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Presenter : Dr.B.Sathish , JR, RT

Presenter : Dr.B.Sathish , JR, RT. Guide : Dr.Shyama Prem , AP, RT, Jipmer Co – Guides: 1. Dr. K.S. Reddy , Professor and head, Radiotherapy, Jipmer 2. Mr.Saravanan , Lecturer in medical physics, Jipmer.

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Presenter : Dr.B.Sathish , JR, RT

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  1. Presenter : Dr.B.Sathish, JR, RT Guide : Dr.Shyama Prem, AP, RT, Jipmer Co – Guides: 1. Dr. K.S. Reddy, Professor and head, Radiotherapy, Jipmer 2. Mr.Saravanan, Lecturer in medical physics, Jipmer

  2. “ACUTE TOXICITY EVALUATION OF 3D CONFORMAL CONCURRENTCHEMORADIATION (PTV Dmax not above 105%)IN CARCINOMA CERVIX “AN OBSERVATIONAL STUDY

  3. PTV PTV

  4. AIMS AND OBJECTIVES To investigate the acute toxicity of 3D conformal concurrent chemo RT (Keeping PTV Dmax <=105%) in carcinoma cervix patients.

  5. Methodology • observational descriptive study • N= 22 (an ongoing study – total 30) • Cisplatin 40 mg/m2 weekly 4-5 weeks (maximum of 5 doses )

  6. Assessment • Acute RTOG toxicity – during EBRT(weekly once) and 1 week post EBRT

  7. Materials and methods

  8. Eclipse Version 10 AAA ALGORITHM

  9. 120 LEAF MLC - 6MV/15MV

  10. REDUCING PTV MAX DOSE • WEIGHTAGES • MLC LEAF POSITION • SUBFIELDS

  11. Results

  12. VAGINAL MUCOSA

  13. INFERENCE

  14. Studies similar to our study using conventional RT

  15. 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

  16. Conclusion 3D CRT WITH OPTIMISATION BY REDUCING Dmax – ACCEPTABLE TOXICITY PROFILE. “The cure of the disease must never be more grievous than the endurance of the same” Sir Robert Hutchison, 20th century physician, British Medical Journal, 1953; 1: 671.

  17. THANK YOU

  18. STRUCTURES CONTOURED

  19. TUMOR LYMPH NODES 5mm 1cm 8mm 5mm GTV GTV CTV CTV PTV PTV

  20. Brachytherapy

  21. NO OF CYCLES CHEMO 5 CYCLES

  22. Of the ten trials only 3 used similar methodology as this study.

  23. ICRU 83

  24. 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)

  25. FEMORAL HEADS = V50 < 50% • SMALL BOWEL = 45 Gy TOTAL DOSE (250 CM3) • Skin : PTV-V107% (>28.6%) more toxicity

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