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Low dose rate versus high dose rate brachytherapy for carcinoma cervix
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Low dose rate versus high dose rate brachytherapy for carcinoma cervix

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Carcinoma cervix is the second most commonly occuring cancer in India. …

Carcinoma cervix is the second most commonly occuring cancer in India.
Brachytherapy forms the most important part radiation therapy
Low dose rate Brachytherapy – Gold Standard
Experience more than a century

Published in: Health & Medicine

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  • 1. Low Dose Rate Versus High Dose Rate brachytherapy in Ca.Cervix
  • 2. Introduction • Carcinoma cervix is the second most commonly occuring cancer in India. • Brachytherapy forms the most important part radiation therapy
  • 3. • Low dose rate Brachytherapy – Gold Standard • Experience more than a century….
  • 4. HDR for Ca. Cerix ??
  • 5. Radiobiological advantages…..
  • 6. Repair The lower the dose rate of radiation a cell is exposed to, the greater the likelihood of repair. Late-reacting normal tissues seem more capable of repair than tumor The tumor is preferentially killed over normal tissue.
  • 7. Reoxygenation • Because of the duration of administration of LDR, acute hypoxia corrects within the tumor during treatment • Oxygen enhancement ratio is lower for LDR than for HDR.
  • 8. Reassortment During the overall treatment time of LDR, tumor cells may pass from the relatively radioresistant phases of late S and early G2 to the more radiosensitive phases of G2 and M
  • 9. Repopulation The continuous administration of LDR prevents repopulation during treatment.
  • 10. Biological equivalent dose • Calculated from LDR • a/b ratio… • Based on formulas !!!!
  • 11. Toxicity High dose / Fraction Increased Late complications
  • 12. HDR delivery Total Dose? Dose per fraction? Conversion? Schedule?
  • 13. Orton et al, Metaanalysis
  • 14. Optimisation???
  • 15. URETHRA RECTUM
  • 16. HDR for all cervix patients??
  • 17. Small tumor & good vaginal anatomy Vaginal anatomy – increase in complications Bulky central disease with high chance of central recurrance
  • 18. • Severely criticized • Lacks any description of statistical methods, • Were not randomized trials • Many have never been published, • None were referenced. • Some of the LDR results used in the comparison are very poor, with complication rates several times higher than those described by Fletcher or Perez
  • 19. What happens at longer follow up??
  • 20. DSS
  • 21. Pelvic recurrance free survival
  • 22. • Teshima et al ; 1993 • 430 patients reported on 10-year OS • 44% (114 out of 259) in the HDR arm versus 52.6% (90 out of 171) in the LDR arm
  • 23. Other studies…
  • 24. Other Factors…
  • 25. • Patient’s expense… • Source life… • Need for intense QA… • Setup up cost…
  • 26. Important Msgs… Radiobiology Dose, Fraction & Schedule Long term survival Optimisation
  • 27. Conclusion • Carcinoma cervix – Life threatening disease • For the price of convenience …, survival should never be compromised • LDR brachytherapy should be the standard of care in carcinoma cervix until long term efficacy of HDR is proven….

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