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  1. Dr.Sandeep.M Junior resident Dr.Ajaykumar Prof & HOD A comparison of two different fractionation schedules in high dose rate brachytherapy for carcinoma cervix in terms of locoregional control

  2. Background • Carcinoma cervix is one of the commonest malignancies in females. • Locally advanced carcinoma cervix is managed with concurrent chemoradiation. • Brachytherapy is usually delivered by either HDR or LDR machines. • ABS(American Brachytherapy Society recommeneds maximum 7.5Gy/fr and min 4 fr)1 • 1 ref:Nag s etalInt J RadiatoncolBiolPhy 2000,48 ,201

  3. In high volume centers for adequate use of resources, their were studies assessing HDR ICRT with reduce fractionation schedules • Hama Y et al Radiology 2001 219;207-212 • 6.8x 3f vs 9gy x2 • Firuzapatel,pankajkumar et alBrachytherapy • Volume 10, Issue 2, March–April 2011, Pages 147–153

  4. Aims and Objectives •  To compare two different fractionation schedules in high dose brachytherapy for carcinoma cervix with respect to locoregionalcontrol of the disease

  5. methodology • Study setting :- Dept. of Radiotherapy Calicut medical college • Study design :- retrospective cohort • Study period :- 2010 jan – 2011 jan

  6. inclusion criteria • All patients with ca cervix , stage II & III who took treatment from our college • Performance status – 1 & 2 • Age between – 35 – 65 years • Squamous cell carcinoma histology

  7. Exclusion criteria • Performance status – 3 & 4 • No proper follow up • Age > 65 years • Stage IV disease • Non concurrent EBRT given cases

  8. Materials & methods • 124 patients with carcinoma cervix with stage II & III were given concurrent chemo radiotherapy • cisplain 40 mg/m2 weekly • RT dose of 45Gy/23 #

  9. Patients are divided in 2 arms • 7Gy given weekly in 3 sittings • 9Gy given weekly in 2 sittings

  10. All patients are assessed clinically for residual disease after CCRT • All patients are followed up as per guidelines for one year for loco regional recurrence acute complications • Recurrences are confirmed with biopsy

  11. stage

  12. ebrt

  13. Residual growth

  14. brachytherapy

  15. statistics • Data assessed using spss version 16

  16. results

  17. No of recurrences in two arms

  18. No of recurrences according to stage

  19. No of recurrence in comparison with presence of residual disease

  20. toxicities • Bladder – grade I- 9Gy – 15% 7 Gy- 20% • None of the pts needed intervention for heamatologic toxicities • Bleeding PR one patient from both arms reported bleeding PR was managed conservatively

  21. conclusion • In carcinoma cervix CCRT followed by HDR ICRT with 9Gy wkly in two fraction is equaly effective in local control as 7GYin three fractions in a follow up period of one year • These patients should be followed up for late toxicities

  22. limitations • Not a prospective study • Only short term follow up

  23. Thank u