High Dose Rate Brachytherapy in Two 9 Gy Fractions in the Treatment of Locally Advanced Cervical Cancer - a South Indian Institutional Experience

  • Ghosh, Saptarshi (Department of Radiotherapy, GSL Cancer Hospital, GSL Medical College) ;
  • Rao, Pamidimukkala Bramhananda (Department of Radiotherapy, GSL Cancer Hospital, GSL Medical College) ;
  • Kotne, Sivasankar (Department of Radiotherapy, GSL Cancer Hospital, GSL Medical College)
  • Published : 2015.11.04


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. Materials and Methods: This is a prospective institutional study in Southern India carried on from $1^{st}$ June 2012 to $31^{st}$ 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.


High dose rate brachytherapy;two fractions;treatment efficacy;late toxicity;cervical cancer


  1. Cox JD, Stetz J, Pajak TF (1995). Toxicity criteria of the Radiation Therapy Oncology Group (RTOG) and the European Organization for Research and Treatment of Cancer (EORTC). Int J Radiat Oncol Biol Phys, 31, 1341-6.
  2. GLOBOCAN 2012: Estimated cancer incidence, mortality and prevalence worldwide in 2012, World Health Organization. Available from [last accessed on 4 November 2014].
  3. Hashim N, Jamalludin Z, Ung NM, et al (2014). CT based 3-dimensional treatment planning of intracavitary brachytherapy for cancer of the cervix: comparison between dose-volume histograms and ICRU point doses to the rectum and bladder. Asian Pac J Cancer Prev, 15, 5259-64.
  4. ICRU Report #38 (1985). Dose and volume specification for reporting intracavitary therapy in oncology. International Commission on Radiation Units and Measurements. Bethesda, MD:1.
  5. Kumaran A, Guruvare S, Sharan K, et al (2014). Chemoradiation related acute morbidity in carcinoma cervix and correlation with hematologic toxicity: a South Indian prospective study. Asian Pac J Cancer Prev, 15, 4483-6.
  6. Madan R, Pathy S, Subramani V, et al. (2014). Comparative evaluation of two-dimensional radiography and three dimensional computed tomography based dose-volume parameters for high-dose-rate intracavitary brachytherapy of cervical cancer: a prospective study. Asian Pac J Cancer Prev, 15, 4717-21.
  7. Nag S, Erickson B, Thomadsen B, Orton C, Demanes JD, Petereit D (2000). The American Brachytherapy Society recommendations for high-dose-rate brachytherapy for carcinoma of the cervix. Int J Radiat Oncol Biol Phys, 48, 201-11.
  8. Orton GC (1995). Width of the therapeutic window: What is the optimal dose-per-fraction for high dose rate cervix cancer brachytherapy? Int J Radiat Oncol Biol Phys, 31, 1011-3.
  9. Patel FD, Kumar P, Karunanidhi G, Sharma SC, Kapoor R (2011). Optimization of high-dose-rate intracavitary brachytherapy schedule in the treatment of carcinoma of the cervix. Brachytherapy, 2, 147-53.
  10. Patel FD, Rai B, Mallick I, Sharma SC (2005). High-dose-rate brachytherapy in uterine cervical carcinoma. Int J Radiat Oncol Biol Phys, 62, 125-30.
  11. Shruthi PS, Kalyani R, Kai LJ, et al (2014). Clinicopathological correlation of cervical carcinoma: a tertiary hospital based study. Asian Pac J Cancer Prev, 15, 1671-4.
  12. Sood BM, Gorla G, Gupta S, et al (2002). Two fractions of high-dose-rate brachytherapy in the management of cervix cancer: clinical experience with and without chemotherapy. Int J Radiat Oncol Biol Phys, 53, 702-6.