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Prospective randomised study comparing three-fraction regimens of High Dose Rate Brachytherapy for cancer of the cervix stage IIB and IIIB

Wondemagegnhu Tigeneh, Jeffry Kotzen, Bernard Donde

Abstract


AIM Limiting the number of high-dose-rate brachytherapy (HDR-BT) applications from 4 or 3 to 2 fractions has the potential benefit of improving patient compliance. Two HDR-BT applications of  9 Gy each is most cost effective and resource sparing compared to 3 or 4 insertions. The aim of this study was to compare the treatment results and incidence of bladder and rectal complications following radical treatment of carcinoma of cervix with 2, 3 or 4 fractions of (HDR-BT) and standard external beam radiotherapy (EBRT).

METHODS Sixty-six patients with biopsy proven stage IIB and stage IIIB cancer of the cervix received EBRT 50 Gy in 25 fractions  and concomitant Cisplatin 80 mg/monce every 3 weeks. The patients were then randomized into one of three-fractionation arms of HDR-BT: (I) 6.5 Gy ´ 4; (II) 8 Gy ´ 3; and (III) 9 Gy ´ 2. The biologic effective dose (BED) to organs at risk was used to assess the complication rates of treatment. Patients were evaluated using SOMA/LENT (subjective, objective, management and analytic/ late effects in normal tissues) scales during treatment, at 6 weeks and finally at 6 months. Pap-smears were performed at 6 months to assess local control.

RESULTS Fifty-nine patients completed chemo-radiotherapy and attended follow up for evaluations at 6 weeks and 6 months. The mean age of the patients was 51.6 years and the mean duration of the treatment was 47.2 days. Of the 59 patients who completed treatment and had six months follow up, 29 patients were stage IIB and 30 were stage IIIB. The overall complete response rate for the whole group was 88%. The response rate was 90% in arm I,   85.7% in arm II, and 88.8 in arm III, which was not statistically significant (p=0.463). The influence of the following prognostic factors on local control was not statistically significant: stage (IIB vs. IIIB) (p=0.995), age above and below 50 years (p=0.532), treatment duration (p=0.6508), and number of fields used (p=0.603). The adverse effects of radiation-induced toxicity depended on age group (p=0.01), number of fields (p=0.001), and BED Gy3 to organs at risk and were statistically significant (p=0.001). The rectal, grade 3 and 4 radiation induced toxicity were observed to be increased when the BED Gy3 dose was above 105 Gy3.  Similarly, bladder grade 3 & 4 toxicity rate were increased with BED Gy3 dose of 120 Gy3 (p=0.001)

CONCLUSION This study showed that 9 Gy ´ 2 fractionations HDR-BT with concomitant chemo-radiotherapy was equally effective in short term local control and had similar incidence of treatment related complications compared to 6.5 Gy ´ 4 and 8 Gy ´ 3 regimens during 6 months of follow up.


Keywords


Cancer of cervix; Implant radiotherapy; Brachytherapy; Dose fractionation; Radiotherapy

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میز اداری صندلی مدیریتی صندلی اداری تبلیغات کلیکی میز تلویزیون پاراگلایدر آگهی رایگان محسن چاوشی مسیح و آرش آهنگ جدید دانلود آهنگ جدید خرید اینترنتی عکس بازیگران اطفار عکس بازیگران