title: High Dose Rate Brachytherapy in Two 9 Gy Fractions in the Treatment of Locally Advanced Cervical Cancer - a South Indian Institutional Experience.
abstract: BACKGROUND
  Although 3D image based brachytherapy is currently the standard of treatment in cervical cancer, most of the centres in developing countries still practice orthogonal intracavitary brachytherapy due to financial constraints. The quest for optimum dose and fractionation schedule in high dose rate (HDR) intracavitary brachytherapy (ICBT) is still ongoing. While the American Brachytherapy Society recommends four to eight fractions of each less than 7.5 Gy, there are some studies demonstrating similar efficacy and comparable toxicity with higher doses per fraction.
  
  
  OBJECTIVE
  To assess the treatment efficacy and late complications of HDR ICBT with 9 Gy per fraction in two fractions.
  
  
  METHODS
  This is a prospective institutional study in Southern India carried on from 1st June 2012 to 31st July 2014. In this period, 76 patients of cervical cancer satisfying our inclusion criteria were treated with concurrent chemo-radiation following ICBT with 9 Gy per fraction in two fractions, five to seven days apart.
  
  
  RESULTS
  The median follow-up period in the study was 24 months (range 10.6 - 31.2 months). The 2 year actuarial local control rate, disease-free survival and overall survival were 88.1%, 84.2% and 81.8% respectively. Although 38.2% patients suffered from late toxicity, only 3 patients had grade III late toxicity.
  
  
  CONCLUSIONS
  In our experience, HDR brachytherapy with 9 Gy per fraction in two fractions is an effective dose fractionation for the treatment of cervical cancer with acceptable toxicity.
authors.affiliation: Department of Radiotherapy, GSL Cancer Hospital, GSL Medical College, Rajahmundry, India E-mail : drsaptarshi10@gmail.com.
authors.forename: Saptarshi
authors.initials: S
authors.lastname: Ghosh
authors.forename: Pamidimukkala Bramhananda
authors.initials: PB
authors.lastname: Rao
authors.forename: Sivasankar
authors.initials: S
authors.lastname: Kotne
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use; D001918:Brachytherapy / Q000009:adverse effects / Q000379:methods*; D059186:Chemoradiotherapy, Adjuvant; D002945:Cisplatin / Q000627:therapeutic use; D018572:Disease-Free Survival; D019583:Dose Fractionation, Radiation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007194:India; D008875:Middle Aged; D011446:Prospective Studies; D015996:Survival Rate; D002583:Uterine Cervical Neoplasms / Q000188:drug therapy / Q000532:radiotherapy*
chemical_list: D000970:Antineoplastic Agents; D002945:Cisplatin