Transcript ACUTE TOXICITY EVALUATION OF CONCURRENT …

Presenter :
Guide :
, JR, RT
, AP, RT,
Jipmer
Co – Guides:
1.
,
Professor and head, Radiotherapy,
Jipmer
2.
,
Lecturer in medical physics,
Jipmer
ICRU
62
Tumor and nodal
PTV covered
between 95% and
107% prescribed
dose
THIS
STUDY
Dose to atleast
98-99% PTV –--->
97- 98% of
prescribed dose
Dmax kept below
105% of
prescribed dose
To investigate the acute toxicity of 3D
conformal concurrent chemo RT (Keeping PTV
Dmax <=105%) in carcinoma cervix patients.
• observational descriptive study
• N= 22 (an ongoing study – total 30)
• Cisplatin 40 mg/m2 weekly 4-5 weeks (maximum
of 5 doses )
• Acute RTOG toxicity – during EBRT(weekly once) and
1 week post EBRT
Inclusion criteria
• Squamous cell
carcinoma cervix
• IIB to IIIB disease
• ECOG 0 to 2 PS
• Age 20 to 55
Exclusion criteria
• Lower 1/3 rd vagina
involvement
• Previous major
abdominal surgeries
• Ovarian mass
• Pre existing gross
PID/tuberculosis of
genital tract
• Endometriosis
• Hemorrhoids/ulcerativ
e colitis
• uncontrolled diabetes,
hypertension, renal or
hepatic dysfunction
Eclipse
Version 10
AAA
ALGORITHM
120 LEAF MLC - 6MV/15MV
• WEIGHTAGES
• MLC LEAF POSITION
• SUBFIELDS
PARAMETER
OBSERVATION
OCTOBER 2011 – ONGOING
MEDIAN AGE
47
COMPLETE LOCAL RESPONSE AFTER 2
MONTH
100%
DOSE
46GY/23#
HDR BRACHYTHERAPY
9 GY/2#
Results
0
1
2
3
10
10
9
8
7
7
6
5
4
3
2
1
0
3
2
0
1
2
3
14
14
12
10
8
6
4
3
3
2
2
0
0
1
2
3
20
20
18
16
14
12
10
8
6
4
2
0
2
0
0
0
1
2
3
16
16
14
12
10
8
6
5
4
2
0
1
0
0
1
2
3
25
21
20
15
10
5
0
0
0
1
0
1
2
3
20
20
18
16
14
12
10
8
6
4
2
0
1
1
0
0
1
2
3
12
10
11
9
8
6
4
2
2
0
0
VAGINAL MUCOSA
0
1
2
3
18
18
16
14
12
10
8
6
4
4
2
0
0
0
Studies similar to our study using conventional RT
PITFALLS
• NON-RANDOMISED (NO COMPARATIVE ARM)
• CONTOURING UNCERTAINTIES/MOTION
SETUP ERRORS
• TIME CONSUMING
• LATE LONG TERM OUTCOME UNKNOWN
• SUBJECTIVE ANORECTAL DISCOMFORT
• SKIN TOXICITY MORE THAN EXPECTED
• EXPENSIVE
Conclusion
STRUCTURES CONTOURED
GTV -T
• Uterocervix
• Adnexa
• Vagina upto
2cm below
tumor
GTV-N
• Iliac nodes
• Obturator
• Presacral
OAR
• Bladder
• Rectum
• Small bowel
• Large bowel
• Bone marrow
• Femoral
heads
1cm
5mm
5mm
8mm
GTV
GTV
CTV
CTV
PTV
PTV
Brachytherapy
9Gy x2 doses
computerized
3D conformal
treatment
planning
(1st dose - 1
week after
EBRT
completion
2nd dose -I
week after the
first dose ).
Ring and
Fletcher type
of applicators
NO OF CYCLES CHEMO
5
CYCLES
Of the ten trials only 3 used similar methodology
as this study.
ICRU 83
Tolerance doses
• Rectum, 75 Gy (mean 68 Gy, <80% of the dose
at point A)
– V50 < 60
– V60 < 50
• Bladder, 80 Gy 2/3RD (mean 70 Gy, 85% of the
dose at point A)
– FULL BLADDER 65 Gy
• Vagina, 120–140 Gy (mean 125 Gy)
• FEMORAL HEADS = V50 < 50%
• SMALL BOWEL = 45 Gy TOTAL DOSE (250 CM3)
• Skin : PTV-V107% (>28.6%) more toxicity