The effect of general anaesthesia versus conscious sedation in dosimetric distribution of intracavitary radiotherapy in cervical cancer patients

Background: Majority of Indian patients presents in locally advanced stage and most of them treated by combination of external teletherapy and intracavitary brachytherapy (ICRT). Because of deficient infrastructure, the waiting period is generally long at existing caner canters. Hence ICRT may be done in conscious sedation to treat more patients by avoiding time consuming general anaesthesia. The aim of this study is to know the effect of general anaesthesia vs. conscious sedation in dosimetric distribution in brachytherapy and its feasibility.Methods: Total 80 ICRT applications were randomized to general anaesthesia (GA) and conscious sedation (CS) groups. Fletcher suit type of applicators was used and dose delivery equipment was cobalt 60 high dose rate remote after loading brachytherapy unit. In CS group, injection midazolam 0.5-8mg (median 2.5mg) in the form of slow i.v. infusion was used along with antiemetic support.Results: Total 6 parameters were analyzed. e.g., Dose to point A1, Dose to point A2, Bladder max dose, Bladder mean dose, Rectal max dose and Rectal mean dose. The dose distribution was found similar both   groups and it did not depend on type of anaesthesia.Conclusions: The high volume centers of developing countries are most suitable candidate to opt conscious sedation to perform ICRT to treat more cancer cervix patients in same time frame

Cancer oesophagus: is sequential chemo radiation better in elderly patients or patients with severe dysphagia?

Background:This study was conducted to analyse the local control, regional control and toxicities of sequential versus concurrent chemo radiation in the patients of oesophageal cancer especially in elderly.Methods: A total of newly diagnosed 50 patients were randomized in concurrent and sequential arm. Two courses of 3 weekly chemotherapy (Cisplatin and 5-FU based) were given concurrently and three courses of same chemotherapy were given neoadjuvantly with EBRT (44 Gys) respectively in randomised arms. HDR-ICBT (2 fractions of 5 Gy) delivered after two weeks of completion of EBRT in both arm.Results: Concurrent arm had higher incidence of grade III+IV overall all toxicity especially in elderly patients or patients that presented with grade IV or higher dysphagia. Other haematological and non-haematological toxicities were equal in both arms. Complete response at both primary and mediastina was higher in concurrent arm but there was no statistically significant difference.Conclusions: Our data suggest that if a patient can tolerate the combination of chemotherapy and radiation, this approach offers superior results but at the cost of higher incidence of severe toxicities especially in patients with grade IV or higher dysphagia or elderly patients. So this group could be treated with sequential chemo radiation

Cobalt-60 is a logical, economical and comparable alternative to Ir-192: analysis and institutional experience from western India

Objectives: The objective of the study was to examine the dosimetry of intracavitary radiotherapy (ICRT) in carcinoma of the cervix using cobalt-60 (Co-60) as source of ICRT, and as an alternative to iridium-192 (Ir-192). Design: This was a retrospective study. Subjects and setting: The study was on 80 ICRT patients attending the radiotherapy department at Maharana Bhupal Government Hospital, Udaipur, India. Outcome measures: The dosimetry of ICRT was studied retrospectively in 80 related applications. The dose to point A, 60 Gy isodose reference volume, and bladder and rectum maximum and mean doses were defined. Results: It was found that dosimetry with Co-60 as a brachytherapy source was consistent with the International Commission on Radiation Units (ICRU 38) recommendations. Conclusion: Co-60 is a logical alternative to Ir-192 in low socio-economic settings when repeated changing of the source is not an option