16 Cervix Carcinoma

Cervix Cancer 349

10 Monitoring during Brachytherapy 10.1 LDR, MDR, PDR brachytherapy Monitoring during the implant has two goals: to check the quality of the irradiation and to assure good patient tolerance. The position of the applicator inside the patient must be checked daily for every standard applicator. With a mould applicator a radiograph must be taken the day after the implant; these films are the basis for the computerised dosimetry, because after the second day, the applicator and consequently the radioactive sources keep their definitive position until the end of the irradiation. MDR and PDR brachytherapy is systematically accomplished with a remote afterloading machine; nowadays, LDR brachytherapy is also performed in >90% of cases with an afterloading device. The aim of a remote afterloading machine is total radioprotection for the personnel and the patient´s family. The patient tolerates the treatment better physically and psychologically and dose distribution can be optimised (possibilities of partial disconnection, change of source length during the application). Medical monitoring is comparable to that of the different LDR brachytherapy procedures. Several days are necessary, usually from one day and a half to six days. Usually, patients are treated with heparin to prevent thromboembolic disorders (less than 1% in modern LDR brachytherapy experience). Antibiotics are not prescribed routinely (“prophylactially”), but only if there is an urinary or other infection. Symptomatic treatment for pain is given, if necessary. If the brachytherapy lasts longer than one or two days, rectal discharge must be avoided. A specific diet for food therefore must be followed the days before application, excluding for example vegetables, fruits, and fresh bread. 10.2 HDR Brachytherapy Mild forms of acute bladder reactions occur regularly as side effects immediately after HDR brachytherapy and usually disappear spontaneously within 1 or 2 days. No specific treatment is necessary.

11 Results 11.1 Local control and survival

Results of treatment for cervix carcinoma are often difficult to compare because of differences in the classification used and, above all, because of the different treatment schedules and methods of brachytherapy (techniques, doses, volumes, dose rates) (34). For clarity, the main results are presented essentially in table form, according to stage distribution and to the main therapeutic approaches as previously presented. Other patient and treatment related factors, which are also of major importance, such as tumour volume (3,88), and overall treatment time (29,45), are not dealt with in the following presentation of results. For limited disease (stage IB, IIA) radiotherapy or surgery may be used with similar effects on outcomes (27). However, adverse side effects in the urinary tract are more pronounced after surgery (69).