A Comparative Study between Two Different Fractionation of High Dose Rate Brachytherapy in Locally Advanced Carcinoma of Uterine Cervix after Pelvic Concurrent Chemoradiotherapy

Abstract

Background: Uterine cervical cancer is the commonest form of gynecologic malignancy in Bangladesh. In locally advanced cases radiotherapy with a combination of external beam radiotherapy (EBRT) with concurrent chemotherapy and intracavitary brachytherapy (ICRT) is the mainstay of treatment. The aim of this study is to compare the treatment outcome and acute complications following treatment with 9 Gy (gray) in two fractions of ICRT with EBRT. Methodology: A prospective study was carried out in the Department of Oncology, Bangabandhu Sheikh Mujib Medical University, Department of Radiation Oncology, National Institute of Cancer Research and Hospital, Dhaka during the period of 2017 to 2018. Results: The mean age of patient at diagnosis was 50 years. During follow up at 6 month after completion of treatment, complete remission was 90% and 86% respectively for arm A and arm B. The overall complete response was 88%. The common toxicities associated with treatment were bladder and rectal toxicities, skin reaction and hematologic complications which were managed conservatively. During follow up after 6 months, rectal and bladder toxicities were similar in both arms. Conclusion: This study showed that a total dose  of 18 Gy ICRT in two fractions of 9 Gy over 2 weeks  is equally effective in short term local control with acceptable toxicities in comparison with a total dose of 21 Gy in three fractions of 7 Gy ICRT.