Impact of treatment breaks during radiation therapy in the survival of cervical cancer patients

Bharathi Srilatha, G (2018) Impact of treatment breaks during radiation therapy in the survival of cervical cancer patients. Masters thesis, Cancer Institute (WIA), Chennai.


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INTRODUCTION: Radiotherapy is a important modality in management of patients with cervical cancer. Discovery of X-rays by Wilhelm Conrad Roentgen on December 28, 1895, marked the dawn of radiation oncology. In 1902 X-rays were used to treat cervical cancer, which was the first documented evidence. In early years they had limited knowledge about the radiobiology and dose distribution in the tumour and surrounding normal tissue. Hence the dose was entirely empirical so complications and failures are common to achieve cure of a patient with any cancer, radiotherapy, must eradicate every stem cell associated with the tumour and also those that are generated during course of treatment. The larger the course of treatment more the stem cells can repopulate, increasing the number of stem cells that have to be killed. As overall treatment time increases the probability of local tumour control decreases. In cervical cancer Overall treatment time includes combined external beam radiation with or without chemotherapy and brachytherapy. Studies have shown that overall treatment time in carcinoma cervix should be as short as possible and should not exceed 56 days. Both surgery and radiotherapy can be offered as primary treatment in stage I-IIA disease as both treatment options showed similar cure rates in this population. Standard treatment for patients with more advanced disease is concurrent chemoradiation and external beam RT followed by brachytherapy. AIM OF THE STUDY: To study the impact of treatment breaks during radiation therapy in the survival of cervical cancer patients also study other factors associated with survival of cervical cancer patient. OBJECTIVES: 1. To assess the impact of treatment breaks during radiation therapy in the survival of cervical cancer patients. 2. To study the pattern of treatment break and association between overall treatment time and outcome in cervical cancer patients treated with external beam radiation with or without chemotherapy. 3. To study various factors that contribute to treatment breaks and management of treatment breaks. Study design: It is a retrospective survival study. Patients treated as case of carcinoma cervix International Federation of Gynaecology and Obstetrics Stage I-IV, who were treated with external beam radiation to pelvis with or without chemotherapy registered from 2010-2012 were studied. Patients age, weight, comorbidity, stage, treatment details and time trend are collected from the records. Statistical analysis: The data will be entered using Epi Data 3.0 and statistical analysis will be done using SPSS software.Survival analysis will be done by generating the Kaplan Meir survival curve. Cox propostional hazard model will be employed to estimate incidence of survival factors. Inclusion criteria: 1. Histologically proven carcinoma of the uterine cervix, treated with curative intent with initial EBRT of 45-50Gy using conventional/conformal technique, with or without concurrent chemotherapy followed by HDR ICA 2. No evidence of metastasis, in Chest x - ray, USG abdomen normal, no palpable lymphadenopathy. Exclusion criteria: 1. Metastatic disease, 2. Palliative intent, 3. Recurrent disease, 4. H/O Treatment for other malignancies. CONCLUSION: This analysis states: 1. Interruption during radiotherapy overall affect local tumour control and survival in all stages of cervical carcinoma. 2. Interrruption during radiotherapy for early stage cervical cancer can also affect local control. 3. Despite combining chemotherapy with radiation treatment interruptions during radiation can significantly affect local control. 4. Though there is a difference in local control between patients who had interruptions for less than or more than 10 days but still it has no major significance on survival and local control.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Impact ; treatment breaks ; radiation therapy ; survival of cervical cancer patients.
Subjects: MEDICAL > Radio Therapy
Depositing User: Subramani R
Date Deposited: 21 Jul 2018 17:09
Last Modified: 21 Jul 2018 17:09

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