Purpose: Dosimetric analysis and effect of different definitions of prescription point “A” to OAR in high dose rate brachytherapy for cervical cancer. Methods and Materials: This retrospective comparative dosimetric study is based on the data of 25 patients with histologically proven cervical carcinoma treated with HDR (high-dose-rate) brachytherapy. Patients received 21 Gy in three fractions (7.0 Gy X three fractions) to point A (AMAN, revised Manchester definition). Further, the patients were replanned with the new point A (AABS) as per the American Brachytherapy Society/ICRU 89 which is defined on CT images. The data compiled was then compared with the data observed from point A (AMAN). Results: When AMAN normalization method was used, the mean dose to the bladder at 0.1cc, 1cc, 2cc and 5cc obtained was 1121.2±54.5, 1058.7±44.1, 875.0±38.6, 780.5±35.9, and 641.2±29.5 cGy respectively. Likewise, using the ICRU-89 point A (ABS) normalization method, the mean dose to 0.1 cc, 0.2 cc, 1 cc, 2 cc, and 5cc bladder volumes was 1178±156.1,1110.0±130.8, 921.6±111.4, 826.6±101.32, and 673.3±80.9 cGy, respectively. For the rectum, point A (MAN) normalization plans, the mean dose of 0.1 cc, 0.2 cc,1 cc, 2 cc, and 5cc rectum volumes was 680±143.5, 652.53±129.8,574.25±131.1, 530±126.9, and 452.5±121.2cGy, respectively. Likewise, using the A (ABS) plan, the mean dose of 0.1 cc, 0.2cc, 1 cc, 2 cc, and 5cc rectum volume was 707.5±148.1, 678.7±128.7, 596.2±135.6, 551.25±127.44 and 471.25±122.64 cGy respectively. The statistical mean difference of Total Reference Air Kerma rate, V100 (cc), bladder, and rectum, was found significant. Conclusion: The present study attempts to analyze the differences in rectum and bladder dose, as well as the size of the volume enclosed for prescribed Isodose curve following ICRU 38 and ABS-ICRU 89 recommendations about intracavitary cervix cancer treated with brachytherapy. With Manchester system being more static, i.e., lesser variation with geometric changes, it is preferable in comparison to ABS system.
Purpose of study : To compare the treatment outcomes in patients with brain metastasis treated with two different fractionation schedules of whole brain radiotherapy. A prospective randomised study was carried out on newly diagnosed cancer patients with MRIMaterials and methods: diagnosis of brain metastasis. Patients with multiple bm with Eastern Cooperative Oncology Group performance status 0-4 were included. In Arm A, patients received whole brain radiotherapy (WBRT) of total dose 30 GY , 3Gy/fraction/10# over 2 weeks ,whereas , in Arm-B patients received total dose of 20 GY in 4Gy/fraction/5# over 1 week. Assessment of improvement in clinical symptoms was done using BARTHEL'S ADJUSTED DAILY LIVE (ADL)14 Score before treatment, just after treatment and 6 week of treatment and improvement was analysed. At three months follow up , radiological response was carried out by MRI scan of brain. Acute toxicities were assessed during treatment and follow up ( up to 90 days post EBRT ) using clinical status, laboratory investigations and radiological test and graded according to RTOG/EORTC criteria. Results: Signicant improvement in terms of ADL score was observed in both arms , however when both arms were compared , no signicant difference was found out. There was no statistically signicant difference in response or morbidity between the two treatment arms. In theConclusions: palliative setting short duration of treatment with minimum discomfort to the patient is desirable. 20 Gy in 5 fractions is equally effective as 30 Gy in 10 fractions, with slight advantage in terms of toxicity. Thus 20 Gy in 5 fractions can be preferred in brain metastasis patients, especially those with poor performance status.
Purpose of study: To evaluate the efficacy and safety of oral pilocarpine concomitantly with radiation treatment for the prevention of radiation induced xerostomia in Head and Neck cancer patients. Material and methods: A prospective randomized study was carried out on 60 histopathological proven squamous cell cancer patients of Head and neck region. All patients received a total radiation dose of 66Gy /33 fraction/6.2 weeks (2Gy/fraction, 5 days/ week) on Telecobalt machine with or without concurrent chemotherapy. The concurrent chemotherapy eligible patients received, weekly chemotherapy courses using cisplatin 30 mg/m2. Patients in the study group received oral pilocarpine 5.0 mg three times a day starting 3 days prior to start of radiotherapy and continued for 3 months post radiotherapy. Patients were evaluated on subjective basis based on Zimmerman Questionnaire and EORTC QLQ HN 35. The statistical analysis was done by Paired sample T test. Results: The average Zimmerman Xerostomia score for all parameters combined was as follows: First assessment -100mm vs 100mm; Second assessment -50mm vs 45mm; Third assessment -59mm vs 52mm; Fourth assessment -64mm vs 57mm, Fifth assessment -71mm vs 68. As per QLQ-HN 35 questionnaire used for assessment of quality of life of patients in both groups, we observed that better scores were obtained in the pilocarpine group in comparison to control group. Conclusion: In the present study, the effectiveness of Pilocarpine given during and 3 months post radiotherapy was observed in terms of better compliance during radiation treatment. Most of the patients had less subjective symptoms with lesser grades of toxicities observed during various phases of assessment post RT.
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