Concurrent External Beam Radiotherapy with High Dose Rate Brachytherapy in Carcinoma Cervix.

A quasi-experimental study, to evaluate the outcome of external beam radiotherapy with concurrent weekly high dose rate brachytherapy in management of carcinoma cervix. All the 60 patients completed the planned treatment and were available for the data analysis. The radiation dose of 5000 cGy to whole pelvis with midline shielding at 2000 cGy with 5 fractions of concurrent High dose rate brachytherapy, 7 Gy per fraction at weekends was found to be effective and safe schedule in the treatment of stage II carcinoma cervix. In view of the therapeutic ratio cumulative biological effective dose of 83.5 Gy10 point A is appropriate for stage II patients. Whereas for stage III it was observed that the radiation dose of 5000 cGy to whole pelvis with midline shielding at 4000 cGy with concurrent 3 fractions of high dose rate brachytherapy, 7 Gy per fraction at weekends is suboptimal as, only 78% of disease free survival could be achieved with 22% survival with disease at 6 months of follow up. The cumulative biological effective dose 83.7 Gy10 need to be increased by parametrial boosting to improve the therapeutic ratio. The cumulative biological effective dose at rectal point showed the rectal dose need to be kept below 110 Gy3 - 140 Gy3 to avoid late toxicities. Late toxicities for stage III is significantly higher than stage II at 0.05 level of probability. Median treatment duration was 44 days. The results might be improved by increasing the point \"A\"dose by boosting or by chemosensitization.