1. Mahatma Gandhi Cancer Hospital and Research Institute Dr P. S. Bhattacharyya, MD Radiation Oncologist. Elekta Synergy CT Simulator Flexitron HDR

2. Computed tomography assisted High Dose Rate Interstitial Brachytherapy in Gynaecologic Malignancies, with Inverse Planning Simulated Annealing ; An Institutional experience. Author-Dr P S Bhattacharyya, MD Co-author-Mr A C prabhu, Med. Phy.

3. Introduction Ca. Cx - 40% of all cases treated at MGCH EBRT + CDDP 40 mg/m ICRT / IBT GEC Estro guidelines for 3D ICRT MUPIT 2

4. Aims of the study To report IPSA based 3D HDR IBT in cancer Cervix and Vagina DVH analysis of CTV and OAR

5. Materials and Methods May 2012 to Dec 2012 Retrospective analysis 34 IBT applications in 17, Ca.Cx / Vagina patients Duration < 3 hrs Median 19 (17-23) needles used 8 – 9.5 Gy X 2 prescibed dose IPSA

6. Clinical and Histopathological features PRESENTATION Bleeding P/V White discharge Pelvic Pain NO. OF PATIENTS 14 12 06 PERCENTAGE 82 70 35 HPE Sq. Cell Ca. Adeno Ca. 16 01 94 06 SITE Intact Cervix Vault Vagina 10 05 02 59 29 12 FIGO STAGE IIB IIIB IIIB with L/3 Vagina involved 07 10 03 41 59 30 Total patients studied-17 Median age -56 Yrs.(18-68 yr)

7. Perineal Template Indications Bad Geometry 47% (08) Ca. Vault area 29% (05) Vaginal and para vaginal involvement 12% (02) Non negotiable cervical OS 06% (01) ICRT high dose to bladder 06% (01) Total No. of patients studied-17

8. Interstitial applicators Vienna CT-MRI Ring/ Ovoid Applicator Syed Neblett Template

9. MUPIT Applicator

10. BED and D EQ Equations BED Ext+HDR = (nd[1+(---)]) + (nd[1+(---)]) D EQ = BED Ext+HDR d d d ref 1+ ( ---- ) n = no. Of fractions d = dose per fraction in Gy a/b = alpha / beta, 10 for tumor, 3 for late effects BED=biologically equivalent dose D Eq= Equivalent dose (Gy) d ref= reference dose, 2 Gy a/b

11. IPSA Planning

12. CTV DVH Interpretations CTVRangeMedianBED 10 Tumor effects Dose Eq. Gy D1004.87 – 8.49 Gy5.82 Gy D957.26 – 9.17 Gy8.42 Gy84.0870.06 D90 8.14 – 9.60 Gy 8.74 Gy85.8071.50 V10085 – 96.77 %91.13% Median Prescribed dose- 8.8 Gy

13. OAR DVH Interpretation Bladder Volume cc Range Gy Median dose Gy BED 3 Late effects Dose Eq. Gy 0.16.25- 9.85 8.0113078.3 1 15.52- 7.90 6.75115.8769.8 0 24.98- 7.13 6.29110.9566.8 4 53.82- 6.47 5.63105.3663.4 7 Rectal Volume cc Range Gy Median dose Gy BED 3 Late effects Dose Eq. Gy 0.16.47- 8.49 7.3612273.49 15.70- 7.27 6.49113.0668.11 25.30- 6.01 6.02108.2065.18 54.23- 6.46 5.4010261.44 URINARY BLADDER RECTUM Median Prescribed Dose- 8.8 Gy

14. IPSA isodose distribution

15. Comparision of bladder dose 0.1 cc bladder dose 12 Gy with ICRT 0.1 cc bladder dose 8.1 Gy with IBT

16. Limitations of the study All the patients did not recieve 6 cycles of CDDP Total duration of treatment more than 8 weeks Applicator volume in CTV No subdivisions in CTV

17. Thank you