Concurrent chemotherapy with high-dose rate brachytherapy after treatment with chemoradiotherapy in cases of locally advanced carcinoma cervix: A study from rural area of Maharashtra, India
Vandana Shailendra Jain1, Mayuresh Virkar1, Mukund B Sarje1, Chaitali M Waghmare1, Sanandan Patel2, Shailendra Mohan Jain3
1 Department of Radiation Oncology, Rural Medical College, PIMS, Ahmednagar, Maharashtra, India
2 Department of Radiotherapy and Oncology, Rural Medical College, PIMS, Ahmednagar, Maharashtra, India
3 Department of Microbiology, Rural Medical College, PIMS, Ahmednagar, Maharashtra, India
Vandana Shailendra Jain,
Department of Radiation Oncology, Rural Medical College, PIMS, Loni, Ahmednagar - 413 736, Maharashtra
Source of Support: None, Conflict of Interest: None
Aim: This study aims to evaluate the efficacy, feasibility, tolerability, and toxicity of concurrent chemotherapy and brachytherapy for locally advanced cervical carcinoma.
Materials and Methods: Forty patients of cervical carcinoma were included in this study. The study period ranges from October 2016 to September 2019. Patients were evaluated and treated as per the protocol: external beam radiotherapy (50 Gy in 25 fractions) and concurrent weekly chemotherapy with injection (Inj.) cisplatin (30 mg/m2) followed by high-dose rate brachytherapy (3 fractions of 7 Gy each) and concurrent chemotherapy Inj. cisplatin (30 mg/m2).
Results: Out of 40 patients enrolled in the study, 36 patients completed the treatment (17 Stage II and 19 Stage III). The incidence of Grade I and II skin toxicities were 78% and 10%, respectively. The incidence of genitourinary toxicities with respect to Grade I and II were 72% and 12%, respectively. There were Grade III hematological toxicities in two patients and the brachytherapy treatment was delayed for 4–6 days. The overall complete response was found in 28 (78%) patients, partial response in six (16.7%) patients, and progressive disease in two (5.6%) patients at 3 months of follow-up. On the last follow-up, 21 (58%) patients were disease-free and there was disease failure in seven patients (5 local recurrence and 2 with distant metastasis).
Conclusion: Brachytherapy with the addition of concurrent chemotherapy is effective and feasible with acceptable toxicity for advanced stages of carcinoma cervix. This study upholds an interesting approach that can be regarded as feasible and tolerable for cervical cancer patients.