Assessment of acute gastro-intestinal and genito-urinary toxicities in the cervical cancer patients using cobalt-60 based high dose rate intra cavitary brachytherapy

Context: Recently introduced Cobalt-60 HDR source has longer half life of 5.2 years compared with 73.8 days of Ir-192, more economical and attractive for low resource settings. Aim: The purpose of this study to know acute gastrointestinal and genitourinary toxicities associated with Co-60 source in HDR ICRT of cervical cancer patients and its comparison with similar toxicities in Ir-192 based HDR ICRT. Settings and Design: Prospective study Methods and Material: The study was completed on 65 patients of carcinoma cervix. External beam radiotherapy (EBRT) of dose 45-50 Gy in 25 fractions @ 180-200cGy per fraction delivered over 5 days per week using teletherapy Cobalt 60 machine. ICRT was started after one week of completion of EBRT. Fletcher suite applicators were used for brachytherapy in all patients. Total 3 sessions of ICRT, 7Gy each, were delivered 72 hours apart. The acute gastro-intestinal and genito-urinary toxicities were assessed using Common Terminology Criteria for Adverse Events version 4.03 (CTCAE). The only highest grade of GU and GI toxicity was used for final analysis and patients were kept in follow up for 3 months in this study. Statistical analysis used: Comparison with previous studies Results: Only 2 patients (3%) had grade 3 acute diarrhea. In other studies, the reported rates of acute toxicities ≥ grade 3 ranged from 0%–8% for gastrointestinal and 0%–3% for genitourinary toxicities. Conclusions: The acute gastrointestinal and genitourinary toxicities of high-dose-rate intracavitary brachytherapy using Co-60 radionuclide source is low and comparable with Iridium-192. Additionally, Cobalt 60 has economic advantage over Ir-192. Thus, it is more suitable for low economic resource settings.