High Dose Rate Brachytherapy in Two 9 Gy Fractions in the Treatment of Locally Advanced Cervical Cancer - a South Indian Institutional Experience

Abstract

Background: Although 3D image based brachytherapy is currently the standard of treatment in cervical cancer, most of the centres in developing countries still practice orthogonal intracavitary brachytherapy due to financial constraints. The quest for optimum dose and fractionation schedule in high dose rate (HDR) intracavitary brachytherapy (ICBT) is still ongoing. While the American Brachytherapy Society recommends four to eight fractions of each less than 7.5 Gy, there are some studies demonstrating similar efficacy and comparable toxicity with higher doses per fraction. Objective: To assess the treatment efficacy and late complications of HDR ICBT with 9 Gy per fraction in two fractions. Materials and Methods: This is a prospective institutional study in Southern India carried on from 1 st June 2012 to 31 st July 2014. In this period, 76 patients of cervical cancer satisfying our inclusion criteria were treated with concurrent chemo-radiation following ICBT with 9 Gy per fraction in two fractions, five to seven days apart. Results: The median follow-up period in the study was 24 months (range 10.6 -31.2 months). The 2 year actuarial local control rate, disease-free survival and overall survival were 88.1%, 84.2% and 81.8% respectively. Although 38.2% patients suffered from late toxicity, only 3 patients had grade III late toxicity. Conclusions: In our experience, HDR brachytherapy with 9 Gy per fraction in two fractions is an effective dose fractionation for the treatment of cervical cancer with acceptable toxicity.

Comparison of two high dose rate Intracavitary brachytherapy regimens in treatment of cervical cancer

“…Various Studies have been done comparing toxicities with higher dose per fraction of BT. patients treated with ICR with a higher dose per fraction [22]. Majority of the toxicities occurred during the course of radiation therapy.…”

Comparison of two high dose rate intracavitary brachytherapy regimens in treatment of cervical cancer: a preliminary report

“…Longer overall treatment time (> 56–60 days) have been linked to a greater probability of recurrence [ 16 , 21 ]. The overall treatment duration was 68 days in Arm A and 59 days in Arm B in our trial.…”

Elimination of cervical cancer as a public health problem—how shorter brachytherapy could make a difference during COVID-19

“…In view of the limited infrastructure, shortage of trained staff and patient convenience, there has always been a compelling need to implement clinically feasible shorter fractionation schedules for HDR brachytherapy. As the shortest fractionation schedule, the 9 Gy × 2 regimen has, therefore, gained particular popularity in these regions, and numerous studies have demonstrated the safety and efficacy of this regimen [9][10][11]. In this context, it is noteworthy that many brachytherapy facilities in LMICs lack facilities for interstitial needle placement, solely depending on the use of intracavitary applications.…”

“…Owing to the greater possibility of normal tissue sparing with advancements in technology, it has been possible to use larger fraction sizes, which allows earlier treatment completion [ 9 ]. In low resource regions, where patient turnover rates and treatment compliance are major issues, hypofractionation is widely employed for increasing patient turnover and treatment compliance with encouraging results [ 10 , 11 ].…”