Dosimetric Comparison between High Dose Rate Brachytherapy Boost and Volumetric Arc Therapy Boost in Locally Advanced Cancer Cervix

Concurrent chemoradiotherapy is considered the standard treatment for the locally advanced cancer cervix (LACC). Radiotherapy is commonly administered by a three-dimensional conformal radiotherapy (3DCRT) approach followed by brachytherapy (BT). High dose rate (HDR) BT is commonly administered; however, several drawbacks exist including invasive technique, pain, requirement of anesthesia, and operative risks. We assessed the dosimetric difference between the HDR BT and the volumetric modulated arc therapy (VMAT) boost in those patients. Ten patients were selected retrospectively with LACC and all received whole pelvis radiotherapy followed by BT boost of 7 Gy in three fractions. The computed tomography (CT) image was transferred to the Varian system for the VMAT plan while the one with the applicator was transferred to the Sagi planning system and the high-risk clinical target volume (HR-CTV), bladder, rectum, sigmoid, and small bowel were delineate with a margin of 5 mm were added to the CTV to create the planning target volume (PTV). The D90 for the PTV in VMAT boost was lower than received by the HR-CTV in the BT boost. Mean volume of the PTV was higher than that of the HR-CTV. The D2cc was higher in VMAT for bladder, sigmoid, and rectum while the D2cc for the small bowel in BT was higher compared with the VMAT. The VMAT is an option that exists for patients who refuse BT or cannot tolerate it, or in case of nonavailability of BT or a nonworking machine.

Acute toxicity profile of three-dimensional conformal concurrent chemoradiation in carcinoma cervix: an institutional experience

Background:Concurrent chemoradiation is the definitive treatment for advanced cervical cancer. Pelvic radiation is known to damage the adjacent normal tissues thereby causing acute toxicities. The modern conformal radiation techniques like three-dimensional conformal radiotherapy (3D-CRT) and intensity-modulated radiotherapy are known to reduce the toxicities and improve clinical outcomes.Aim:To retrospectively evaluate the frequency and severity of acute toxicities encountered during concurrent chemoradiation of locally advanced cancer cervix treated with 3D-CRT.Methods:The medical case records of 174 cervical cancer patients treated between November 2015 and November 2018 were studied. One hundred and thirteen histologically proven locally advanced cancer cervix patients (Stage IIB–IIIB) treated with concurrent 3D conformal chemoradiation between were included in the study. Patients received 46 Gy in 23 fractions with concurrent weekly cisplatin (40 mg/m2) on days 1, 8, 15 and 22 of radiation. The study endpoints were treatment-related toxicities which were graded according to CTCAE version 5.0.Results:One hundred and thirteen patients were analysed for the study. Gastrointestinal toxicity was the predominant toxicity observed followed by haematological toxicity. 31·7% patients reported grade 1–2 diarrhoea and 39·7% reported grade 1–2 leucopenia. None of the patients reported grade 3 or higher toxicities. Treatment interruptions were noted due to these toxicities.Conclusion:Concurrent chemoradiation is the definitive treatment for locally advanced carcinoma cervix with acceptable toxicities. Proper management measures should be undertaken for these toxicities to avoid treatment interruptions and ensure better treatment compliance.