Dosimetric Evaluation of Bladder and Rectal Radiation Dose in Carcinoma Cervix patients using Orthogonal Radiographs and CT Planning in HDR Brachytherapy

Madhumathi, S (2010) Dosimetric Evaluation of Bladder and Rectal Radiation Dose in Carcinoma Cervix patients using Orthogonal Radiographs and CT Planning in HDR Brachytherapy. Masters thesis, Madras Medical College, Chennai.


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INTRODUCTION: Carcinoma of the uterine cervix is the second most common cancer among global women and the first most common cancer in Indian women. The main stay of treatment in locally advanced inoperable carcinoma Cervix is combination of external beam radiotherapy (EBRT) and intracavitary brachytherapy ICBT. Brachytherapy forms an integral part and cornerstone of radiation therapy for both the local control rates and toxicities. Intracavitary brachytherapy has a high therapeutic index by delivering a high dose to the primary cervical lesion and lower dosed to critical structures namely, bladder, rectum resulting in increased local control and survival without increase in toxicity. However, the dose deliver to critical structures are difficult to quantify accurately. AIM AND OBJECTIVE OF THE STUDY: To compare bladder and rectal radiation dose between based dosimetry and CT based dosimetry. MATERIALS AND METHODS: STUDY PERIOD : From June 2010 to August 2010. STUDY DESIGN : Comparative descriptive study. CASE SELECTION : Biopsy proven squamous cell Carcinoma cervix cases of stage IIB – IIIB who had completed EBRT and slated for HDR brachytherapy. NUMBER OF PATIENTS: 30 INCLUSION CRITERIA: 1. All eligible biopsy proven squamous cell carcinoma cervix patients, who had completed EBRT and slated for HDR Brachytherapy. 2. Stage II B – III B where HDR is contemplated. 3. Age: 30 - 60 years. 4. Performance Status: ECOG 0-1 histological proof from primary lesion. 5. Informed consent to be taken. 6. Patient should be fit for anesthesia. EXCLUSION CRITERIA: 1.Age > 60 years. 2. ECOG more than 2. 3. Patients not fit for anesthesia. 4. Patients with stage IV disease. 5. Histology other than squamous cell carcinoma. 6. History of prior radiotherapy / chemotherapy to Ca cervix. CONCLUSION: Radiotherapy is an effective treatment modality for carcinoma cervix. HDR brachytherapy is incorporated along with EBRT in the treatment protocols. Our study suggested that maximum bladder and rectal 3D values were 1.69 and 1.36 times greater than the ICRU reference bladder and rectal doses respectively. Bladder - D2 /dose to ICRU reference point Ratio - 1.69 (p < 0.001 Statistically significant). Rectum - D2 /dose to ICRU reference point Ratio - 1.36 (p < 0.001 Statistically significant). 2D underestimates bladder dose. 2D underestimates the rectal dose. 3D - Image based brachytherapy is the standard of care for locally advanced CA cervix patients in western countries. However, image based brachytherapy, is not widely used in developing countries in routine clinical practice due to various limitations. Further, incorporation of newer imaging modalities, refinements in applicators and planning systems and wider acceptability of conformal brachytherapy may revolutionize brachytherapy practices in carcinoma cervix in Government setups in developing countries.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Dosimetric Evaluation, Bladder and Rectal Radiation Dose, Carcinoma Cervix patients, Orthogonal Radiographs, CT Planning, HDR Brachytherapy.
Subjects: MEDICAL > Radio Therapy
Depositing User: Subramani R
Date Deposited: 23 Mar 2020 15:50
Last Modified: 23 Mar 2020 15:50

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