Treatment of locally advanced carcinoma cervix with special emphasis on brachytherapy: A practice pattern survey among young radiation oncologist of India

Abstract

Background:Carcinoma cervix is one of the two most common cancers of Indian women with very high morbidity and mortality burden. Although India probably is the leading country in numbers patients of cervix treated radically with combination of teletherapy and brachytherapy (BT), there is presumed diversity of practice across the country due to the inequality of available infrastructure, absence of uniform the training of the radiation oncologists, and absence of any national guidelines. The present survey was conducted to determine current practice patterns in management of locally advanced carcinoma cervix with regard to gynecologic high-dose-rate among the radiation oncologist across the country.Methodology:A 25-item survey was undertaken to study the standard management pattern of Stage IIB–IIIB cervical cancer with special emphasis on the BT practice patterns among various young radiation oncologist working across the country. The survey was undertaken in person in the form of interview questionnaire among the younger members of association of radiation oncologist of India during two national conferences, along with telephonic interview of other members as obtained from the national directory.Results:About 57 young radiation oncologists from 57 centers across the country were surveyed. 25 of them represented private nonacademic centers, 24 represented government academic centers, the rest were from private academic, nongovernmental organization (NGO) run and other centers. The most common teletherapy dose prescribed was 46 Gy/23# for Stage II, and50 Gy/25 # for Stage III disease. HDR after loader with 192Ir is the most common machine (82.6%) in use and computed tomography scan is the most commonly (30/57) used imaging for planning. The most common intracavitary dose pattern for all stages was 7 Gy × 3 fractions (30/57s) and 9 Gy × 2 (12/57) fractions. Although in most centers, computed tomography-based delineation of organs at risk is done routinely; however, target volume delineation and dose prescription/optimization for the same is routinely done in handful of centers (5/57). The mean planned dose to Point A for combined external-beam radiation and BT (EQD210) was about 77.5 Gy for Stage IIIB and 72.6 Gy for Stage II disease.Conclusion:Although fractionation patterns may vary, the overall mean dose administered for cervical cancer is similar across the country, which is slightly lower than the recommended doses as per stage by various international guidelines.

Patterns of cervical cancer brachytherapy in India: results of an online survey supported by the Indian Brachytherapy Society

“…All the respondents reported a near uniform EBRT treatment protocol of 45-50 Gy followed by ICBT schedules most commonly prescribing 7 Gy × 3-4 fractions, mirroring earlier reported practice in India [21]. Also, the overwhelming majority reported using HDR brachyther- *indicates percentages may add up to more than 100, HDR -high-dose-rate, LDR -low-dose-rate, PDR -pulsed-dose-rate apy (97%), which is reflective of changing global practice [22] and > 90% completing the treatment within 56 days and 10% exceeding the overall treatment time (OTT).…”

Toxicity outcome of concurrent teletherapy and brachytherapy compared with teletherapy followed by brachytherapy in locally advanced carcinoma cervix

“…This was similar to the findings of another study, where majority of patients were from FIGO stage IIB. 10 However, globally majority of cancer cases present at more advanced stages, ranging from stage III to stage IV of FIGO staging. [11][12][13] The patients of both the groups completed their treatment as per protocol without any treatment delay or any interruption.…”

Dosimetric and clinical outcomes of CT based HRCTV delineation for HDR intracavitary brachytherapy in carcinoma cervix — a retrospective study

“…The requirement of CT guidelines has been addressed in various trials that have tried to establish a CT based guidelines for CTV contouring in the cervix [17][18][19]27]. The recommendations provided by JRSOG [26] used MRI scans at diagnosis and at brachytherapy to delineate cervical CTV. Those recommendations could not be taken in our study as the contouring was done retrospectively and MRI plates were not always available for reference.…”