Research Article
Comparative Prospective Study Assessing Early Clinical Outcomes with or Without Use of Contrast Enhancement in CT Based Image Guided HDR Brachytherapy
Issue:
Volume 10, Issue 2, June 2025
Pages:
36-50
Received:
3 March 2025
Accepted:
12 March 2025
Published:
26 March 2025
Abstract: Background: Brachytherapy has been part of the standard of care in the treatment of cervical cancer. Brachytherapy has evolved from two to three-dimensional treatment for better volume delineation for target and OAR thus leading to better LC and reduced toxicities. Presently, MR Brachytherapy is the gold standard. However, its use is limited by its availability and patient logistics. To combat this barrier, CT-guided brachytherapy guidelines were established over time and have been proven non-inferior to MR brachytherapy. The recent IBS-GEC-ESTRO recommendation 2021 has advised the use of contrast to delineate tumor and normal tissue. The objective of this study is to assess LRR and normal tissue toxicities at 3 months with the use of contrast versus non-contrast CT-based contouring. Material and methods: Data from all patients with proven LACC, treated by brachytherapy after CCRT between May 2023 and Sep'2024 were reviewed. CCRT followed by BT. Two patient data sets included arm1; without and arm2; with contrast during brachytherapy CT simulation. 1-2 ml contrast in the bladder and 4-5 ml rectum contrast diluted in 20 ml and 10-15 ml NS, respectively. I.V. contrast was given only to patients with residual disease. CT-based contouring and planning were done similarly in both arms. Results: Forty patients with LACC, as per recent FIGO stage (II A: 5.72%, II B: 22.86%, III B: 17.41%, III C: 40%, and IV: 14.29%), who completed treatment were part of this study. Out of 40 patients, 11 (27%) underwent adaptive brachytherapy. Higher stages were observed more commonly in arm 1. LRR was higher in arm 1 (85%) than arm2 42%. Defaulters in arm 2 were more (23.81%) than in arm 1 (5%). In a median follow-up of 3 months, 10% of local failure was observed in arm 1 and 33.33% in arm 2. No acute toxicities were seen in 55% of the cases (22/35 patients). No High-grade acute toxicity events (> grade 2) were reported. A significant difference was observed in the G1 bladder and rectal toxicity in both arms. G2 rectal toxicity was reported only in arm 2 in 1 patient. Only G1 Bowel toxicity was seen and was insignificant between both arms. Conclusion: Local control was significantly more in arm 1 (p- 0.019). Only G1 toxicities were observed in both arms. No significant difference was observed in the D2cc volume of any of the OARs between both groups. This implies, no significance of implementing contrast material in CT-based brachytherapy treatment.
Abstract: Background: Brachytherapy has been part of the standard of care in the treatment of cervical cancer. Brachytherapy has evolved from two to three-dimensional treatment for better volume delineation for target and OAR thus leading to better LC and reduced toxicities. Presently, MR Brachytherapy is the gold standard. However, its use is limited by its...
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Research Article
Evaluation of Response and Toxicity of Pemetrexed-Carboplatin Versus Paclitaxel-Carboplatin as First-Line Treatment in Metastatic NSCLC
Uday Kumar Sarkar*,
Sarwar Alam,
Syed Md Asadul Hoque,
Newton Kumar Sarker,
Tasnim Mahmud
,
Safayet Hossain
Issue:
Volume 10, Issue 2, June 2025
Pages:
51-58
Received:
2 March 2025
Accepted:
12 March 2025
Published:
28 March 2025
Abstract: Non-small cell lung cancer (NSCLC) accounts for 80-85% of all lung cancer approximately. The paclitaxel-carboplatin combination is the established standard regimen of choice in metastatic NSCLC. Pemetrexed, a folate antimetabolite is also effective against non-small cell lung cancer. To compare the response and toxicity of the Pemetrexed-Carboplatin regimen with Paclitaxel-Carboplatin in the treatment of metastatic NSCLC. This Quasi-experimental study was conducted from three centers of Dhaka city. 80 patients (40 patients on each arm) who met the inclusion criteria of the study were enrolled. Arm-A received 500mg/m2 Pemetrexed (Day 1) plus Carboplatin; AUC=5 (Day 1) IV, in another arm, 175mg/m2 Paclitaxel (Day 1) plus Carboplatin AUC=6; (Day 1) IV, dexamethasone was given 12 mg on night before and on the morning of chemotherapy of each cycle & repeated every 21 days for 6 cycles; were given. Both outcome and toxicities were evaluated. Regarding the tumor control, there was no statistically significant difference in both arms at the follow-up after 6 weeks of completion of chemotherapy [Partial response was seen in 24 (60.00%) patients in Arm-A and in 22 (55.00%) patients in Arm-B, p= 0.58]. Grade ≥3 neutropenia was seen in 09 (22.50%) patients of the Arm-A and 20 (50.00%) patients of Arm-B, p<0.005. Treatment-emergent alopecia was significantly higher in Arm-B [Arm-A, 07 (17.50%) vs Arm-B, 22 (55.00%) p<0.05]. Other non-hematological toxicity was also assessed in both arms and there was no significant difference in the frequency of adverse events. This study supports the fact that Pemetrexed-Carboplatin-based chemotherapy may be equally effective with less haematologic & non-haematologic toxicity than the Paclitaxel-Carboplatin-based chemotherapy regimen.
Abstract: Non-small cell lung cancer (NSCLC) accounts for 80-85% of all lung cancer approximately. The paclitaxel-carboplatin combination is the established standard regimen of choice in metastatic NSCLC. Pemetrexed, a folate antimetabolite is also effective against non-small cell lung cancer. To compare the response and toxicity of the Pemetrexed-Carboplati...
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