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Background: The course, the origin of the branch, and the division of the aorta may vary and the aortic bifurcation level and branching can be determined by arteriogram, magnetic resonance imaging, computed tomography (CT) scan, and cadaveric dissection. Aims and Objectives: This study aimed to find the variation in aortic bifurcation levels in cervical malignancy patients who underwent radiotherapy. Materials and Methods: Between January 2018 and December 2022 previously untreated, histologically proven squamous cell carcinoma of the cervix patients who received radiotherapy in our department were selected for this retrospective analysis. A planning contrast-enhanced CT scan with a 3 mm slice thickness was done in a CT simulator to delineate the target volume and aorta, common iliac vessels in all patients. Results: 407 cervical carcinoma patients who received radiotherapy in Linear Accelerator (LINAC) were included in this analysis. The aortic bifurcation is most commonly situated at the level of the L3-L4 intervertebral disc in 290 (71.25%) cases with a range between the upper L3 body and the lower L5 body. The common iliac bifurcation was situated at the level of L5-S1 in 338 cases (83.04%) and S1 vertebral body in 63 cases (15.47%). The average length of the left common iliac artery was 4.58 cm and the right common iliac artery was 4.44 cm. The diameter of the aorta at the level of just before the bifurcation is 1.39 cm. The average diameter of the left common iliac artery and right common iliac artery were 1.21 cm and 1.13 cm, respectively. The right and left take-off angles (αR, αL) are 25.58° and 23.78°, respectively. Conclusion: The knowledge regarding the anatomic variation of branching and bifurcation of the aorta of utmost importance for surgical procedures, interventional radiology procedures, and proper radiotherapy treatment planning. Acknowledging these anatomic variations may also reduce complications. [ABSTRACT FROM AUTHOR]

INTRODUCTION Carcinoma cervix is one of the most deadly killer malignancy worldwide with about 500000 diagnosed cases per year and 233000 deaths.In our country disease burden is about 100000 cases per year(2001). A total dose of EBRT of 45 to 55 Gy appears to be sufficient for microscopic disease in the pelvic nodes in most patients.It is customary to treat lymph nodes known to contain gross disease and heavily involved parametria to a total dose of 60 to 65 Gy including the contributions from brachytherapy systems. All treatment, including external-beam and brachytherapy must be concluded within 56 days from initiation of treatment. American Brachytherapy Society proposes that Brachytherapy may be initiated earlier, but no earlier than approximately 20 Gy, if the physician determines that the applicator placed at this time point would provide adequate tumour coverage andsparing of normal tissues. Alternatively, if 45 Gy is delivered to the whole pelvis prior to brachytherapy, two brachytherapy insertions per week should be given to avoid treatment prolongation. This was a prospective study to evaluate the effects of treatment duration shortening with the recommendation of ABS comparing with conventional EBRT followed by brachythrapy to complete the treatment with respect to tumour response, disease free survival, quality of life & toxicity in case of locally advanced carcinoma cervix. AIM & OBJECTIVE a) Primary endpoint -Assessment of Tumour response b)Secondary endpoint- • Assessment of disease free survival • Assessment of quality of life • Assessment of toxicity(acute & late). MATERIALS AND METHODS From January 2016 -June 2017, Patients with biopsy proven cases of locally advanced cancer( IIB - IVA) of cervix coming in the OPD of Medical College Kolkata, for management were allocated randomly to one of the following arms, using a computer generated random number table: In study arm, (n=30) patients were treated with EBRT by Tele-cobalt machine to a dose of 50 Gy in 25 fractions over 5 weeks. The high dose rate intracavitary brachytherapy using Ir192 interdigitated from the 3rd week of EBRT, was given in 3fractions(single fraction of 7Gy per week) . EBRT was omitted on the day of brachytherapy and the missed fraction was administered on Saturday(Treatment completion within 5weeks). In control arm (n= 30) patients were treated with external beam radiotherapy by Tele-cobalt machine to a dose of 50Gy in 25# followed by HDR brachytherapy starting 1 week after (Treatment completion within 8weeks). In both arm concurrent Cisplatin 40mg/m2 weekly, was given. Response was assessed using RECIST version 1.1. Radiation induced toxicities was assessed and graded according to RTOG/ EORTC acute and late toxicity grading criteria. All statistical analysis were done by IBM SPSS software, Version 23. RESULTS In this study, youngest included patients were in their 4th decade of life and elderly patients were in their 7th decade of life. Minimum follow up period was 7 month and maximum follow up period was 18 month with a meanperiodwas12.775month. Both the arms were comparable in demographic & pre treatment parameters, most commonly patients presented with FIGO stage III (67.5%) non-bulky(<4cm) disease.All the patients were treated with pretreatment haemoglobin >11 gm/dL and mean pretreatment Hb was 11.77gm/dL(12.5±2.5). Dosimetry of ICRT, in view of Point A dose, 2cc bladder dose, 2cc rectum dose was comparable in both arms. Post Brachytherapy locoregional response after 6 months was better in Interdigitated arm( p = 0.03) . Acute toxicities like, Nausea (p= 0.056), vomiting ( p= 0.032), proctitis (p= 0.046), haematochezia (p= 0.049) were more in Interdigitated arm. Late toxicities like vaginal stricture (p= 0.027) & dyspareunia (p= 0.007) was more in study arm though quality of life score was comparable with better 1 yr survival in study arm. CONCLUSION In conclusion, it can be said that Interdigitated Brachytherapy is a viable option to reduce treatment duration in cervical cancer treatment even in our Indian population with acceptable acute toxicity and little more late toxicity expected, which to be evaluated with a large randomised trial in our population. Large study also needed to evaluate potential benefit of interdigitation in achieving better locoregional control, disease free survival and overall survival. [ABSTRACT FROM AUTHOR]