कैंसर विज्ञान एवं चिकित्सा

Background: Cancer of the uterine cervix is the eight most common cancer among women worldwide and third among all malignancies and the second most common cancers in female in Bangladesh. The treatment of cervical cancer requires multidisciplinary approaches Concurrent chemoradiation is the treatment of choice in locally advanced carcinoma cervix uteri. Radiotherapy is the primary local treatment for most patients having FIGO stage IIB to IVA diseases. The success of treatment depends on a careful balance between EBRT and Brachythcrapy that optimizes the dose to tumor. Iridium-192 is highly used radionuclide for modern remote after loading HDR brachytherapy till date. Recently Cobalt-60 source is available with miniature size and identical physical properties for remote afterloaders.

Methods: Ninety-eight patients with biopsy proven locally advanced carcinoma of the uterine cervix were enrolled in the study. Arm A was formed comprising 49 patients who were treated by Ir¹⁹² HDR brachytherapy and Arm B formed with equal number of 49 patients who received HDR brachytherapy treatment with Co⁶⁰ radionuclide. This prospective observational study was carried out to compare the treatment effect between two Arm.

Results: 98 patients were enrolled in the study with an age ranges from 35 to 63 years. Most of the patients presented with stage IIB disease, consisting of 64 patients (65.3%). Among them 79 patients had squamous cell carcinoma (80.60%), adenocarcinoma trailing with 15 patients (15.3%) and rest were adenoid-squamous carcinoma 3 and small cell carcinoma 1. In all three insertions, urinary bladder dose distribution was slightly smaller by HDR Co⁶⁰ irradiation than HDR Ir¹⁹² exposure. These differences were statistically significant in first two insertions but not in third one

Conclusion: In this study radiation dose distribution at OARs i.e. urinary bladder and rectum were compared between Arm A and Arm B. In all three insertions in urinary bladder the mean dose distribution was slightly smaller in HDR Cobalt-60 irradiation than HDR Iridium-192 exposure. These differences were statistically significant in first two insertions but not in third one. In case of rectum point, the mean dose distribution were significantly lower in all three insertions of Co⁶⁰ exposure than Ir¹⁹² exposure. So that considering the long half life and low cost, Co⁶⁰ can be a acceptable alternative radionuclide’s used in HDR brachytherapy.

Clear cell carcinomas (CCCs) occur most often in young women (median age: 20 years) even before the first pregnancy. It is essential to be conservative and to respect the genital system as much as possible to preserve ovarian hormonal function and fertility. Mutations in KRAS, BRAF, and TP53 are present in some clear cell carcinomas, but their frequency is generally low. Mutations predicted to deregulate PI3K/PTEN signaling. Because of resistance to the usual platinum and taxane chemotherapies, the advanced stages have a much worse prognosis than that of serous tumors. Thus, some studies have suggested that CCCs may be more sensitive to a combination of irinotecan than paclitaxel-based chemotherapy.

The low α/β ratio in prostate cancer has prompted several teams to propose and evaluate hypofractionated protocols for moderate or stereotactic radiotherapy, in order to deliver larger doses per session over a shorter spread. This allows a better observance of the treatment, while arriving at equivalent radiobiological doses, or even higher than in the standard irradiation protocols. Moreover, the fear of generating intolerable toxicities, especially urinary and gastrointestinal compromising the quality of life of patients has always been a barrier to the generalization and approval of these schemes hypofractionated by all centers. The objective of this article is to present several studies evaluating hypofractionated radiotherapy for localized prostate cancer, whether performed alone or as an adjunct to surgery. We will also discuss the role of new radiotherapy techniques and control imaging in the realization of this treatment. Finally, we discuss the practical recommendations of the hypofractionated protocol.