title: Comparison Between Concurrent EBRT and ICA with Conventional EBRT Followed by ICA in Cervical Cancer.
abstract: BACKGROUND
  In carcinoma of cervix, if overall treatment time (OTT) is prolonged beyond 6 weeks, then the total dose required to achieve a given probability of tumor control is to be increased by 0.6 Gy for each day of prolongation, to control the accelerative repopulation of the cells, i.e., 1 % loss of tumor control, and to avoid increased treatment delays and drop outs due to the prolonged gap between EBRT and intracavitary brachytherapy (ICBT).
  
  
  OBJECTIVE
  To evaluate local disease control and early complications of concomitant HDR-ICBT with EBRT and thereby decrease the OTT in I B-III B stage carcinoma cervix.
  
  
  METHODS
  Fifty patients of carcinoma cervix (FIGO-I B/III B) were randomly divided into two groups: the study group treated with concomitant EBRT and HDR-ICBT (EBRT = 50-50.4 Gy/25-28 Fr, HDR 7 Gy in 3 Fr during the 3rd, 4th, and 5th weeks), EBRT and weekly cisplatin were not given on the day of HDR-ICBT; and the control group treated with EBRT followed by HDR-ICBT and weekly cisplatin. Acute reactions and local disease response were compared after treatment and at 6-month follow-up.
  
  
  RESULTS
  Medians of OTTs were 42 and 63 days in the study and the control groups, respectively. Dysuria and diarrhoea incidences were more in the study but manageable. At the completion of the treatment, there were 92 and 80 % complete responses; 4 and 4 % partial responses; and 4 and 16 % stable diseases in the study group and the control group, respectively. DFSs (disease free survivals) at 6-month follow-up were, respectively, 96 and 84 %, and most of the stable diseases were observed in stage III B.
  
  
  CONCLUSIONS
  Response was better in the study group but statistically insignificant, acute reactions were manageable, and there was decrease in drop outs due to completion of treatment at a stretch, but larger number of patients and longer follow-up are required to arrive at concrete conclusions.
authors.affiliation: NTR University of Health Sciences, Vijayawada, Andhra Pradesh India ; Mnjio & Regional Cancer Center, Room No-9, Paying Rooms, Bazar Ghat, Red Hills, Hyderabad, India.
authors.forename: M
authors.initials: M
authors.lastname: Pandu Ranga Kumari
authors.affiliation: NTR University of Health Sciences, Vijayawada, Andhra Pradesh India.
authors.forename: B
authors.initials: B
authors.lastname: Nagarjun Reddy
authors.affiliation: NTR University of Health Sciences, Vijayawada, Andhra Pradesh India.
authors.forename: C
authors.initials: C
authors.lastname: Sanjeeva Kumari
authors.affiliation: NTR University of Health Sciences, Vijayawada, Andhra Pradesh India.
authors.forename: M
authors.initials: M
authors.lastname: Rama Krishna
keywords: Cervical cancer; Concurrent EBRT and HDR; Decreasing OTT; Early reactions; Local response; Preventing drop outs