TMSS Medical College Journal

Introduction: A combination of external beam radiotherapy (EBRT) and intracavitary brachytherapy (ICBT) is well established as the standard radical radiotherapy (RT) for cervical cancer. But in our center there is brachytherapy machine but no source is available. Around 80% patients attending in our Department are poor and come from rural area. These patients can not able to go to our capital city Dhaka for brachytherapy due to their poverty which is 220km in distance. For these patients, we initiated EBRT alone with 3-dimensional conformal radiotherapy (3DCRT). The purpose of this study is to evaluate the radiation toxicity and tumor response with EBRT alone without ICBT for patients with cervical cancer. Methods: Between June 2015 to December 2015, 8 patients with cervical cancer were treated with a high dose 3-dimensional conformal boost (3DCB). There were four in stage IIA, three in stage IIB and one in stage IIIB. Total dose of EBRT was 65-70 Gy in conventional fractionation (CF). They received whole pelvis RT with a median dose of 50 Gy (range 45-50 Gy) and midline shielding done at 40 Gy. Then a boost of 20-25 Gy to central tumor was given after a gap of two weeks. Results: 7 patients achieved complete response (CP) 87.5% and one patient had a partial response (PR) 12.5%. Therefore the response rate (CP + PR) was 100%. All patients tolerated the dose well without any severe adverse effects. However, acute toxicity of mild dysuria was seen in two patients and one patient suffered from mild diarrhoea. Conclusions: The use of the high dose 3DCB in the treatment of the cervical cancer is safe and feasible where ICRT is unable to perform. Escalation of 3DCB dose and assessment of late effect is currently under evaluation.

A combination of external beam radiotherapy (EBRT) and intracavitary brachytherapy (ICBT) is well established as the standard radical radiotherapy (RT) for cervical cancer. The use of ICBT was a factor significantly associated with decreased local failure according to results of a pattern of care study [1-3], and traditionally, it is known that a cure is rarely achieved without a high dose of radiation delivered by ICBT. However, in the actual clinical setting it is sometimes necessary to perform EBRT alone for patients where ICBT is not feasible due to a failure to insert a tandem, a narrow vagina, relapse at the cervical stump, or the refusal of the patient. For these medical condition some Radiotherapy Center practice EBRT alone for the treatment of cervical cancer where brachytherapy can not perform [4]. Study carried out by Kanji Matsuura et al. [5]. For these patients, from 2002 initiated EBRT alone with 3-dimensional conformal radiotherapy (3DCRT) in order to improve LC. Their radiotherapy treatment modality was EBRT alone with the concomitant boost (CCB). The observation was that the 3-year overall survival (OAS) and local control (LC) rates were 43.8% and 75.0%, respectively. No severe acute and late adverse effects were encountered for any of the patients. These results suggested that 3DCRT with the CCB program is a feasible treatment modality. Our Radiotherapy Department is at Shaheed Ziaur Rahman Medical Collage Hospital, in Bogra town, which is 220Km away at north side from the capital city Dhaka. We have brachytherapy machine but unfortunately source is not available from the begining. More than 80% cancer patients attending in our Department are from rural area and their economic status are poor. These patients can not go to our capital city Dhaka for brachytherapy due to their lower financial condition. For these patients, we have initiated EBRT alone with three-dimensional conformal radiotherapy (3DCRT) in order to improve local control (LC).