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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


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


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



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.




TUMOR

LYMPH NODES

5mm

1cm

8mm

5mm

GTV

GTV

CTV

CTV

PTV

PTV




Of the ten trials only 3 used similar methodology as this study.



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)



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