External beam radiotherapy and intracavitary brachytherapy is an acceptable treatment for locally advanced carcinoma of the uterine cervix

Abstract

Background: Cervical carcinoma is the second most common neoplasm in women worldwide and is the most frequent cancer among women in Bangladesh. In recent years, High Dose Rate (HDR) brachytherapy in combination with External Beam Radiotherapy (EBRT) has been popular in the management of cancers of uterine cervix.

Objectives: To evaluate the effectiveness and acute toxicity of four fractions high dose rate intracavitary brachytherapy following pelvic external beam radiotherapy in the treatment of locally advanced cervical carcinoma.

Methods: Bangabandhu Sheikh Mujib Medi­cal University & NICRH chosen as a research place for EBRT and HOR brachytherapy. A typical radiotherapy treatment involves daily inadiation for several weeks. Whole pelvis was treated with total dose of SO Gy in 5 weeks. Patients were treated once a day, 5 days a week with a daily fraction size of 2.0 Gy. EBRT: Pelvic radiotherapy dose is 50 Gy in 25 fractions (2.0 Gy per fraction) over 5 weeks. HDR brachytberapy dose is 7 Gy per fraction, total 4 fractions, each in a week over 4 weeks.

Results: Ninety-eight patients were entered in the study. Three patients were excluded due to active non-malignant diseases. One patient had active tuberculosis, two patients had severe skin reactions and two patients withdrew following the first HDR application. The remaining Ninety patients were analyzed. Ninety patients completed the prescribed treatment and were evaluated. Eighty had complete response with relief of symptoms, negative Pap-smear and no clinical signs of persistence disease at 3 months. Ten patients had a positive Pap-smear with clinical signs of persis­tence disease. Patients were evaluated before statting treatment with EBRT and before starting treatment with HDR ICBT.

Conclusion: It can be easily concluded that 4 fractions of HDR ICBT, 7 Gy each weekly and pelvic EBRT can effectively and safely control locally advanced carcinoma of the uterine cervix. So that EBRT and HDR ICBT is an acceptable treatment for locally advanced carcinoma of the uterine cervix. Careful attention to normal tissue doses such as the rectum, bladder, and small bowel is important in the treatment of locally advanced cervical cancer.