scholarly journals Comparative study to evaluate dosimetric differences in patients of locally advanced carcinoma cervix undergoing intracavitary brachytherapy under two different anaesthesia techniques: an audit from a tertiary cancer centre in India

2019 ◽  
Vol 31 (1) ◽  
Author(s):  
Divyesh Kumar ◽  
G. Y. Srinivasa ◽  
Ankita Gupta ◽  
Bhavana Rai ◽  
Arun S. Oinam ◽  
...  
Keyword(s):  
Day Care ◽  
Treatment Time ◽  
Locally Advanced ◽  
Effective Alternative ◽  
External Beam Radiation ◽  
Intracavitary Brachytherapy ◽  
High Dose ◽  
Carcinoma Cervix ◽  
Beam Radiation ◽  
Significant Difference

Abstract Background Carcinoma cervix is amongst the leading causes of mortality and morbidity in women population worldwide. High-dose-rate intracavitary brachytherapy (HDR-ICBT) post external beam radiation therapy (EBRT) is the standard of care in managing locally advanced stage cervical cancer patients. HDR-ICBT is generally performed under general anaesthesia (GA) in operation theatre (OT), but due to logistic reasons, sometimes, it becomes difficult to accommodate all patients under GA. Since prolonged overall treatment time (OTT) makes the results inferior, taking patients in day care setup under procedural sedation (PS) can be an effective alternative. In this audit, we tried to retrospectively analyse the dosimetric difference, if any, in patients who underwent ICBT at our centre, under either GA in OT or PS in day care. Results Thirty five patients were analysed 16/35 (45.71%) patients underwent HDR-ICBT under GA while 19/35 (54.28%) patients under PS. In both groups, a statistically significant difference was observed between the dose received by 0.1 cc as well as 2 cc of rectum (p < 0.05), while the bladder and sigmoid colon had comparable dosages. Conclusion Though our dosimetric analysis highlighted better rectal sparing in patients undergoing HDR-ICBT under GA when compared to patients under PS, PS can still be considered an effective alternative, especially in centres dealing with significant patient load. Further studies are required for firm conclusion.

scholarly journals Comparison of Response to the Concurrent Low Dose Daily Cisplatin Vs Weekly Cisplatin Vs Three Weekly Cisplatin with External Beam Radiotherapy in Carcinoma Cervix Patients of Stage IIB, IIIA & IIIB: A Prospective Study from Single Institution

2021 ◽  
Vol 5 (11) ◽  
Author(s):  
Amol Ubale ◽  
Shruti Chandra ◽  
S N Prasad ◽  
P K Singh
Keyword(s):  
Cervical Cancer ◽  
Low Dose ◽  
External Beam Radiotherapy ◽  
Locally Advanced ◽  
External Beam Radiation ◽  
External Beam ◽  
Carcinoma Cervix ◽  
Beam Radiation ◽  
Significant Difference ◽  
Weekly Cisplatin

Introduction: Cervical cancer continues to be a major public health problem affecting middle-aged women, particularly in less-resourced countries. External beam radiation therapy along with intra cavitary insertion has long been the treatment of choice for locally advanced (IIB-IVA) cervical cancer, but long-term successes are limited in terms of pelvic recurrence or distant metastasis. Outcome of low dose daily versus weekly versus three weekly Cisplatin concurrent with External beam radiotherapy in locally advanced cervical carcinoma was compared in this study. Methods: A prospective cross sectional study was carried out in J K cancer institute, Kanpur. Total 60 patients of cervical cancer were randomized into 3 arms. Arm I, Arm II and Arm III received External beam radiotherapy concurrent with either daily (8mg/m2), weekly (40 mg/m2) or three weekly (100 mg/m2) Cisplatin respectively. External beam radiotherapy was given with a dose of 50 Gy / 25 # / 5 week / 2 field or 4 field. Patients were evaluated weekly during treatment and afterwards up to 1year. Results: Most of the patients were from fourth and fifth decade, low socioeconomic strata and illiterate. Majority of the cases belong to squamous cell carcinoma (96.6%) and stage III B (55%). Objective response in arm I was 80.0%, in arm II was 75.0% and in arm III was 60.0% respectively. Statistically significant difference was noted between arm III and Arm I (80%Vs60% p<0.05). Results were better in arm I as compare to arm II but not statistically significant. (80%Vs75% P>0.05) Conclusions: This study showed that response was better in ARM I as compared to ARM III and best results was seen with Cisplatin concurrent daily with radiation. Keywords: Cisplatin, concurrent chemotherapy, daily, weekly, three weekly, carcinoma cervix

A new perspective of different schemes of neoadjuvant chemotherapy followed by concurrent chemotherapy and radiotherapy for locally advanced cervical cancer.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e18011-e18011
Author(s):  
Xue Tian ◽  
Fenghu Li ◽  
Ran Li ◽  
Feiyue Yang ◽  
Jianying Chang ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Large Scale ◽  
Locally Advanced ◽  
Survival Rates ◽  
Concurrent Chemotherapy ◽  
External Beam Radiation ◽  
Intracavitary Brachytherapy ◽  
Beam Radiation ◽  
Significant Difference

e18011 Background: To observe the clinical effect, survival time and toxicity and side effects in unoperated cervical cancer patients treated with different schemes of neoadjuvant chemotherapy (NACT) followed by concurrent chemotherapy and radiotherapy (CCRT). Methods: A retrospective analysis was performed in 120 patients who were followed up until they died or being followed up at least 5 years. The treatment schedules consisted of 2 cycles of intravenous paclitaxel 135-175 mg/m2 plus cisplatin 60-80mg/m2 (TP group, 62 patients) or lobaplatin 30mg/m2 (TL group, 58 patients) every 21 days. Patients were then submitted to CCRT. Chemotherapy regimen of CCRT was cisplatin 40 mg/m2 (TP group) or lobaplatin 30mg/m2 (TL group) weekly. External beam radiation therapy (total 50.4-56.35Gy, 28 fractions, 180-215cGy per fraction daily) was administered using the3D-CRT or IMRT followed by intracavitary brachytherapy (5Gy per fractions, mostly 5 fractions, Ir192 based). Results: The proportion who had a complete/partial response was 81.7% after NACT, and 99.2% after all treatment. In all patients, the one-year, three-year and five-year survival rates were 99.2%, 81.7% and 69.2% respectively. In TP group vs. TL group, the 3-yr and 5-yr survival rates were 85.5% vs.77.6% (χ2= 1.248, p = 0.264) and 75.8% vs. 63.8% (χ2= 2.059, p = 0.151) with no significant difference. In mass size ≥ 5cm group vs. <5cm group, 3-yr survival rates were 88.0% vs.77.1% with no significant difference (χ2= 2.296, p = 0.130), but 5-yr survival rates were 82.0% vs.61.4% (χ2= 5.878, p = 0.015) with significant difference. The 3-yr and 5-yr OS rates between stage IIB and stage IIIB were not significantly different, respectively 83.1% vs. 70.6% (χ2= 2.083, p = 0.149) and 67.7% vs. 64.7% (χ2= 0.090, p = 0.765) . In TP group, grade 3 or 4 digestive reaction was obviously more frequent than TL group, respectively 54.3% vs. 1.8%(p = 0.000). Neutropenia and thrombocytopenia are more common in TL group than TP group, respectively 48.3% vs. 30.6%(p = 0.0.048) and 44.8% vs. 1.6%(p = 0.000). Conclusions: For patients with severe digestive system reaction or contraindications of cisplatin, lobaplatin was might be used as an alternative drug. A prospective research is undergoing in our hospital. NACT may improve the prognosis of patients with large-scale mass. A undergoing prospective study protocol was approved by the Ethics Committee of hospital number 2017-02 and was registered in ClinicalTrial.gov as ChiCTR-IIR-17011559.

The influence of overall treatment time to the efficiency of chemo-radiotherapy for locally advanced cervical cancer

2017 ◽  
Vol 17 (1) ◽  
pp. 124-130
Author(s):  
Ekkasit Tharavichitkul ◽  
Panupat Rugpong ◽  
Nisa Chawapun ◽  
Razvan M. Galalae
Keyword(s):  
Cervical Cancer ◽  
Treatment Time ◽  
Locally Advanced ◽  
Disease Free Survival ◽  
Intracavitary Brachytherapy ◽  
Treatment Results ◽  
Overall Treatment Time ◽  
Free Survival ◽  
Significant Difference ◽  
The Mean

AbstractPurposeThis study aims to clarify the influence of overall treatment time (OTT) on the efficiency of combined chemo-radiotherapy in cervical cancer.Material and methodsThis retrospective study enrolled 122 cervical cancer patients who had squamous cell carcinoma and had undergone definitive chemo-radiotherapy from 2009 to 2013. All patients received whole pelvic radiotherapy (WPRT) with the dose of 50 Gy in 25 fractions (with central shielding after 44 Gy) plus intracavitary brachytherapy with the dose of 28 Gy in four fractions. During WPRT, all patients received concurrent chemotherapy with weekly platinum-based regimen. The data of patient characteristics, OTT, treatment results and toxicities were collected and evaluated.ResultsThe mean follow-up time was 36 months. The mean age of patients was 52 years old; 68% of patients were stage IIB related to International Federation of Gynaecology and Obstetrics staging. Pelvic control (PC), distant metastasis-free survival (DMFS), disease-free survival (DFS) and overall survival (OS) rates did not differ significantly in the data-derived cut points of 55·8 and 53 days. No statistically significant difference in treatment results between the two groups of OTT<49 and OTT≥62 days was observed.ConclusionsIn our data-derived cut point, OTT did not influence to PC, DMFS, DFS and OS. The influence of OTT on treatment results may be found in longer periods.

Long-Term Results of a Phase II Trial of Concomitant Cisplatin-Paclitaxel Chemoradiation in Locally Advanced Cervical Cancer

2016 ◽  
Vol 26 (6) ◽  
pp. 1162-1168 ◽  
Author(s):  
María Isabel Martínez-Fernández ◽  
Jairo Legaspi Folgueira ◽  
Germán Valtueña Peydró ◽  
Mauricio Cambeiro ◽  
Jaime Espinós ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Locally Advanced ◽  
High Dose Rate ◽  
External Beam Radiation Therapy ◽  
External Beam Radiation ◽  
Long Term Results ◽  
High Dose ◽  
External Beam ◽  
Beam Radiation

ObjectivesThe aim of this study was to determine the long-term results of a 7-week schedule of external beam radiation therapy, high dose rate brachytherapy, and weekly cisplatin and paclitaxel in patients with locally advanced carcinoma of the cervix.MethodsThirty-seven patients with International Federation of Gynecology and Obstetrics stages IB2 to IVa cervical cancer were treated with 40 mg/m2 per week of intravenous cisplatin and 50 mg/m2 per week of intravenous paclitaxel combined with 45 Gy of pelvic external beam radiation therapy and 28 to 30 Gy of high dose rate brachytherapy.ResultsSixteen patients (43.2%) were able to complete the 6 scheduled cycles of chemotherapy. The median number of weekly chemotherapy cycles administered was 5. Thirty-six (16.2%) of 222 cycles of chemotherapy were not given because of toxicity. The mean dose intensity of cisplatin was 29.6 mg/m2 per week (95% confidence interval, 27.0–32.1); that of paclitaxel was 40.0 mg/m2 per week (95% confidence interval, 36.9–43.1). Thirty-four patients (91.8%) completed the planned radiation course in less than 7 weeks. Median radiation treatment length was 43 days. After a median follow-up of 6 years, 7 patients (18.9%) experienced severe (RTOG grade 3 or higher) late toxicity. No fatal events were observed. Ten patients have failed, 1 locally and 9 at distant sites. The 14-year locoregional control rate was 96.7%, and the 14-year freedom from systemic failure rate was 64.6%. Fourteen-year actuarial disease-free survival and overall survival rates were 44.8% and 50%, respectively.ConclusionsThis study demonstrates excellent very long-term results and tolerable toxicity although the target weekly dosage of cisplatin and paclitaxel needs to be adjusted in the majority of the patients.

External Beam Radiation Therapy Plus High-Dose-Rate Brachytherapy in the Treatment of Locally Advanced Prostate

Brachytherapy ◽  
2016 ◽  
Vol 15 ◽  
pp. S184
Author(s):  
Ferran Guedea ◽  
Cristina Gutierrez ◽  
Anna Maria Boladeras ◽  
Luigina Santorsa ◽  
Ferrer Ferran ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Dose Rate ◽  
Locally Advanced ◽  
High Dose Rate ◽  
External Beam Radiation Therapy ◽  
External Beam Radiation ◽  
High Dose ◽  
External Beam ◽  
Beam Radiation ◽  
High Dose Rate Brachytherapy

Patterns-of-failure analysis of patients with high pretreatment prostate-specific antigen levels treated by radiation therapy: the need for improved systemic and locoregional treatment.

1996 ◽  
Vol 14 (4) ◽  
pp. 1093-1097 ◽  
Author(s):  
G E Hanks ◽  
A L Hanlon ◽  
G Hudes ◽  
W R Lee ◽  
W Suasin ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Prostate Specific Antigen ◽  
Metastatic Disease ◽  
Distant Metastasis ◽  
Specific Antigen ◽  
External Beam Radiation ◽  
High Dose ◽  
Patterns Of Failure ◽  
Beam Radiation ◽  
Significant Difference

PURPOSE The patterns of failure (local and/or regional v metastatic) have been determined for patients with prostate cancer and pretreatment prostate-specific antigen (PSA) levels > or = 20 ng/mL treated with radiation alone with the purpose to design appropriate multimodal treatments. MATERIALS AND METHODS One hundred twenty patients with pretreatment PSA levels > or = 20 ng/mL were treated with external-beam radiation alone between February 1988 and October 1993. They were arbitrarily divided by PSA levels, 20 to 29.9 ng/mL, 30 to 49.9 ng/mL, and > or = 50 ng/mL, and analyzed in terms of freedom from any failure (no evidence of biochemical disease [bNED], and PSA level < 1.5 ngm/mL and not increasing), as well as freedom from imaging evidence of distant metastasis (fdm). RESULTS There was no significant difference in short-term outcome by pretreatment PSA level, and thus all patients were pooled for analysis. At 4 years, 81% were fdm and 28% were free of any failure. This suggests that approximately 50% have recurred with local and/or regional disease or undetectable metastatic disease. Multivariate analysis indicated that low palpation stage and higher center of prostate dose were associated with better bNED survival. Multivariate analysis indicated that increasing stage and younger age are significantly associated with increasing distant metastasis. CONCLUSION Patients with pretreatment PSA levels > or = 20 ng/mL are not optimally treated by irradiation alone. The pattern of failure suggests improvement may come from systemic treatment of metastatic disease and high-dose radiation to improve locoregional disease. To evaluate this, we have begun a multimodal trial of chemohormonal therapy followed by extended-field irradiation.

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