Objective To decrease radiotherapy treatment time (RTT), measured from the day of initiation of radiotherapy to the day of its completion, specific strategies were initiated in early 2020 in the only academic safety-net medical center in a rural, resource-lean state. The factors that can succeed and those that need further improvements were analyzed in this initial assessment phase of our efforts to shorten the RTT. Methods This is an analysis of 28 cervix cancer patients treated with magnetic resonance imaging (MRI)-guided brachytherapy (February 2020-November 2021). The relationship between independent and dependent variable were analyzed by simple linear regression, and p-values ≤ 0.05 were considered statistically significant. SPSS software version 28.0 (IBM, Armonk, NY, USA) was used for statistical analysis. Results Two RTT groups (≤ 60 (32.1%) vs. > 60 days {67.9%}) with median RTT of 68 days (range, 51 to 106 days) were analyzed. Caucasians represented 66.7% of the RTT ≤ 60 days group. Four 'issues' were identified that increased the RTT: non-compliance, learning curve (early days of implementation of MRI-guided brachytherapy in the department), stage IV comorbidities, and with more than one issue mentioned; 77.8% with no issues had ≤ 60 days RTT vs. 26.3% for the > 60 days group. The breakdown of the no-issues factor by calendar year showed the RTT of ≤ 60 days was achieved higher in 2021 (85.7% vs. 20.0%; p=0.023) compared to 2020. For this entire cohort, the RTT of ≤ 60 days was achieved higher in 2021 (50.0% vs. 8.3%; p=0.019) compared to 2020. Data also showed improvement in RTT of ≤ 60 days for every sequential six months. 'Non-compliance' and 'learning curve' were the most important factors among patients having the longest RTTs. Conclusion The RTT can be further decreased. As a result of this preliminary analysis of the our strategic planning approach of 'circular' "See it," "Own it," "Solve it," and "Do it" and go back to the first step again, we plan to implement the following strategies in the immediate future to shorten the RTTs further and, in turn, improve our overall outcomes (local/regional control, disease-free survival, and overall survival): (a) Interdigitate MRI-guided brachytherapy during external beam radiotherapy (EBRT); patients who can not get the interdigitated brachytherapy procedures performed during the course of EBRT for any reason will receive two brachytherapy procedures per week; (c) attempt to add a cervix cancer care navigator to our staff to help patients having social issues, thus leading to compliance problems; (d) finally, in a year or two after these new strategic implementations, the RTT data will be reanalyzed.

Introduction Stereotactic body radiation therapy (SBRT) is an effective treatment for early-stage non-small cell lung cancer (NSCLC) patients who are either medically inoperable or who decline surgery. SBRT improves tumor control and overall survival (OS) in medically inoperable, early-stage, NSCLC patients. In this study, we investigated the effectiveness of two different SBRT doses commonly used and present our institutional experience. Purpose To determine the clinical outcomes between two treatment regiments (50 Gray [Gy] vs. 55 Gy in five fractions) among Stage I NSCLC patients treated with SBRT at a state academic medical center. Methods We performed a retrospective analysis of 114 patients with Stage I (T1-2 N0 M0) NSCLC treated at a state academic medical center between October 2009 and April 2019. Survival analyses with treatment regimens of 50 Gy and 55 Gy in five fractions were conducted to detect any improvement in outcomes associated with the higher dose. The primary endpoints of this study included OS, local control (LC), and disease-free survival (DFS). Log-rank test and the Kaplan-Meier method were used to analyze the survival curves of the two treatment doses. The SPSS v.24.0 (IBM Corp., Armonk, NY, USA) was used for statistical analyses. Results The 114 early-stage NSCLC patients (median age, 68 years; range 12 to 87 years) had a median follow-up of 25 months (range two to 86 months). The number of males (n = 72; 63.2 %) exceeded the number of females (n = 42; 36.8 %). The majority of patients in this study were Caucasians (n = 68; 59.6 %) and 46 patients were African Americans (40.4 %). Two-thirds of the patients (n = 76; 66.7 %) were treated with 50 Gy in five fractions, and 38 patients (33.3 %) with 55 Gy in five fractions. The one-, two-, and three-year OS and DFS rates were improved in the patients treated with 55 Gy [OS, 81.7 % vs. 72.8 %; 81.7 % vs. 58.9 %; 81.7 % vs. 46.7 % (p = 0.049)], [DFS, 69.7 % vs. 69.7 %; 61.9 % vs. 55.7 %; 61.9 % vs. 52.0 % (p = 0.842)], compared to those treated with 50 Gy. Adenocarcinoma was the most common histology in both groups (51.3 % and 68.4 %). Failure rates were elevated for the 50 Gy regimen [39 (34.2 %) vs. 12 (8.5 %)]. Three year control rates were (66.3 % vs. 96.6 %; p = 0.002) local control; (63.3 % vs. 94.4 %; p = 0.000) regional control; and (65.7 % vs. 97.1 %; p = 0.000) distant control, compared to those treated with 55 Gy. Conclusion Early-stage NSCLC patients treated with SBRT 55 Gy in five fractions did better in terms of local control, overall survival, and disease-free survival rates compared to the 50 Gy in five fractions group.

Cervical cancer remains a major health challenge in the United States (US), especially among the low socioeconomic and African American populations.The demographics of Mississippi constitute a relatively high percentage of this high-risk population.External beam radiation therapy (EBRT) combined with concurrent chemotherapy and followed by brachytherapy is the gold standard of treatment for stage IB3 through IVA cervical cancer.Arguably, brachytherapy is the most important component of this treatment process.Patterns of Care studies (PCS) and other more recent studies have shown that brachytherapy cannot be omitted or replaced by conventional or image-guided EBRT.The last decade has witnessed the expanding use of image-guided brachytherapy (IGBT).Studies have established the superiority of IGBT over point-based brachytherapy.MRI is associated with superior soft tissue definition compared with CT and is emerging as the new standard of care.The Gynaecological Groupe Européen de Curiethérapie and the European Society for Radiotherapy and Oncology [(GYN) GEC-ESTRO] have recommended that the dose be prescribed to the high-risk clinical target volume (HR-CTV).This volume includes residual tumor present at the time of brachytherapy, the cervix, and any gray areas seen on the scan.The (GYN) GEC-ESTRO has shown that a dose of >8500 cGy delivered in <50 days results in an approximate 10% increase in pelvic control (PC), disease-specific survival, and overall survival (OS) compared to historical controls.The normal tissue toxicity is comparable or better than historical controls as well.This dose, while maintaining normal tissue constraints, may only be achievable with a hybrid intracavitary/interstitial (IC/IS) needle device guided by MRI-based targeting.The University of Mississippi Medical Center (UMMC) has initiated an MRI-based cervical brachytherapy program and has treated 18 patients to date; our experience confirms the above findings.In this report, we propose that MRI guidance is necessary and a hybrid IC/IS needle device is required to achieve adequate dose coverages.

Racial differences in clinical outcomes among laryngeal cancer patients have been reported and Black American patients appear to have worse survival compared to White Americans. However, there are not many studies looking at the potential racial differences in outcomes in T1 Glottic cancers. One of the hypotheses underlying racial differences in clinical outcomes is lack of adequate access to healthcare for the Blacks. Thus, the Blacks may present with more advanced stages at the time of diagnosis, thus leading to poorer outcomes. We hypothesized that since T1 glottic cancer is one of the earliest stages, with the least tumor burden, outcomes should be similar between the two races. At our institution, a safety-net academic medical center, there are no differences in the treatment being given Blacks or Whites, stage-for-stage. To our surprise, we found poorer clinical outcomes for the blacks. What we report here is a hypothesis generating analysis. To evaluate the impact of race (Black vs. White) on the outcome of T1 glottic squamous cell carcinoma (SCCa) in patients treated with radiation therapy (RT) alone. Between 2002 and 2018, twenty-five (37.3%) Black patients and forty-two (62.7%) White patients with T1 glottic SCCa underwent RT in our academic state institution. Chi- square test, Kaplan- Meier method, and Cox regression models were used to assess for racial influence; p-values less than 0.05 were considered statistically significant. The SPSS 24.0 software was used for data analyses. The baseline characteristics of all 67 T1 glottic SCCa patients documented. The median follow-up duration was 51 months (range, 0-266 months). Black patients (n=14; 20.9%) and White patients (n=28; 41.8%) were treated with a conventional schedule (CONV) 2 Gy/ day; total dose 66 Gy/ 7 weeks. Eleven Black patients (16.4%) and White patients (n=14; 20.9%) were treated in a hypo-fractionated (HYPO) schedule 2.25 Gy/ day; total dose 63 Gy/5 weeks. The 5-year overall survival (OS) for Blacks vs. Whites treated with CONV was 51.6 vs. 66.0% (p= 0.001). For those treated with HYPO, the OS was 85.7 vs. 99.6% (p= 0.001). The 5- year local relapse free survival (LRPS) for Blacks vs. Whites treated with CONV was 34.1 vs. 40.9% (p= 0.163) and for those treated with HYPO was 42.6 vs. 72.7% (p= 0.163), showing no statistical significance between the two groups. In the univariate Cox regression analysis, the covariates of ethnicity, RT type, voice-hoarseness, gender, and type of insurance were statistically significant with p-value less than 0.05. However, in the multivariate Cox regression analysis only, the co-variates of ethnicity-Black (HR, 4.39; 95% CI, 1.46-13.17; p=0.008), RT type-CONV (HR, 20.82; 95% CI, 3.63-119.32; p=0.001), voice-hoarseness (HR, 3.80; 95% CI, 1.26-11.41; p=0.017), and gender-male (HR, 7.08; 95% CI, 1.46-34.22; p=0.015) were statistically significant. Race appears to be an independent prognostic factor for OS in T1 glottic cancers. Although local control rates were poorer for Blacks, it didn’t reach statistical significance.

The Centers for Medicare and Medicaid Services has proposed alternate payment models to improve the efficiency and decrease the redundancy of health care. Bundled payments or episode-based care is one example. Herein, we report on the successful implementation of a quality improvement project in which changing the clinical workflow for postoperative radiation treatment to the hip to prevent heterotopic ossification improved the efficiency of patient care and decreased cost by eliminating redundant imaging through multidisciplinary participation. This project is a model for interdisciplinary collaboration to improve patient care and reduce unnecessary health care spending in the era of bundled payment/episodes of care program implementation.

Abstract Objective: To evaluate patterns of patient management in an academic Radiation Oncology department between 3/17/20 and 5/8/20 during the COVID-19 pandemic. Background: As a response to the worldwide COVID-19 pandemic, our Radiation Oncology department instituted a number of measures to limit spread of the disease to our patients and staff. This included prospectively evaluating all new referrals for radiation treatment and determining an appropriate course of action, which if appropriate included delaying the start of radiation, hypofractionation, or using other modalities of treatment prior to start of radiation. Methods: We analyzed data for 82 patients between 3/17/20-5/8/20 to evaluate patterns of management. The chi-squared test was used to evaluate the descriptive characteristics of the study population, with P values ≤ 0.05 considered statistically significant. One sample t-test was used to compare the statistical mean difference between sample variables. Data were analyzed using SPSS 24.0 software (IBM, Armonk, NY, USA). Results: The data set comprised 38% Caucasians and 59% African Americans. An age breakdown revealed 12.3% below age 30, 42% between ages 30-60, and 45.7% over age of 60. When the data were analyzed by gender, we noted a significant difference by site of treatment (p=0.005) and whether immediate treatment was required or not (p=0.029). This likely reflects gender-driven differences in cancer site with patients diagnosed with prostate cancer getting LHRH agonist therapy prior to start of radiation. Hypofractionated radiation schedules were used in 2 patients with cord compression early during the study period compared to 3 patients who received standard fractionation later, and one person elected to go straight to hospice care (p=0.002). Of patients for heterotopic ossification prophylaxis, 3/14 declined radiation and one was over the weight limit of the radiation table (p=0.000). 41% of patients were inpatients. No patients developed COVID-19 during our study period. Conclusion: A prospective evaluation of new patient referrals may have helped mitigate the spread of COVID-19 at our Radiation Oncology facility. This is one of several prospective measures that our department took to protect patients and staff. Citation Format: Sanjay Joseph, Mary Nittala, Paul Roberts, Maurice King, Hiba Ahmed, Ashley Albert, Toms Thomas, Robert Allbright, Satyaseelan Packianathan, Eswarkumar Mundra, Srinivasan Vijayakumar. Prospective planning of radiation treatment at new patient conference during the COVID-19 Pandemic: The University of Mississippi Medical Center experience [abstract]. In: Proceedings of the AACR Virtual Meeting: COVID-19 and Cancer; 2020 Jul 20-22. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(18_Suppl):Abstract nr PO-034.

OBJECTIVE:Adjuvant hysterectomy following chemoradiation (CRT) is a treatment option used worldwide for early-stage cervical cancer but the benefit of hysterectomy in this setting is unclear. An analysis of the National Cancer Database (NCDB) was performed to identify patterns of care and determine the survival impact of adjuvant hysterectomy.METHODS:The NCDB was queried for patients with International Federation of Gynecology and Obstetrics stage IB2 to IIA2 cervical cancer diagnosed from 2010-2014 who underwent preoperative concurrent chemoradiation followed by hysterectomy (CRT+S) or definitive CRT. Overall survival (OS) curves were generated using the Kaplan-Meier method and compared via the log-rank test. Univariable and multivariable logistic regression and Cox regression were used to determine covariables associated with utilization and OS.RESULTS:There were 1,546 patients who met the study criteria, of which 1,407 (91.0%) received concurrent CRT alone and 139 (9.0%) received CRT+S. Four-year OS for the CRT+S group was 82.2% and 74.9% for the CRT group (p=0.036). On subgroup analysis by lymph node status, the 4-year OS for patients without positive pelvic or para-aortic lymph nodes was 84.9% in the CRT+S group vs. 77.8% in the CRT group (p=0.072). On multivariable Cox regression, there was no difference in survival based on treatment group (hazard ratio=0.63; 95% confidence interval=0.06-1.04; p=0.069).CONCLUSION:We found from this hospital database that completion hysterectomy is used infrequently and did not result in a significant survival difference when accounting for other factors.

OBJECTIVE:Primary sarcoma of the cervix is rare and is associated with worse outcomes as compared to other histologies. The purpose of this study was to identify national treatment patterns and outcomes based on histological subtype using the National Cancer Database (NCDB). METHODS:The NCDB was queried for patients with cervical cancer from 2004-2015. Clinico-demographic treatment details were obtained and compared between patients with squamous cell carcinoma (SCC), adenocarcinoma, and sarcoma of the cervix. Multivariable Cox regression and the Kaplan-Meier method was used to examine survival. RESULTS:107,177 patients met inclusion criteria including 81,245 (75.8%) women with SCC, 24,562 (22.9%) women with adenocarcinoma, and 1,370 (1.3%) women with sarcoma. Of the patients with cervical sarcoma, 680 (49.6%) patients had carcinosarcoma or malignant mixed Müllerian tumor, 255 (18.6%) patients had leiomyosarcoma, 197 (14.4%) patients had adenosarcoma, 28 (2.0%) patients had endometrial stromal sarcoma (ESS), 85 (6.2%) patients had rhabdomyosarcoma, and 125 (9.1%) patients had sarcoma not otherwise specified (NOS). Patients with sarcoma were older and more likely to be treated primarily with surgery. On multivariable Cox regression, sarcoma had decreased overall survival (OS) as compared to patients with SCC (hazard ratio=2.17; 95% CI=1.99-2.37; p<0.001). Among patients with sarcoma, 5-year OS was 89.2% for adenosarcoma, 66.2% for rhabdomyosarcoma, 55.6% for leiomyosarcoma, 45.8% for ESS, 31.6% for carcinosarcoma, and 29.2% for sarcoma NOS. CONCLUSIONS:Primary cervical sarcomas have inferior outcomes compared to SCC and adenocarcinoma. Sarcoma NOS and carcinosarcoma have the worst prognosis among sarcoma subtypes.

Peer review systems within radiation oncology are important to ensure quality radiation care. Several individualized methods for radiation oncology peer review have been described. However, despite the importance of peer review in radiation oncology barriers may exist to its effective implementation in practice. The purpose of this study was to quantify the rate of plan changes based on our group peer review process as well as the quantify amount of time and resources needed for this process.

OBJECTIVES:Stereotactic radiation surgery (SRS) and hypofractionated stereotactic radiation surgery (HF-SRS) have become an alternative to external beam radiation therapy (EBRT) in the adjuvant treatment of meningiomas. The purpose of this study was to identify national treatment patterns and survival outcomes for meningiomas on the basis of radiation treatment modality in the adjuvant setting. METHODS AND MATERIALS:The National Cancer Database was queried for patients with meningioma diagnosed between 2010 and 2012. World Health Organization grade I disease with subtotal resection and all cases of grade II disease regardless of the extent of the resection were included. Logistic regression was used to determine factors that were associated with receipt of SRS/HF-SRS compared with EBRT. Cox regression was used to determine covariables associated with differences in overall survival (OS). RESULTS:A total of 802 patients met the inclusion criteria of which 173 patients received SRS/HF-SRS (22%) and 629 patients (78%) received EBRT. The 3-year OS rate was 97.3% for the SRS/HF-SRS group and 93.4% for the EBRT group (P = .018). On subgroup analysis by grade, for grade I the 3-year OS rate was 98.3% for the SRS/HF-SRS group versus 96.7% for the EBRT group (P = .117). For grade II disease, the 3-year OS rate was 94.4% in the SRS/HF-SRS group versus 92.4% in the EBRT group (P = .199). On multivariable analysis, World Health Organization grade II histology (odds ratio [OR]: 0.34; 95% confidence interval [CI], 0.21-0.56; P < .001) and gross total resection (OR: 0.29; 95% CI, 0.15-0.57; P < .001) were associated with a decreased likelihood of receiving SRS/HF-SRS but private insurance (OR: 8.89; 95% CI, 1.15-68.47; P = .036) and Medicare (OR: 10.03; 95% CI, 1.28-78.69; P = .028) were associated with an increased likelihood of receiving SRS/HF-SRS. Year of diagnosis was not associated with receipt of SRS/HF-SRS. The multivariable Cox regression demonstrated a trend toward improved OS for treatment with SRS/HF-SRS (hazard ratio: 0.24; 95% CI, 0.06-1.03; P = .055). CONCLUSIONS:SRS and HF-SRS are associated with similar survival as EBRT; however, SRS/HF-SRS is used infrequently and usage has not increased over time.

PURPOSE:Disparities in the receipt of standard of care based on age have been identified for several types of cancer including cervical cancer. The purpose of this study is to analyze patterns of care and survival for older patients receiving definitive treatment in a large, national cohort. MATERIALS AND METHODS:The National Cancer Database was queried for patients with FIGO/AJCC IB2-IVA cervical cancer diagnosed from 2004 to 2014 who underwent definitive radiation or concurrent chemoradiation. Standard of care was defined as concurrent chemotherapy with external beam radiation and brachytherapy to a total dose ≥70 Gy. Multivariable logistic regression was used to determine factors associated with the receipt of standard of care. Multivariable Cox regression was used to determine covariables associated with differences in overall survival. RESULTS:24,126 patients met inclusion criteria including 4052 women 61-70 years old, 2471 women 71-80 years old, and 1325 women over 80 years old. A smaller percentage of patients over age 60 received standard of care compared to younger aged patients. On multivariable analysis, older patients were less likely to be treated with standard of care. On multivariable Cox regression, ages 71-80 (HR 1.25, 95% CI-1.16-1.36, p < .001) and age > 80 (HR 1.90, 95% CI 1.73-2.07, P < .001) were associated with decreased overall survival. On subgroup analysis for patients with significant comorbidities, treatment with standard of care resulted in increased 5-year OS as compared to incomplete treatment. CONCLUSIONS:Age was found to be an independent predictor for the receipt of standard of care treatment for cervical cancer.

Peer review is an essential component of quality improvement for patient care within the practice of radiation oncology. Various national programs and regulatory agencies have recognized peer review as a critical element in the process of radiation therapy treatment planning, and prospective peer reviewing has resulted in enhanced patient outcomes when this practice is implemented [ 1 Ohri N. Shen X. Dicker A.P. et al. Radiotherapy protocol deviations and clinical outcomes: a meta-analysis of cooperative group clinical trials. J Natl Cancer Inst. 2013; 105: 387-393 Crossref PubMed Scopus (197) Google Scholar , 2 Peters L.J. O’Sullivan B. Giralt J. et al. Critical impact of radiotherapy protocol compliance and quality in the treatment of advanced head and neck cancer: results from TROG 02.02. J Clin Oncol. 2010; 28: 2996-3001 Crossref PubMed Scopus (576) Google Scholar , 3 Cancer Care Ontario. Radiation oncology peer review guidance document. Available at: https://cancercare.on.ca/common/pages/UserFile.aspx?fileId=299876. Accessed March 15, 2017. Google Scholar , 4 Marks L.B. Adams R.D. Pawlicki T. et al. Enhancing the role of case oriented peer review to improve quality and safety in radiation oncology: executive summary. Pract Radiat Oncol. 2013; 3: 149-156 Abstract Full Text Full Text PDF PubMed Scopus (125) Google Scholar ].

*,1Rui He, M.S., 2Elgenaid Hamadain, 3Hamed Benghuzzi, 4Satya Packianathan, 5Madhava R. Kanakamedala, 6Michelle Tucci, 7Robert M. Allbright, 8Sophy H. Mangana, 9Srinivasan Vijayakumar and 10Claus Chunli Yang 1Medical Physicist, Assistant Professor, Department of Radiation Oncology, University of Mississippi Medical Center, Jackson, Mississippi 2Elgenaid Hamadain, Biostatistician, Professor, Department of Diagnostic and Clinical Health Sciences, University of Mississippi Medical Center, Jackson, Mississippi 3Hamed Benghuzzi, Professor, Department of Diagnostic and Clinical Health Sciences, University of Mississippi Medical Center, Jackson, Mississippi 4Satya Packianathan, Radiation Oncologist, Assistant Professor, Department of Radiation Oncology, University of Mississippi Medical Center, Jackson, Mississippi 5Madhava R. Kanakamedala, Radiation Oncologist, Assistant Professor, Department of Radiation Oncology, University of Mississippi Medical Center, Jackson, Mississippi 6Michelle Tucci, Professor, Department of Orthopedic Surgery, University of Mississippi Medical Center, Jackson, Mississippi 7Robert M. Allbright, Radiation Oncologist, Assistant Professor, Department of Radiation Oncology, University of Mississippi Medical Center, Jackson, Mississippi 8Sophy H. Mangana, Radiation Oncologist, Assistant Professor, Department of Radiation Oncology, University of Mississippi Medical Center, Jackson, Mississippi 9Srinivasan Vijayakumar, Radiation Oncologist, Professor, Department of Radiation Oncology, University of Mississippi Medical Center, Jackson, Mississippi 10Claus Chunli Yang, Medical Physicist, Professor, Department of Radiation Oncology, University of Mississippi Medical Center, Jackson, Mississippi

BACKGROUND:Pneumocephalus is a rare phenomenon that can occur as a complication after operations involving the thoracic discs, following thoracotomy for tumor resection, and after an intracranial operation or cranial trauma. This complication frequently occurs when a tumor is located in the costovertebral angle and an operative intervention creates a tear in the dura resulting in a pleural-dural fistula.CASE PRESENTATION:We describe the case of a 58-year-old man with an inoperable superior sulcus tumor who developed pneumocephalus after the initiation of chemoradiation secondary to a pleural-dural fistula.CONCLUSIONS:Although a rare occurrence, pneumocephalus should be considered when patients with tumors in the superior sulcus treated with radiation develop neurologic symptoms characteristic of increased intracranial pressure.

PURPOSE:To compare the short-term toxicity and dosimetry of tandem and ring (TR), and tandem and ovoid (TO) applicators in treatment of gynecologic malignancy.MATERIAL AND METHODS:Following pelvic external beam radiation therapy (EBRT), a total of 52 computed tomography-based plans from 13 patients with cervical cancer (FIGO IB2-IIIB) were evaluated for HDR brachytherapy. Prescription was 7 Gy to the ICRU point A for four weekly fractions. Gastrointestinal and genitourinary toxicities were evaluated. Clinical target volume (CTV) and organs at risk were delineated on CT scans. Bladder, rectum, and sigmoid mean doses and D2cc were calculated. Treatment time and irradiated tissue volume were compared. Percent of CTV receiving 100% (CTV100%) of the prescribed dose as well as the percent of the prescription dose covering 90% of the CTV (D90) were evaluated.RESULTS:Gastrointestinal and genitourinary toxicities were not different between TO and TR applicators. No significant differences in the dose to the right and left point A, or the left point B were observed. TO delivered a higher dose to right point B. Organs at risk doses were similar between the two applicators, except mean rectal dose was lower for TO applicator. Overall, TO treats a larger tissue volume than TR. Mean treatment time was shorter for TR. Tumor coverage (D90 and CTV100%) was equivalent between TO and TR applicators.CONCLUSION:Although TO treats a larger tissue volume than TR, short-term toxicities and tumor coverage are similar. Long-term clinical outcomes will be elucidated with longer follow up period.

The incidence of carcinoma of the cervix has continuously declined over the past decades because of effective screening. The International Federation of Gynecology and Obstetrics (FIGO) clinical staging, though universally used, is considered inadequate either to determine the type of treatment or to predict treatment outcome. Over the last 10 years, treatment of cervical cancer has become increasingly sophisticated with advances in external beam and brachytherapy in the radiotherapeutic management of this carcinoma. In particular, brachytherapy plays a major role in enhancing both local control and survival. Experience to date suggests that either high-dose-rate (HDR) or low-dose-rate (LDR) brachytherapy, when properly applied, can be effective and give similar rates of local control with minimal complications. This article analyzes the current literature regarding treatment techniques of radiotherapy with special emphasis on brachytherapy integration to optimize radiotherapy treatment outcome.