completion of EBRT. Conclusion: Lack of proper clinical evaluation and documentation, delay in referral and lack of implementation of a standard protocol for the treatment of carcinoma cervix are the major obstacles in our country. DOI: http://dx.doi.org/10.3329/dmcj.v1i2.15915 Delta Med Col J. Jul 2013;1(2):31-36