Comparison Between Concurrent EBRT and ICA with Conventional EBRT Followed by ICA in Cervical Cancer

Abstract

Introduction: In carcinoma of cervix, if overall treatment time (OTT) is prolonged beyond 6 weeks, then the total dose required to achieve a given probability of tumor control is to be increased by 0.6 Gy for each day of prolongation, to control the accelerative repopulation of the cells, i.e., 1 % loss of tumor control, and to avoid increased treatment delays and drop outs due to the prolonged gap between EBRT and intracavitary brachytherapy (ICBT). Objectives: To evaluate local disease control and early complications of concomitant HDR-ICBT with EBRT and thereby decrease the OTT in I B–III B stage carcinoma cervix. Methods: Fifty patients of carcinoma cervix (FIGO-I B/III B) were randomly divided into two groups: the study group treated with concomitant EBRT and HDR-ICBT (EBRT = 50–50.4 Gy/25–28 Fr, HDR 7 Gy in 3 Fr during the 3rd, 4th, and 5th weeks), EBRT and weekly cisplatin were not given on the day of HDR-ICBT; and the control group treated with EBRT followed by HDR-ICBT and weekly cisplatin. Acute reactions and local disease response were compared after treatment and at 6-month follow-up. Results: Medians of OTTs were 42 and 63 days in the study and the control groups, respectively. Dysuria and diarrhoea incidences were more in the study but manageable. At the completion of the treatment, there were 92 and 80 % complete responses; 4 and 4 % partial responses; and 4 and 16 % stable diseases in the study group and the control group, respectively. DFSs (disease free survivals) at 6-month follow-up were, respectively, 96 and 84 %, and most of the stable diseases were observed in stage III B. Conclusions: Response was better in the study group but statistically insignificant, acute reactions were manageable, and there was decrease in drop outs due to completion of treatment at a stretch, but larger number of patients and longer follow-up are required to arrive at concrete conclusions.