ABSTRACT
PURPOSE: The purpose of this series is to study the effectiveness of MRI based image-guided brachytherapy (IGBT) in Indian patients with cervical cancer who mostly present in later stages with bulky diseases. PATIENTS AND METHODS: 151 cervical cancer patients treated at our institution in last four years, with definitive chemoradiation followed by MRI-based brachytherapy were reviewed. With median follow up of 26â¯months, Kaplan Meier estimates at two years were calculated for local control (LC), pelvic control (PC), disease-free survival (DFS) and overall survival (OS). Also, severe late sequelae were reported. RESULTS: The patients predominantly presented with locally advanced cervical cancer in FIGO stages IIB (53.6%) and IIIB (23.2%). Tumour dimensions at diagnosis were ≥5â¯cm in 56.3% and pelvic nodal involvement was found in 38.4% of the patients. 94% of the patients received curative chemoradiation. Mean HRCTV volume at the time of brachytherapy was 42.2⯱â¯19â¯cm3 and mean cumulative dose to HRCTV was 78.9⯱â¯5.6â¯Gy. Overall LC, PC, DFS and OS at 2â¯years were 88.7%, 88.1%, 82.2% and 94% respectively. The predictors for local failure were FIGO stage (pâ¯=â¯0.002) and tumour size at diagnosis (pâ¯=â¯0.009). Late grade 3-4 bladder and bowel toxicities were observed in 3.8% of the patients. CONCLUSION: Our review demonstrates that IGBT is an effective strategy to improve locoregional control with limited long-term sequelae in patients with locally advanced extensive cervical cancer in the setting of a developing country.
Subject(s)
Adenocarcinoma/therapy , Brachytherapy/methods , Carcinoma, Squamous Cell/therapy , Uterine Cervical Neoplasms/therapy , Adenocarcinoma/diagnostic imaging , Adenocarcinoma/secondary , Adult , Aged , Brachytherapy/adverse effects , Carcinoma, Squamous Cell/diagnostic imaging , Carcinoma, Squamous Cell/secondary , Chemoradiotherapy , Disease-Free Survival , Dose Fractionation, Radiation , Female , Follow-Up Studies , Humans , Magnetic Resonance Imaging , Middle Aged , Neoplasm Staging , Radiography, Interventional , Survival Rate , Tomography, X-Ray Computed , Tumor Burden , Uterine Cervical Neoplasms/diagnostic imaging , Uterine Cervical Neoplasms/pathologyABSTRACT
BACKGROUND: Purpose of the present study was to examine the response of cervical cancer cell line (HeLa cell line) to low dose radiation using clonogenic assay and mathematical modeling of the low dose response by Joiner's induced repair model. MATERIALS AND METHODS: Survival of HeLa cells following exposure to single and fractionated low doses of γ (gamma)-ray, 6 MV, and 15 MV photon was measured by clonogenic assay. RESULTS: HeLa cell line demonstrated marked low dose response consisting of an area of HRS and IRR in the dose region of <1 Gy. The two gradients of the low dose region (αs and αr) were distinctly different with a transition dose (Dc) of 0.28-0.40 cGy. CONCLUSION: HeLa cell line demonstrates marked HRS and IRR with distinct transition dose. This may form the biological basis of the clinical study to investigate the chemo potentiating effect of low dose radiation in cervical cancer.
