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ORIGINAL ARTICLE
Year : 2017  |  Volume : 3  |  Issue : 1  |  Page : 12-16

Weekly versus biweekly high-dose rate brachytherapy schedules in carcinoma cervix following concomitant chemoradiation with paclitaxel and carboplatin


1 Department of Radiation Oncology, Andaman Nicobar Islands Institute of Medical Sciences, GB Pant Hospital, Port Blair, Andaman and Nicobar Islands, India
2 Department of Radiation Oncology, Pt. B. D. Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India

Correspondence Address:
Anil Kumar Dhull
Department of Radiation Oncology, Regional Cancer Centre, Pt. B. D. Sharma Post Graduate Institute of Medical Sciences, P.O. Box 100, GPO, Rohtak - 124 001, Haryana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ASJO.ASJO_111_16

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Context: In the management of cervical cancer, though a number of chemotherapeutic drugs have been used for concomitant chemoradiation, paclitaxel and carboplatin have shown improved overall response rates with acceptable side effects. The use of intracavitary irradiation significantly improves survival and reduces local failures. However, the ideal time-dose-fraction schedule remains controversial with high-dose rate (HDR) brachytherapy. Aims: The aim of this study was to determine the efficacy and safety of paclitaxel and carboplatin for concomitant chemoradiation therapy and to compare the local control, toxicity, and tolerability of the two HDR brachytherapy schedules in patients of carcinoma cervix. Subjects and Methods: The patients were divided randomly into two groups of thirty patients each. Both the groups were treated with a combination of external beam radiotherapy with 50 Gy/5 weeks/25 fractions to whole pelvis along with concomitant chemotherapy. The concomitant chemotherapy schedule was injection paclitaxel (135 mg/m2) and injection carboplatin (area under the curve - 4.5 mg min/ml) at 4-week interval followed by HDR brachytherapy. Following which, patients received HDR-intracranial brachytherapy on the basis of random allocation, Group I: 6 Gy × 3 fractions (weekly) and Group II: 5 Gy × 4 fractions (biweekly). Results and Conclusion: The survival difference between the two groups (weekly and biweekly) was not statistically significant. However, Grade 2–3 rectal reactions in Group I were significantly higher than Group II (P = 0.038). The twice-weekly schedule of brachytherapy was a significant factor influencing the late complication rate but not the local pelvic control rate or overall survival rate.


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