الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Cervical cancer ranked as the third most common cancer among women worldwide. Brachytherapy (BT), in conjunction with External-beam radiation and chemotherapy, is the standard of care in the curative management of locally advanced cervical cancer. WPRT treatment results in the irradiation of large volumes of small and large bowel, rectum and bladder. Therefore, gastrointestinal and genitourinary symptoms are among the most important acute and chronic toxicities in these patients.
To improve treatment side effects , advanced techniques are required to allow delivering adequate doses to both tumor and areas of lymphatic drainage, while at the same time sparing normal structures. Three dimensional conformal radiation therapy (3D-CRT) as well as intensity-modulated radiation therapy (IMRT) clearly improve dose conformity and optimize the doses to the target volumes without increasing the dose to the critical organs.
The present study included 45 patients with locally advanced (stage IB-IIIB) non metastatic cervical cancer presented to the department of Radiotherapy, Vienna Medical University. The patients in this study were divided into two groups. Group A (therapeutic group) included 30 female patients and Group B (imaging group) included 15 female patients with locally advanced cervical cancer.
The purpose of this study was to report the clinical outcomes using The IMRT for treatment of locally advanced cervical cancer, comparing it with conformal radiotherapy in terms of acute and chronic toxicity. Group A was be subdivided two subgroups according to type of EBRT modality; where
Group A1: including 15 patients with locally advanced cervical cancer were treated with 3D-conformal whole pelvis radiotherapy then image guided high dose rate (HDR) brachytherapy.
Group A2: including 15 patients with locally advanced cervical cancer were treated with intensity modulated whole pelvis radiotherapy then image guided HDR brachytherapy.
Most of the patients experienced mild acute toxicity and none required interruption of treatment. Moreover, the toxicity profile of the IMRT patients compared favorably with that of the conformal RT group. There were higher incidence of acute GIT toxicities occurred in patients treated with 3D CRT than in those treated with IMRT. Diarrhea was the most frequent acute GIT toxicity. Diarrhea and abdominal pain developed in 73.3% and 40% of patients of group A1 compared to 60% and 13% of group A2 respectively.
The rate of grade 2 acute GIT toxicity was lower in the IMRT group and the frequency of medication (anti-diarrheal) used was reduced. Also late GIT toxicities were developed more frequently in patients treated with 3D CRT where 60% of patients of group A1 developed GIT toxicities compared to 46.7% of group A2. only one patients in group A2 suffered from late sever GIT toxicity as she had rectovaginal fistula.
The same was reported for genitourinary toxicity where All acute genitourinary symptoms were frequently higher in patients received 3D CRT compared to patients received IMRT. The most frequently encountered symptom was frequency of urination where grade II was reported in 20% and 6% of patients of groups A1 and A2 respectively. Also Acute grade I haematuria was seen in 26.7% of patients in group A1 and in 6.7% of group A2.