Background: Concurrent chemoradiation with weekly cisplatin is the treatment of choice in a case of carcinoma cervix. Prolonging treatment time is detrimental to disease control. When brachytherapy is scheduled during external beam radiation therapy (EBRT), treatment time can be shortened signicantly thereby improving local control. As the delivery of radiation with brachytherapy is uniform and spares normal tissues it reduces the acute toxicities. In this study, we aimed to study the acute toxicities associated with this unique scheduling of brachytherapy along with EBRT. Fifty patients with carcinoma cervix between stage IIA to IIIB treated at our institution with chemo-Methods: radiation were included in the study. Concurrent chemotherapy was delivered using weekly cisplatin (40mg/m2) for 5 cycles. EBRT was delivered using four eld box technique. HDR brachytherapy was introduced after 3rd week of EBRT. Brachytherapy was delivered in 3 fractions each 8.5Gy at the end of the 3rd, 4th, and 5th week. Acute RTOG toxicities were assessed during the treatment and one week post treatment. The median age of the study population is 45 years. Eighty four percent ofResults: patients received 4 or more cycles of concurrent chemotherapy, whereas 16% of patients received only 3 cycles of concurrent chemotherapy. Most common toxicity observed in the current study population is diarrhea followed by vomiting. Most toxicities are of RTOG grade 0 or 1 and none of the patients developed grade 4 toxicity. Only two patients developed grade 3 diarrhea and one patient developed grade 3 neutropenia. Integrating brachytherapy schedule along with EBRT decreasesConclusion: overall treatment time with an acceptable acute toxicity prole.

IntroductionThis study aimed to measure cervical regression during external beam radiation therapy (EBRT) and optimize the scheduling of brachytherapy concurrently with EBRT.MethodsFifty consecutive patients with carcinoma of the cervix stage IIA to IIIB received concurrent chemoradiotherapy with weekly Cisplatin 40 mg/m2. Cervical regression was evaluated using serial CT scans obtained before and during concurrent chemoradiotherapy (on the third, fourth, and fifth weeks). High dose rate brachytherapy was introduced after 30Gy of EBRT. A total of 25.5Gy in three fractions were delivered during the third, fourth, and fifth weeks of EBRT. Cervical volumes were recorded from the CT scan for cervical regression.ResultsThe mean cervical volume at baseline (i.e., before the start of treatment) was 85.53 cubic centimetres (cc). The mean cervical volumes at the end of the third, fourth, and fifth week were 28.95cc, 24.92cc, and 21.80cc, respectively. The mean cervical regression from baseline to the end of the third, fourth, and fifth week was 60%, 65%, and 69%, respectively. The time for 50% cervical regression was calculated to be 18 days and occurred around 27Gy of EBRT.ConclusionMore than 50% of cervical regressions occur at the end of the third week (i.e., after delivery of 30Gy of EBRT), so it is optimal to introduce brachytherapy at the end of the third week. A conventional point-based plan can cover the high-risk clinical target volume (HRCTV) if the volume is <25cc, but an HRCTV >25cc may be well covered with optimization or a combination of intracavitary and interstitial brachytherapy.