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Presenter : Dr.B.Sathish , JR, RT. Guide : Dr.Shyama Prem , AP, RT, Jipmer Co – Guides: 1. Dr. K.S. Reddy , Professor and head, Radiotherapy, Jipmer 2. Mr.Saravanan , Lecturer in medical physics, Jipmer.

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presenter dr b sathish jr rt

Presenter : Dr.B.Sathish, JR, RT

Guide : Dr.Shyama Prem, AP, RT,

Jipmer

Co – Guides:

1. Dr. K.S. Reddy,

Professor and head, Radiotherapy,

Jipmer

2. Mr.Saravanan,

Lecturer in medical physics,

Jipmer

slide2

“ACUTE TOXICITY EVALUATION OF 3D CONFORMAL CONCURRENTCHEMORADIATION (PTV Dmax not above 105%)IN CARCINOMA CERVIX “AN OBSERVATIONAL STUDY

slide4

PTV

PTV

aims and objectives
AIMS AND OBJECTIVES

To investigate the acute toxicity of 3D conformal concurrent chemo RT (Keeping PTV Dmax <=105%) in carcinoma cervix patients.

methodology
Methodology
  • observational descriptive study
  • N= 22 (an ongoing study – total 30)
  • Cisplatin 40 mg/m2 weekly 4-5 weeks (maximum of 5 doses )
assessment
Assessment
  • Acute RTOG toxicity – during EBRT(weekly once) and 1 week post EBRT
slide10

Eclipse

Version 10

AAA ALGORITHM

reducing ptv max dose
REDUCING PTV MAX DOSE
  • WEIGHTAGES
  • MLC LEAF POSITION
  • SUBFIELDS
pitfalls
PITFALLS
  • NON-RANDOMISED (NO COMPARATIVE ARM)
  • CONTOURING UNCERTAINTIES/MOTION SETUP ERRORS
  • TIME CONSUMING
  • LATE LONG TERM OUTCOME UNKNOWN
  • SUBJECTIVE ANORECTAL DISCOMFORT
  • SKIN TOXICITY MORE THAN EXPECTED
  • EXPENSIVE
conclusion
Conclusion

3D CRT WITH OPTIMISATION BY REDUCING Dmax – ACCEPTABLE TOXICITY PROFILE.

“The cure of the disease must never be more grievous than the endurance of the same”

Sir Robert Hutchison,

20th century physician, British Medical Journal, 1953; 1: 671.

slide34

TUMOR

LYMPH NODES

5mm

1cm

8mm

5mm

GTV

GTV

CTV

CTV

PTV

PTV

tolerance doses
Tolerance doses
  • Rectum, 75 Gy (mean 68 Gy, <80% of the dose at point A)
    • V50 < 60
    • V60 < 50
  • Bladder, 80 Gy 2/3RD (mean 70 Gy, 85% of the dose at point A)
    • FULL BLADDER 65 Gy
  • Vagina, 120–140 Gy (mean 125 Gy)
slide43

FEMORAL HEADS = V50 < 50%

  • SMALL BOWEL = 45 Gy TOTAL DOSE (250 CM3)
  • Skin : PTV-V107% (>28.6%) more toxicity
ad