Comparison of two very common fractionation schedules for HDR Gyn brachytherapy

Summary:

9Gy x2 fr Vs 6.8 Gy x3 fr for HDR Cervix Intracavitory Brachytherapy

Comparison of two very common fractionation schedules for HDR Gyn brachytherapy

Nikhilesh Patil 23 Feb 2011 04:08

One of the most recent comparison of two common but different fractionation schedules practiced for intracavitory HDR gynecological brachytherapy.
http://www.ncbi.nlm.nih.gov/pubmed/20685179

Re: Comparison of two very common fractionation schedules for HDR Gyn brachytherapy

Indranil Mallick 26 Feb 2011 18:43

Dear Nikhilesh
This paper has taken a long time coming. And all things considered validates the 9Gy x 2 fractionation scheme. I am trying to get hold of the full paper, but if my memory serves me right, the 6.8 x 3 fractionation started after EBRT completion in all their patients, thereby introducing a difference in total treatment time in these patients. It would be interesting to see the TMH 7 Gy x 3 results (where the first brachy fr is often in the 5th week of EBRT) somewhere and compare outcomes.
Indranil

Re: Comparison of two very common fractionation schedules for HDR Gyn brachytherapy

Nikhilesh Patil 27 Feb 2011 03:07

TMH 7Gyx3# is for Stage IIIb but is nonrandomized data.
There was an IAEA multicentric RCT started in 2005/6 comparing 9Gy x 2# vs 7Gyx4# using ring applicators and both arms receive 46Gy/23# EBRT. Dont know if the results are out or still awaited.

Re: Comparison of two very common fractionation schedules for HDR Gyn brachytherapy

Dr Rahul Krishnatry 15 May 2011 03:50

well the debate for different fractionation in HDR has been since almost 20 years. it was discussed in recent WCI recommendations/ guidelines conference at TMH where different eminent gynecological oncologists from India and abroad were there.
it was felt by the expert panel (Dr Firuza Patel, Dr Pearcy….) and the representatives from various institutes across the globe that
"there is no need of any randomized trials comparing different schedules as long as total duration of treatment is in 6-8 weeks and the total dose to Point A is >80Gy EQD2 and bladder <90Gy EQD2 and rectum < 75GyEQD2 is achieved.
to reach that various fractionation from 5Gy to 9Gy may be used but the goal remains the same."

now the issue which may remain is EBRT to Brachy ratio in the scenerio of EBRT doses ranging from 40-50Gy. the difference of 10 Gy delivered by brachytherapy can make lot of difference in local cervical growth control and also treatment time (5 days to none). this becomes especially important if you have pelvic LN >/=3cm and if you are not using SIB IMRT for addressing the nodes.

Re: Comparison of two very common fractionation schedules for HDR Gyn brachytherapy

Nikhilesh Patil 16 May 2011 02:42

Good conclusion, our brachy dose does not change even if we choose to do SIB for nodes.