A dosimetric comparison between applicators used for brachytherapy in carcinoma cervix - A single-institute prospective study.

INTRODUCTION: Cervical cancer is the second most common cancer among Indian women. Radical radiotherapy with external beam radiation therapy (EBRT) and brachytherapy is the standard treatment for FIGO stage IB2 to IVA. An appropriate selection of brachytherapy applicator is needed according to the patient's anatomy. The two most commonly used applicators for intracavitary radiotherapy (ICR), Fletcher's and Henschke, have dosimetric differences which are not well studied with two-dimensional (2D)-based planning which is the most common method used for women with carcinoma cervix in India. The purpose of our study was to compare and evaluate the dosimetric differences between these two applicators, which would help in better selection of the applicator in cervical cancer patients. MATERIALS AND METHODS: This is a single-institute prospective study. Fifty patients randomly included in the study received EBRT and ICR by Ir192 HDR remote afterloading technique with computer-based 2D planning. Fletcher's and Henschke applicators were used alternately for first two fractions. RESULTS: The results of the study showed lower bladder and rectal doses with Fletcher's applicator and similar doses to point A for both applicators. However, point B doses are lower with Fletcher's applicator. CONCLUSION: Our results showed a favorable dosimetry with Fletcher's applicator in ICR of carcinoma cervix. The feasibility of placement is much better for Henschke but dosimetric advantages of Fletcher's encourage use of Fletcher's applicator for patients with favorable anatomy to reduce organs at risk doses but with the disadvantage of lower dose to point B.