Cervical Cancer Clinical Trial
Official title:
A Feasibility and Safety Study of Single Application Multi-fractionated High Dose Rate (HDR) Brachytherapy in Locally Advanced Cervical Cancer
The purpose of the study is to evaluate safety and feasibility of single brachytherapy application with dose delivery in multiple fractions. Study will be conducted in Phase I/II clinical trial setting with strict Image guidance protocol.This study is expected reduce treatment duration and to increase ease and acceptability of brachytherapy in patients along with significant saving of resources
Brachytherapy for cervical cancers has evolved a long way from the era of Manchester based
point A prescription to volume-based prescription in the current era of 3 Dimensional (3D)
imaging. Advancement in imaging technology and widespread availability of this technology has
allowed most centers worldwide to incorporate Image guided brachytherapy as a routine part of
their clinical practice.
The primary advantage of 3D image guided brachytherapy is that it allows the dose given by
brachytherapy to conform to the anatomy of each individual patient while reducing the doses
to organs at risk (OAR) (1). This technique has shown to improve local control rates and also
reduce the rates of moderate to severe morbidity in multiple single institutional series
(2-6). However, treatment related urinary and gastrointestinal late morbidity is still a
significant problem with the 3 year actuarial incidence of intermediate to major morbidity
(Grade≥2) being 30% and 29% for urinary and gastrointestinal side effects, respectively and
Major morbidity (Grade≥3) is seen in 7% and 8%, respectively [An intErnational study on MRI
guided BRachytherapy in locally Advanced CErvical cancers (EMBRACE) study 2014, work in
progress(7)].
Most important factor determining late toxicities in radiotherapy is dose per fraction and
total dose (total BEDGy3) rather than rate of dose accumulation or number of applications,
which is evident from many trials of HDR brachytherapy.
The dose per fraction in the protocol of 9Gy, 7Gy and 7Gy HDR is effective in terms of local
control rates and toxicities which has been published(8,9).
Our study is designed to evaluate the feasibility to deliver complete course of HDR
brachytherapy in a single application while achieving dose constraints to OARs and keeping in
account inter-fraction variation of doses to OAR's.
In the protocol proposed here, The Investigators intend to deliver fractionated treatments in
a strict image based and quality controlled environment to minimize the doses to OAR's. Also
if the constraints are not achieved, patients would be offered Standard brachytherapy
regimen. This would ensure that the anticipated late toxicities would be minimized.
This study is expected to decrease overall treatment time and increase the ease and
acceptability of brachytherapy in patients and with significant saving of resources while
maintaining disease control rates and toxicity rates similar to standard protocols.
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