A PROSPECTIVE CLINICAL STUDY ON THE BENEFIT OF ADDING CHEMOTHERAPY TO BRACHYTHERAPY IN PATIENTS WITH INCOMPLETE RESPONSE TO EXTERNAL BEAM IRRADIATION WITH CONCURRENT CHEMOTHERAPY IN LOCALLY ADVANCED CASES OF CARCINOMA CERVIX

Introduction: Concurrent chemoradiation followed by brachytherapy is the standard treatment of carcinoma cervix by radiotherapy. Efficient brachytherapy is all the more important in Indian scenario where bulky residual disease is mostly found after external radiotherapy. Our study investigates the feasibility and tolerability of High Dose Rate Brachytherapy (HDR-BT) combined with concurrent cisplatin against HDR-BT alone which is considered the traditional standard of care. Materials and Methods: Carcinoma cervix patients who have undergone ‘partial response’ or ‘stable disease’ to external beam radiotherapy have been randomized into two arms in this study: Concurrent brachytherapy(CBT arm) where weekly 7Gy HDR X 3 fractions was delivered with weekly 40mg/m2 cisplatin given few hours prior to brachytherapy and brachytherapy(BT) alone arm with same HDR schedule. Results: There were significantly higher complete responses in CBT arm 8 weeks post brachytherapy in CBT arm (59% vs 33.3%, p= 0.038). Systemic toxicities, viz. dermatitis, mucositis, diarrhea, anemia were also significantly higher in CBT arm. Rectal, vaginal and bladder toxicities were also higher in CBT arm, although not significant. Conclusion: CBT is a feasible approach with acceptable higher toxicties.