Monthly palliative pelvic radiotherapy in advanced carcinoma of uterine cervix

Background: Patients with locally advanced cervical cancer are often severely distressed with incessant vaginal bleeding, offensive discharge and pelvic pain and are in some instances are beyond curative potential. At our institution we routinely use monthly palliative pelvic radiotherapy for these patients. Methods and Material: One hundred patients treated between 2000 & 2004 were included in this analysis. Patients were treated with parallel-opposed pelvic portals with megavoltage radiation monthly up to a maximum of three fractions (10Gy/ fraction). Patients with good response after second fraction were considered for intracavitary brachytherapy delivering 30Gy to point A. Response was documented with regard to relief of bleeding, vaginal discharge and pelvic pain. The other aspects evaluated were patient compliance, disease response, toxicity and survival. Results: Sixty-eight percent had FIGO stage IIIB, 12% had stage IVA and 14% had IVB disease. Twenty patients had metastatic disease. The median symptom duration was 5 months. Majority (67%) presented with vaginal bleeding, followed by discharge (69%) and pelvic pain (48%). All patients received at least one fraction of palliative pelvic radiotherapy. Sixty-one patients received the second fraction and 33 the third. Five patients received an intracavitary application. The overall response rates in terms of control of bleeding, discharge and pain were 100%, 49% and 33% respectively. The treatment was generally well tolerated with a median survival of 7 months. Conclusions: Monthly palliative pelvic radiotherapy results in satisfactory control of symptoms in patients with locally advanced carcinoma of cervix with acceptable complications

Dose optimization of intra-operative high dose rate interstitial brachytherapy implants for soft tissue sarcoma

Objective: A three dimensional (3D) image-based dosimetric study to quantitatively compare geometric vs. dose-point optimization in combination with graphical optimization for interstitial brachytherapy of soft tissue sarcoma (STS). Materials and Methods: Fifteen consecutive STS patients, treated with intra-operative, interstitial Brachytherapy, were enrolled in this dosimetric study. Treatment plans were generated using dose points situated at the "central plane between the catheters", "between the catheters throughout the implanted volume", at "distances perpendicular to the implant axis" and "on the surface of the target volume" Geometrically optimized plans had dose points defined between the catheters, while dose-point optimized plans had dose points defined at a plane perpendicular to the implant axis and on the target surface. Each plan was graphically optimized and compared using dose volume indices. Results: Target coverage was suboptimal with coverage index (CI = 0.67) when dose points were defined at the central plane while it was superior when the dose points were defined at the target surface (CI=0.93). The coverage of graphically optimized plans (GrO) was similar to non-GrO with dose points defined on surface or perpendicular to the implant axis. A similar pattern was noticed with conformity index (0.61 vs. 0.82). GrO were more conformal and less homogeneous compared to non-GrO. Sum index was superior for dose points defined on the surface of the target and relatively inferior for plans with dose points at other locations (1.35 vs. 1.27). Conclusions: Optimization with dose points defined away from the implant plane and on target results in superior target coverage with optimal values of other indices. GrO offer better target coverage for implants with non-uniform geometry and target volume