The tolerance to chemoradiation for cervical cancer patients: A comparative prospective study of rural versus urban population.

Context: Rural versus urban cervical cancer. Aims: This study aims to study the difference in toxicities and clinical outcome of chemoradiation in urban and rural cervical cancer patient. Settings and Design: This was a prospective study. Subjects and Methods: In a double-arm prospective study, cervical cancer patients were treated with chemoradiation followed by brachytherapy. Patients were monitored weekly for hematological, gastrointestinal toxicities, and electrolyte imbalance. Acute toxicities and long-term outcome were compared between the two groups. Statistical Analysis Used: Kaplan-Meier survival curves for analysis of disease free and overall survival and Pearson's Chi-square test and Fisher's exact tests for analysis of toxicities were used. Results: Fifty-seven patients from urban and 114 from rural region were studied. There were no difference between the two groups as far as the patient characteristics, overall treatment time (OTT), hematological, electrolyte imbalance, local control, and disease-free survival between the two groups. Associated comorbidities were significantly higher (53% vs. 17%) with P < 0.0001 in urban population. Grade II and III enteritis were significantly higher 15.78% versus 21.05% (P = 0.00001) and 12.28% versus 11.40% (P = 0.03) in urban patients, respectively. Conclusions: Tolerance to chemoradiation, disease-free survival, and overall survival are similar in both urban and rural patients of cervical cancer, with more enteritis in urban group. However, this did not increase OTT.

Compliance with bladder protocol during concurrent chemoradiation for cancer of the cervix and its impact on enteritis: A prospective observational study.

AIM: This prospective study aims to assess the compliance with bladder protocol and the correlation with enteritis during pelvic radiation. BACKGROUND: Bladder protocol is routinely used for patients undergoing pelvic radiation to reduce radiation enteritis. It is very difficult to maintain constant volume especially in the last two weeks due to radiation enteritis and cystitis. MATERIALS AND METHODS: Histologically proven 35 cervical cancer patients treated with concurrent chemoradiation in a tertiary care center were the subjects of this prospective study. Following CT simulation and after every fraction, patients were asked to void urine in a calibrated urine container and the volume was documented. Patients were assessed for the highest grade of radiation enteritis weekly as per common toxicity criteria. The mean voided urine volume was correlated with the radiation enteritis. RESULTS: The mean urine volume at planning CT scan was 295.85 ± 300 ml (SD) with a range of 75-650. At the end of treatment, it was reduced to 233.14 ± 250 ml (range 50-400 ml), a reduction by 21% (p < 0.001). The maximum grade of enteritis was grade I (11%), II (11.4%), III (3-29%) in week 1,2 and 3-5, respectively with a p value of <0.001. A mean urine volume of 230 ml was associated with grade III enteritis in the third week. CONCLUSIONS: Urine output volume measured using a calibrated container is a simple, efficient and practical method to monitor bladder distension thereby reducing enteritis in cervical cancer patients treated with concurrent chemoradiation.

Implication of Bifurcation of Abdominal Aorta for Radiotherapy Planning for Cervical Cancers.

INTRODUCTION: External Beam Radiotherapy plays a major role in the management of Carcinoma Cervix. The Radiotherapy treatment portals are designed to adequately cover the gross disease and areas of microscopic spread. The upper border of Radiotherapy field is traditionally placed at the level of L4-L5 intervertebral space to cover the common iliac nodal area. It is determined based on anatomical and surgical series which have shown that division of Abdominal aorta occurs at that level. AIM: To study the level of the division of abdominal aorta in relation to the lumbar vertebral levels. To propose the change in the upper border of Radiotherapy portals used in the treatment of Cervical Cancers. MATERIALS AND METHODS: Patients who underwent Radiotherapy for Cervical Cancer from December 2010 to January 2012 formed the subjects of this prospective study. All the patients underwent aquaplast immobilization in supine position and contrast enhanced Computed Tomography (CT) simulation for Radiotherapy planning following bladder protocol. The Radiotherapy planning was done on commercial treatment planning system, Prowess version 4.71. The level of division of Abdominal Aorta into right and left Common Iliac arteries with respect to vertebral level was determined and studied. RESULTS: The division of abdominal aorta into common iliac arteries occurred at the level of L3-L4 intervertebral space, in front of body of L4 vertebra and L4-L5 intervertebral space in 53.84%, 30.76% and 15.40% of the patients respectively. CONCLUSION: The division of abdominal aorta occurs at a higher level than L4-L5 intervertebral space in majority of patients. It is highly recommended to use CT scan based planning. However, in institutes where there are no facilities for CT based planning, it is advisable to shift the upper border of Radiotherapy treatment portal above the L3-L4 intervertebral space for delivering adequate doses to the common iliac lymphnodes.