Back Ground:

Carcinoma cervix is the most common gynecological cancer and fourth most common malignancy in women in the world.Radiotherapy with or without chemotherapy has shown promising result both in terms of local control and survival rates. Toxicities due to normal pelvic organ irradiation is causing significant morbidity during and after treatment. Acute toxicities like gastrointestinal, genitourinary, actions are the most common and challenging events of radiotherapy . With the use of more conformal treatments like three dimensional conformal radiotherapy (3D–CRT), acute genitourinary and gastroinestinal toxicities can be reduced, which in turn depend largely on bladder filling during treatment.This present study aimed at assessing these common toxicities largely in relation with urinary bladder filling.

Material and Methods:

This is a retrospective study in which total 26 patients were included, and 13 patients were recruited in each arm. Patients in Arm A treated with 2–Dimensional conventional radiotherapy planning without bladder protocol and in Arm B patients treated with 3–DCRT planning with bladder protocol.In Arm–B patients are asked to empty the bladder and  set with knee rest immobilisation device on couch and  planning was done. In Arm–B, patients are asked to empty the bladder first and then asked to drink 500 ml of water and  wait for 30 minutes, after that patient was set on CT couch with Knee rest immobilization and planning CT was taken and images were transferred to treatment planning system. planning was verified and patient treated with 3D–CRT technique. Acute complications such as gastroenteritis and cystitis were documented as per RTOG toxicity criteria(6) in both arms.

Results:

Acute gastroenteritis grade 1 had been shown by 3(23%)patients in Arm A and 6(46%)patients in Arm B .5(38.4%)patients in Arm A and 2(15.3%)patients in Arm B had grade 2 reactions. 5(38.4%)patients in Arm A and2(15.3%)patients in Arm B had grade 3 reactions. Grade 4 reactions are not observed in both arms. Acute genitourinary reactions (cystitis) grade 1 has been shown by 7(53.8%)patients in Arm A and 6(46%) patients in Arm B . 3(23%)patients in Arm A and 1(7.6%) patient in Arm B had grade2 reactions.3(23%)patients in Arm A and 1(7.6%)patient in Arm B had grade3 reactions. Grade 4 reactions are not observed in both Arms.

Conclusion:

 From our study, it may be concluded that over all incidence of acute gastrointestinal and genitourinary complications, especially grade 2 or more are less with bladder protocol compared to no bladder protocol during external beam radiotherapy treatment of carcinoma cervix with radical intent.