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171 Dynamic dose fractionation of HDR-brachytherapy at preoperative irradiation of cervical cancer patients
  1. V Sukhin,
  2. H Hranovska,
  3. O Sukhina and
  4. K Nemaltsova
  1. Grigoriev Institute for medical Radiology and Oncology NAMS of Ukraine, Oncogynecology, Kharkov, Ukraine


Introduction/Background*The direct influence of irradiation on cervical cancer can be realized by brachytherapy (BT). We have developed methodic of dynamic dose fractionation of brachytherapy, which determined the relevance of this investigation.

The aim of this study is efficacy improvement of combined treatment of cervical cancer patients, by application of high dose-rate brachytherapy (HDR) by the method of dynamic dose fractionation as a first step of preoperative course of radiochemotherapy.

Methodology There were enrolled 54 cervical cancer patients with primary stages IB – IIA (T1b-2aNxM0). All the patients were divided into 2 groups. BT was performed by device «MultiSource», and external beam radiation therapy (EBRT) – by «Clinac 600C», with chemomodification agent cisplatin 40 mg/m2 weekly.

Group 1 included 34 patients, whose treatment was started with two sessions of BT (step 1) – the first one with single dose of 7 Gy, the second one – of 5 Gy, and then EBRT (20 Gy) up to the total dose of 32/23 Gy (step 2).

Group 2 included 20 patients, whose treatment was started with EBRT (20 Gy) – step 1, with sequential two sessions of BT with each single dose of 5 Gy (step 2), up to the total dose of 30/22.5 Gy.

The follow-up period was 3-26 months, mean – 17.2 months.

Result(s)*The effectiveness of dynamic dose fractionation HDR-BT was proved by complete tumor regression (pathomorphosis grade IV) in 35.3% of 34 patients: 50.0% of stage IB patients and 36.4% – stage IIA. In group 2, there was detected only partial tumor regression (pathomorphosis of grade II-III) in all the patients. The relapsed disease was detected in 1 (6.7%) patient of Group 2 at follow-up before 1 year.

Conclusion*Dynamic dose fractionation HDR-brachytherapy, as 1st step of preoperative chemo-irradiation, allows to reach the total tumor regression, which enable further ablastic surgery and relapse-free follow-up.

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