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Can Cyberknife SBRT Be An Alternative to Brachytherapy for Cervical Cancer Treatment?


T Podder

T Podder1*, D Fried1, B Holland1, J Rosenman2, T Biswas1, (1) East Carolina University, Greenville, NC, (2) Univ North Carolina, Chapel Hill, NC

SU-E-T-412 Sunday 3:00:00 PM - 6:00:00 PM Room: Exhibit Hall

Purpose:
To investigate the effectiveness of stereotactic body radiation therapy (SBRT) with Cyberknife for treatment of squamous cell carcinoma (SCCa) of cervix that are commonly treated with brachytherapy.
Methods:
SCCa of cervix is routinely treated with external beam radiation therapy (EBRT) followed by brachytherapy. Common practice is to use high-dose-rate (HDR) brachytherapy, mainly with Ir-192; however, low-dose-rate (LDR) brachytherapy with Cs-137 is also used. Three of our patients with cervical SCCa who were chosen to have LDR brachytherapy (Cs-137 with tandem and ovoids) could not tolerate the prolonged treatment or applicator placement. All these patients previously received 45Gy (1.8Gy/fratction) from EBRT and well tolerated. Planned LDR treatment dose and time were for patient-1: 42.63Gy in 73.5hr, patient-2: 42.34Gy in 73hr, patient-3: 41.76Gy in 72hr. Delivered LDR dose and time were: 3.75Gy in 6.5hr, 0Gy in 0hr, and 17.3Gy in 19.8hr, for patient-1, -2 and -3, respectively. Two of the three patients tolerated LDR treatment partially; the second patient could not tolerate the applicator, which required immediate removal after placement. Treatments were completed with Cyberknife SBRT (CK-SBRT) doses of 25Gy, 15Gy and 25Gy for patient-1, -2 and -3, respectively; all had 5Gy/fraction and 3fractions/week. Prescriptions were at 80% isododelines; CTV coverages were 96.6%, 99.9% and 100% for patient-1, -2 and -3, respectively.
Results:
Till their last follow-up in February 2012, all three patients were doing fine clinically without any evidence of disease; none of these patients had any complications that could be related to CK-SBRT.
Conclusions:
Appears that CK-SBRT can be a viable treatment alternative to brachytherapy. CK-SBRT may also be more appealing to patients and physicians for a variety of reasons such as out-patient procedure, shorter treatment time, no need for operating room, and no need for applicator insertion and tolerance. However, extensive clinical study is warranted in this regard.


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