Palliative Radiotherapy In Advanced Cancer Of The Cervix

摘要

Aim: To assess the role of high dose palliative pelvic radiotherapy in patients with locally advanced/metastatic cancer of the cervix not suitable for radical treatment.Method: Seventy two patients with carcinoma of the cervix receiving palliative radiotherapy to the pelvis from January 2006-December 2010 were included in this study. Patients were treated with parallel-opposed pelvic portals with megavoltage radiation monthly up to a maximum of three fractions. The dose per fraction was 8Gy. The patients were assessed for relief of bleeding, vaginal discharge, pain, response and toxicity.Results: The mean age at presentation was 55 years and the mean duration of symptoms was 10 months. A control in vaginal bleeding was observed in 95% patients receiving three fractions. Sixty-six percent patients receiving three fractions had relief from vaginal discharge. Fifty eight percent patients had 100% pain relief after the third fraction. No grade 3-4 acute or late toxicity was observed in evaluable patients on follow up.Conclusion: 8Gy per fraction in two to three monthly fractions is an effective schedule for palliation in patients with advanced cancer of the cervix not suitable for radical radiation. Introduction Cancer of the cervix is one of the commonest malignancies in Indian women and is the leading cause of cancer mortality in India accounting for 23.3% of all cancer deaths (1).The high prevalence and burden of cervical cancer in India is attributed to lack of awareness, lack of access to health services, social inhibitions and poor socio-economic status. As a result many of our patients present to us late in advance stages of disease. Though standard curative treatment for cancer cervix is external radiation with concurrent chemotherapy followed by brachytherapy, many of these patients are not potentially curative in view of advanced and metastatic disease. Moreover, poor general condition, financial and logistical constraints make it further difficult for these patients to undergo prolonged treatment. Also acute treatment related toxicity with conventional fractionated regimens along with the co-existing problems only adds on to the patient’s misery. Thus these patients with advanced local and/or metastatic disease are best suited for palliative radiotherapy where aim of treatment is symptom control and improvement of quality of life. A single or limited number of high dose fractions have been used by various centres in palliative radiotherapy of cancer cervix. Monthly palliative radiotherapy has been used in various studies in patients with advanced loco regional disease and has been found to be an effective schedule in terms of patient tolerance and symptom control (2-6). However, this treatment is recommended in only those patients in whom the life expectancy is less than one year (4).At our institute, we use a dose of 8Gy to the pelvis in 1-3 fractions at monthly intervals for patients with advanced or metastatic disease in whom life expectancy is less than one year. We present our experience of using this fractionation schedule in palliative radiotherapy in cancer cervix. Material and Methods A total of 72 patients received patients with carcinoma cervix in who palliative radiotherapy was delivered to the pelvis from January 2006-December 2010 were included in this prospective study. The inclusion criteria were as follows:The demographic profile of patients is shown in table-1. The patients received treatment with local pelvic external radiotherapy with parallel opposed anterior-posterior field fields. The superior border of the radiation field was kept at junction of L4-L5 vertebral bodies and the inferior border was kept at the inferior border of the obturator foramina. The lateral borders were kept at 2 cm lateral to the pelvic brim. A dose 8 Gy was prescribed at mid plane delivered in a single fraction. The patients were treated with megavoltage radiation. All the patients were registered with the palliative clinic