Outcomes of single application and three fraction hybrid MR adaptive brachytherapy in Carcinoma Cervix—Early experience from an Indian cancer center

Abstract

AIM: Hybrid brachytherapy in Carcinoma Cervix provides excellent dosimetry and offers opportunity to complete treatment in shorter fractions. There is very limited data on single insertion three fraction hybrid MR adaptive brachytherapy for Cervical Cancer. The purpose of this study was to analyze the local control and toxicities in patients treated with this approach. MATERIALS AND METHODS: Carcinoma Cervix patients treated with single application MR hybrid brachytherapy were included. Patients underwent brachytherapy over 3 fractions delivered minimum 6 h apart. A CT scan was performed before 2nd and 3rd fractions to exclude displacement of the applicator and recalculate doses to the OARs. RESULTS: A total of 20 patients were analyzed. The MR compatible hybrid applicator was inserted once along with interstitial needles (median −5). Thirteen patients received 8Gyx3 and 7 patients received 7Gyx3 fractions over 2 days. The mean OTT was 50 days. The mean HRCTV volume was 33.7cc ± 18.3cc. The mean dose to D90 HRCTV was 88 Gy ± 4.6 Gy. The mean bladder, rectum and sigmoid D2cc doses were 74.2 Gy ± 5.6 Gy, 62.1 Gy ± 6.4 Gy and 63.1 Gy ± 6.4 Gy respectively. At a median follow-up of 20 months (6–24 months), the local control was 95%. Two patients developed Grade 2 rectal toxicity. No patients reported any Grade 3 or above toxicity. CONCLUSION: Single application three fraction hybrid brachytherapy in Carcinoma Cervix is feasible with excellent local control rates and minimal toxicities. This approach helps reduce OTT and travel constraints for patients coming from distance.