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Matsuda Y, Nagamine Y, Irie T, Goto T. Effects of pain management using nonsteroidal anti-inflammatory drug suppositories during brachytherapy for cervical cancer: A single-center prospective observational study. Brachytherapy 2024; 23:257-265. [PMID: 38462384 DOI: 10.1016/j.brachy.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 12/18/2023] [Accepted: 01/07/2024] [Indexed: 03/12/2024]
Abstract
INTRODUCTION No standardized pain management protocol exists for intracavitary brachytherapy, and various methods of analgesia have been used in different countries and institutions. This study aimed to investigate the effects of pain management during intracavitary brachytherapy using nonsteroidal anti-inflammatory drugs (NSAIDs) or acetaminophen suppositories. METHODS In this single-center, prospective, observational study, patients undergoing intracavitary brachytherapy for cervical cancer completed a questionnaire survey after each brachytherapy session, which comprised questions regarding pain intensity, satisfaction with analgesia, and desire for effective anesthesia. RESULTS Data analysis was performed using data from 100 brachytherapy sessions of 27 patients. The median numerical rating scale (NRS; 0-10) score for each intracavitary brachytherapy session was 3-4. The median satisfaction scale score for analgesia (5-point scale, 1-5) for each session was approximately 4. Eight patients (29.6%) answered that they desired anesthesia more effective than suppositories at any session of brachytherapy. A comparison of the high (NRS ≥4) and low (NRS ≤3) NRS groups during the first session revealed that the high NRS group tended to have higher NRS scores and lower satisfaction with analgesia during all sessions. A positive correlation was observed between tumor size and the NRS score during the first brachytherapy session. CONCLUSIONS The NRS score was approximately 3-4, and satisfaction with analgesia was approximately 4 out of 5 when NSAIDs or acetaminophen suppositories were used as analgesics during intracavitary brachytherapy for cervical cancer. Although the current pain management protocol is clinically acceptable, inadequate analgesia is indicated in approximately 30% of patients.
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Affiliation(s)
- Yuko Matsuda
- Department of Anesthesiology and Critical Care Medicine, Yokohama City University Hospital, Yokohama, Japan
| | - Yusuke Nagamine
- Department of Anesthesiology and Critical Care Medicine, Yokohama City University Hospital, Yokohama, Japan.
| | - Tomoya Irie
- Department of Anesthesiology and Critical Care Medicine, Yokohama City University Hospital, Yokohama, Japan
| | - Takahisa Goto
- Department of Anesthesiology and Critical Care Medicine, Yokohama City University Hospital, Yokohama, Japan
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Ndarukwa S, Flores JA, Rosenblatt E, Berger D, Akbarov K, Hedden N, Chopra S, Hande V, Rubio AP. Brachytherapy Workflow Practices: Analysis of Different Workflow Scenarios in Patients With Cervical Cancer and Impact on IGBT Implementation-An IAEA Study. JCO Glob Oncol 2024; 10:e2300336. [PMID: 38386958 PMCID: PMC10898675 DOI: 10.1200/go.23.00336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 10/19/2023] [Accepted: 12/19/2023] [Indexed: 02/24/2024] Open
Abstract
PURPOSE The workflow of brachytherapy (BT) is an essential aspect of treatment to consider in image-guided brachytherapy (IGBT). It has an overarching effect influencing patient throughput and the number of cancer treatments that can be performed as it occupies equipment, space, and personnel. There is limited research addressing this issue. Under the International Atomic Energy Agency's Coordinated Research Activity titled IGBT for cervix cancer: An implementation study, our study analyzes various scenarios in the clinical workflow of BT delivery for cervical cancer. It aims to determine the extent to which these scenarios allow the routine implementation of IGBT. With this information, current barriers and individualized adaptations to efficient workflows can be identified to enhance the global application of IGBT, leading to better cervical cancer treatment. MATERIALS AND METHODS A web-based poll of questions regarding practices in BT workflow was presented to 62 participants from low-, lower middle-, upper middle-, and high-income countries (19 countries). RESULTS This study highlighted diversity in BT practices across countries, income levels, and regions. It identified variations in workflow, patient throughput, and resource availability, which can have implications for the efficiency and quality of BT treatments. Scenario A, utilizing multiple locations for the steps of the BT procedure, was the most commonly used. The availability of resources, such as imaging devices and trained personnel, varied among the participating centers and remained challenging for IGBT implementation and sustainability. CONCLUSION The design of the BT facility plays a vital role in improving efficiency, with a dedicated BT suite contributing to an efficient workflow but limiting patient throughput, especially for high-volume centers. Although IGBT is effective, its implementation requires consideration of various logistical challenges and should be individualized.
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Affiliation(s)
- Sandra Ndarukwa
- Applied Radiobiology and Radiotherapy Section, Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Jerickson Abbie Flores
- Applied Radiobiology and Radiotherapy Section, Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Eduardo Rosenblatt
- Applied Radiobiology and Radiotherapy Section, Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Daniel Berger
- Section of Dosimetry and Medical Radiation Physics, Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Kamal Akbarov
- Applied Radiobiology and Radiotherapy Section, Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Natasha Hedden
- Applied Radiobiology and Radiotherapy Section, Division of Human Health, International Atomic Energy Agency, Vienna, Austria
| | - Supriya Chopra
- Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Varsha Hande
- Advanced Centre for Treatment Research and Education in Cancer (ACTREC), Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Alfredo Polo Rubio
- City Cancer Challenge, Technical Cooperation and Capacity Development, Geneva, Switzerland
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Becerra-Bolaños Á, Jiménez-Gil M, Federico M, Domínguez-Díaz Y, Valencia L, Rodríguez-Pérez A. Pain in High-Dose-Rate Brachytherapy for Cervical Cancer: A Retrospective Cohort Study. J Pers Med 2023; 13:1187. [PMID: 37623438 PMCID: PMC10456084 DOI: 10.3390/jpm13081187] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 07/18/2023] [Accepted: 07/24/2023] [Indexed: 08/26/2023] Open
Abstract
High-dose-rate brachytherapy (HDR) is part of the main treatment for locally advanced uterine cervical cancer. Our aim was to evaluate the incidence and intensity of pain and patients' satisfaction during HDR. Risk factors for suffering pain were also analyzed. A retrospective study was carried out by extracting data from patients who had received HDR treatment for five years. Postoperative analgesia had been administered using pre-established analgesic protocols for 48 h. Pain assessment was collected according to a protocol by the acute pain unit. Analgesic assessment was compared according to analgesic protocol administered, number of needles implanted, and type of anesthesia performed during the procedure. From 172 patients treated, data from 247 treatments were analyzed. Pain was considered moderate in 18.2% of the patients, and 43.3% of the patients required at least one analgesic rescue. Patients receiving major opioids reported worse pain control. No differences were found regarding the analgesic management according to the intraprocedural anesthesia used or the patients' characteristics. The number of inserted needles did not influence the postoperative analgesic assessment. Continuous intravenous infusion of tramadol and metamizole made peri-procedural pain during HDR mild in most cases. Many patients still suffered from moderate pain.
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Affiliation(s)
- Ángel Becerra-Bolaños
- Department of Anesthesiology, Intensive Care and Pain Medicine, Hospital Universitario de Gran Canaria Doctor Negrín, 35010 Las Palmas de Gran Canaria, Spain; (Y.D.-D.); (L.V.); (A.R.-P.)
- Department of Medical and Surgical Sciences, Universidad de Las Palmas de Gran Canaria, 35010 Las Palmas de Gran Canaria, Spain
| | - Miriam Jiménez-Gil
- Department of Anesthesiology, Complejo Hospitalario Universitario Materno Infantil, 35016 Las Palmas de Gran Canaria, Spain;
| | - Mario Federico
- Radiation Oncology Department, Hospital Universitario de Gran Canaria Doctor Negrín, 35010 Las Palmas de Gran Canaria, Spain;
| | - Yurena Domínguez-Díaz
- Department of Anesthesiology, Intensive Care and Pain Medicine, Hospital Universitario de Gran Canaria Doctor Negrín, 35010 Las Palmas de Gran Canaria, Spain; (Y.D.-D.); (L.V.); (A.R.-P.)
| | - Lucía Valencia
- Department of Anesthesiology, Intensive Care and Pain Medicine, Hospital Universitario de Gran Canaria Doctor Negrín, 35010 Las Palmas de Gran Canaria, Spain; (Y.D.-D.); (L.V.); (A.R.-P.)
| | - Aurelio Rodríguez-Pérez
- Department of Anesthesiology, Intensive Care and Pain Medicine, Hospital Universitario de Gran Canaria Doctor Negrín, 35010 Las Palmas de Gran Canaria, Spain; (Y.D.-D.); (L.V.); (A.R.-P.)
- Department of Medical and Surgical Sciences, Universidad de Las Palmas de Gran Canaria, 35010 Las Palmas de Gran Canaria, Spain
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Song S, Han D, Zhang N, Mao Z, Guo X, Cheng G. The MRI-guided two adaptive brachytherapy fractions versus one adaptive brachytherapy fraction in one application for the cervical cancer: a retrospective study. Radiat Oncol 2023; 18:46. [PMID: 36879287 PMCID: PMC9990264 DOI: 10.1186/s13014-023-02237-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 02/23/2023] [Indexed: 03/08/2023] Open
Abstract
PURPOSE This study retrospectively compared the clinical and toxicity outcomes for the cervical cancer of the MRI-guided two adaptive brachytherapy (IGABT) fractions versus one IGABT fraction in one application. METHODS One hundred and twenty patients with cervical cancer received external beam radiotherapy combined with or without concurrent chemotherapy, which was followed by the IGABT. The IGABT in 63 patients had one IGABT in each application (Arm 1), while in the other 57 patients, at least one treatment was two continuous IGABT every other day in one application (Arm 2). Clinical outcomes including overall survival (OS), cancer specific survival (CSS), progression free survival (PFS), local control (LC) were analyzed. Brachytherapy-related toxicities were evaluated, which included pain, dizziness, nausea/vomiting, fever/infection, blood loss during the removal of applicator and needles, the deep venous thrombosis, and other acute toxicities. The Common Terminology Criteria for Adverse Events (CTC-AE 5.0) was used to evaluate the incidence and severity of toxicities of the urinary system, lower digestive system, and reproduction system. Kaplan-Meier and the Log-rank test were used to analyze the clinical outcomes. RESULTS The median follow-up time of the patients in Arm 1 and Arm 2 was 23.5 and 12.0 months, respectively. The overall treatment time was significantly shorter in Arm 2 than Arm 1 (60 vs. 64 d; P = 0.017). The OS, CSS, PFS, and LC in Arm1 and Arm 2 was 77.8% vs. 86.0% (P = 0.632), 77.8% vs. 87.7% (P = 0.821), 68.3% vs. 70.2% (P = 0.207), and 92.1% vs. 94.7% (P = 0.583), respectively. The highest NRS of the pain during brachytherapy waiting period (2.22 ± 1.84 vs. 3.02 ± 1.65; P < 0.001) and at the time of the removal of the applicator (4.69 ± 1.49 vs. 5.30 ± 1.18; P < 0.001) in the patients who received one hybrid intracavitary and interstitial brachytherapy (IC/ISBT) in one application and two continuous IC/ISBT every other day in one application were significantly different. So far four patients with grade 3 late toxicities have been reported. CONCLUSIONS The findings of this study demonstrated that the two continuous IGABT every other day in one application is a logistically applicable, safe, and effective treatment strategy that could shorten the overall treatment time and reduce the medical cost, comparing with the one IGABT in one application.
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Affiliation(s)
- Shanshan Song
- Department of Radiation Oncology, China-Japan Union Hospital of Jilin University, No.126 Xiantai Street, Changchun, China
| | - Dongmei Han
- Department of Radiation Oncology, China-Japan Union Hospital of Jilin University, No.126 Xiantai Street, Changchun, China
| | - Ning Zhang
- Department of Radiation Oncology, China-Japan Union Hospital of Jilin University, No.126 Xiantai Street, Changchun, China
| | - Zhuang Mao
- Department of Radiation Oncology, China-Japan Union Hospital of Jilin University, No.126 Xiantai Street, Changchun, China
| | - Xin Guo
- Department of Radiation Oncology, China-Japan Union Hospital of Jilin University, No.126 Xiantai Street, Changchun, China
| | - Guanghui Cheng
- Department of Radiation Oncology, China-Japan Union Hospital of Jilin University, No.126 Xiantai Street, Changchun, China.
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Mahapatra BR, Barik BK, Muraleedharan A, Badajena A, Amritt A, Kanungo S, Pattanaik A, Mishra M, Dhar SS, Barik SK, Das Majumdar SK, Parida DK. High-Dose-Rate Intracavitary Brachytherapy Under Conscious Sedation a Viable Practical Alternative to Spinal Anaesthesia in Carcinoma Cervix: A Retrospective Study in a Tertiary Care Centre in Eastern India. Cureus 2021; 13:e20063. [PMID: 35003939 PMCID: PMC8723729 DOI: 10.7759/cureus.20063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2021] [Indexed: 12/02/2022] Open
Abstract
Introduction Intracavitary brachytherapy (ICBT) is an integral component in the management of locally advanced cervical cancer. Spinal anaesthesia is the preferred mode of pain management during brachytherapy procedures. In high volume, resource constraint settings, it is difficult to provide spinal anaesthesia to all patients. This study attempts dosimetric comparison of high-dose-rate ICBT with spinal anaesthesia to that under conscious sedation to find out whether brachytherapy under conscious sedation is comparable with spinal anaesthesia. Methods Retrospective data of total of 56 cervical cancer patients who received ICBT after completion of external beam radiotherapy (EBRT) were collected. Among these 56 patients, 28 patients received brachytherapy under spinal anaesthesia (SA group) and the rest under conscious sedation (CS group). Brachytherapy dose was 7 Gray per fraction weekly for three weeks. Thus, 84 brachytherapy plans of each group were analysed with respect to doses received by points A, B, P and Organs at Risk. Results The mean doses received by points A, B and P were comparable in SA and CS groups (p-value >0.05). Similarly, the mean doses received by Organs at Risk (rectum, urinary bladder, and sigmoid colon) were also comparable in both the groups (p-value>0.05). Conclusion ICBT under CS is dosimetrically non-inferior to SA, which makes it an alternative option.
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Kumar V, Gulia A, Garg R, Gupta N, Bharati SJ, Mishra S, Bhatnagar S. Perioperative anesthesia management for brachytherapy in cancer patients: A retrospective observational study. J Anaesthesiol Clin Pharmacol 2021; 37:598-603. [PMID: 35340946 PMCID: PMC8944377 DOI: 10.4103/joacp.joacp_63_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 09/17/2020] [Accepted: 12/02/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND AND AIMS Anesthetic management for brachytherapy require repeated exposure to anesthesia in elderly patients with comorbidities. The varying locations provide an anesthesiologist with further challenges. MATERIAL AND METHODS We studied retrospectively anesthesia type, details of anesthetic techniques and complications that occurred in patients having received anesthesia for brachytherapy in our institute in the last 6 years. Categorical variables were described as frequency and percentage, and continuous variables described as median and interquartile range. For continuous variables, mean values compared using two sample t tests for independent samples. RESULTS The majority of patients were females who received brachytherapy for carcinoma cervix. A higher percentage of carcinoma breast and male genitourinary malignancies had comorbidities. Predominant side effects included 22 (1.85%) had hypotension, 19 (1.59%) had difficulty in putting spinal, 13 (1.09%) patients had tachycardia and 11 (0.92%) had headache in the postoperative period. CONCLUSION Neuraxial block as anesthetic technique in pelvic brachytherapy using fentanyl as additive helped reduce the dose of local anesthetic and avoided the complications of high spinal. The choice of anesthesia can vary depending on the duration and site of brachytherapy keeping in consideration the patient's factors.
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Affiliation(s)
- Vinod Kumar
- Oncoanesthesia and Palliative Medicine, Dr BR Ambedkar IRCH AIIMS, Delhi, India
- Address for correspondence: Dr. Vinod Kumar, Room No. 139, Dr BRAIRCH, AIIMS, Ansari Nagar, Delhi - 110 029, India. E-mail:
| | - Abhity Gulia
- Oncoanesthesia and Palliative Medicine, Dr BR Ambedkar IRCH AIIMS, Delhi, India
| | - Rakesh Garg
- Oncoanesthesia and Palliative Medicine, Dr BR Ambedkar IRCH AIIMS, Delhi, India
| | - Nishkarsh Gupta
- Oncoanesthesia and Palliative Medicine, Dr BR Ambedkar IRCH AIIMS, Delhi, India
| | | | - Seema Mishra
- Oncoanesthesia and Palliative Medicine, Dr BR Ambedkar IRCH AIIMS, Delhi, India
| | - Sushma Bhatnagar
- Oncoanesthesia and Palliative Medicine, Dr BR Ambedkar IRCH AIIMS, Delhi, India
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Non-anesthetist-administered moderate sedation with midazolam and fentanyl for outpatient MRI-aided hybrid intracavitary and interstitial brachytherapy in cervix cancer: a single-institution experience. J Contemp Brachytherapy 2021; 13:286-293. [PMID: 34122568 PMCID: PMC8170517 DOI: 10.5114/jcb.2021.105946] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 03/13/2021] [Indexed: 11/17/2022] Open
Abstract
Purpose The aim of the study was to determine the feasibility of interstitial brachytherapy under non-anesthetist-administered moderate sedation, to identify factors influencing the insertion, and the total procedural time. Material and methods A total of 47 insertions with hybrid intracavitary and interstitial applicators were performed in 23 patients from March 2017 to March 2020. Moderate sedation was achieved with intravenous midazolam and fentanyl administered by non-anesthetist. Insertion time and procedural time was recorded. Univariate and multivariate analysis were performed to evaluate the impact of different factors on insertion and procedural time. Results A total of 238 needles (range, 2-8 per insertion) were implanted, with an average insertion depth of 30 mm (range, 20-40 mm). The mean doses for midazolam and fentanyl were 3 mg (standard deviation [SD] = 1) and 53.3 mcg (SD = 23.9) per insertion, respectively. The median insertion time was 30 minutes (interquartile range [IQR] = 22-40), and the median total procedural time was 4.3 hours (IQR = 3.6-5.2). First time insertion, insertions performed before 2019, and higher midazolam dose were associated with significantly longer insertion time, whereas longer insertion time, MRI-based planning, and insertions performed before 2019 were associated with significantly longer total procedural time. Conclusions Outpatient interstitial brachytherapy with non-anesthetist-administered sedation is achievable and well-tolerated. This method may significantly lessen the burden on hospital resources and has the potential to be cost-effective.
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Humphrey P, Dures E, Hoskin P, Cramp F. Brachytherapy for locally advanced cervical cancer: A survey of UK provision of care and support. Radiother Oncol 2021; 159:60-66. [PMID: 33741466 PMCID: PMC8216428 DOI: 10.1016/j.radonc.2021.03.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 03/04/2021] [Accepted: 03/07/2021] [Indexed: 11/26/2022]
Abstract
91% response rate. Eleven different scheduling regimes identified. Typical duration ranged from three to 52 h. Positive responses about current service provision including support for patients. Respondents made many suggestions for improvements to patient support.
Background and purpose Gynaecological brachytherapy can cause anxiety, distress and discomfort. It is not known how variation in delivery impacts women’s experiences. To inform future research an online survey was carried out to identify variations in brachytherapy and support available to women receiving treatment for locally advanced cervical cancer (LACC). Materials and methods An online survey was sent to 44 UK brachytherapy centres using the Qualtrics® survey platform. It included questions about brachytherapy scheduling, inpatient/day case treatment, anaesthetic/analgesia, non-pharmacological support and health professionals’ opinions regarding holistic care. A mixture of closed questions with pre-specified options and open questions were employed. Descriptive statistics were generated to identify variance in UK practice. Free text responses were analysed using inductive content analysis. Results Responses were received from 39/43 eligible centres (91% response rate). Brachytherapy was predominantly given on an inpatient basis at 65% and day case at 35% of centres. Eleven scheduling regimes were reported with typical duration of brachytherapy ranging from three to 52 h. The main categories identified in response to what worked well were: ‘consistency of staff’; ‘good information provision’ and ‘experienced/skilled/senior staff’. The main categories identified as needing improvement were: ‘training of different staff groups’ and ‘follow up and support’ with many suggestions for service improvements. Conclusion The survey provided a comprehensive overview of brachytherapy services for LACC demonstrating wide variability in scheduling regimes, duration of treatment and holistic care. The findings support the need to explore women’s experiences with a range of treatment regimes and anaesthesia and analgesia techniques to inform improvements to future clinical care.
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Affiliation(s)
- Pauline Humphrey
- Radiotherapy Department, Bristol Cancer Institute, Bristol Haematology and Oncology Centre, UK; Faculty of Health and Applied Sciences, Glenside Campus, University of the West of England, UK.
| | - Emma Dures
- Faculty of Health and Applied Sciences, Glenside Campus, University of the West of England, UK.
| | - Peter Hoskin
- Mount Vernon Cancer Centre, Northwood, UK; Division of Cancer Sciences, Faculty of Biology Medicine and Health, University of Manchester, UK.
| | - Fiona Cramp
- Faculty of Health and Applied Sciences, Glenside Campus, University of the West of England, UK.
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Thiruthaneeswaran N, Tharmalingam H, Hoskin PJ. Practical brachytherapy solutions to an age-old quandary. Tech Innov Patient Support Radiat Oncol 2020; 16:39-47. [PMID: 33385072 PMCID: PMC7769855 DOI: 10.1016/j.tipsro.2020.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 09/17/2020] [Accepted: 09/18/2020] [Indexed: 11/29/2022] Open
Abstract
Age should not be a limiting factor for brachytherapy in patients with localised cancer or for palliation in metastatic disease. In tumour streams where brachytherapy forms part of the curative management, it should not be omitted in elderly patients who are medically fit for treatment. Treatment decisions should factor in patient preferences, the relative merits of different therapeutic approaches and maintaining minimal impact on quality of life.
Cancer is predominantly a disease of the elderly and as population life expectancy increases, so will the incidence of malignant disease. Elderly patients often have other comorbidities and social complexities, increasing the support required to safely deliver all treatment modalities. Brachytherapy is a relatively simple technique by which radiation therapy can be delivered. It offers dosimetric advantages through a highly conformal dose distribution thereby limiting radiation exposure to normal tissues reducing toxicity. Requiring fewer hospital visits, it also offers practical and logistical advantages to the elderly population and in many cases can be performed without the need for general anaesthesia. In tumour streams where brachytherapy forms part of the curative management, it should not be omitted in elderly patients who are medically fit for treatment. In the palliative setting, brachytherapy often offers an excellent means for achieving either local tumour and/or symptom control and should be actively considered in the therapeutic armamentarium of the oncologist in this context.
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Affiliation(s)
- N Thiruthaneeswaran
- Division of Cancer Sciences, The University of Manchester, Manchester, UK.,Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | | | - P J Hoskin
- Division of Cancer Sciences, The University of Manchester, Manchester, UK.,Mount Vernon Cancer Centre, Northwood, UK
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Kumar V, Ahuja D, Gupta N, Bharati SJ, Garg R, Mishra S, Haresh KP, Gupta S, Bhatnagar S. Anesthesia concerns in prostate brachytherapy: An institutional experience. Indian J Cancer 2020; 57:411-415. [PMID: 33078747 DOI: 10.4103/ijc.ijc_666_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Prostate cancer is a common cancer found in men worldwide. Brachytherapy is an established modality used for the treatment of these patients. Although anesthetic management of such patients is challenging but the ideal anesthetic technique has not yet been established. Our study aims to identify the most efficacious anesthetic technique for perioperative management of prostate cancer patients undergoing brachytherapy. METHODS Retrospective analysis of ten patients who underwent 16 brachytherapy sessions under combined spinal epidural (CSE) anesthesia between April 2016 and December 2016 was done. The data were collected, tabulated using MS Excel, and statistically analyzed with EPI Info 6 and SPSS-16 statistical software (SPSS Inc. Chicago, USA) to draw relative conclusions. RESULTS The median peak sensory dermatome level achieved was T6 and the median maximum motor block achieved was grade 2. The mean (± standard deviation (SD)) time to sensory regression to T10 (range T5-T8) dermatome was found to be 118.00 ± 47.110 (range = 0-238) minutes. Despite the presence of co-morbidities, minor intraoperative complications were observed only in two patients. The postoperative numerical rating scale (NRS) was less than 4 in all patients during the first 24 hours. None of our patients complained of nausea, vomiting, pruritus and respiratory depression. The mean (± SD) patient satisfaction score was 44.40 ± 0.871 (range : 1-5) at the end of 24 hours. CONCLUSIONS CSE anesthesia is a safe and effective technique for anesthetic management of patients undergoing prostate brachytherapy.
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Affiliation(s)
- Vinod Kumar
- Department of Onco-Anaesthesia and Palliative medicine, Dr. Bhim Rao Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Deepti Ahuja
- Department of Onco-Anaesthesia and Palliative medicine, Dr. Bhim Rao Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Nishkarsh Gupta
- Department of Onco-Anaesthesia and Palliative medicine, Dr. Bhim Rao Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Sachidanand J Bharati
- Department of Onco-Anaesthesia and Palliative medicine, Dr. Bhim Rao Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Garg
- Department of Onco-Anaesthesia and Palliative medicine, Dr. Bhim Rao Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Seema Mishra
- Department of Onco-Anaesthesia and Palliative medicine, Dr. Bhim Rao Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - K P Haresh
- Department of Onco-Anaesthesia and Palliative medicine, Dr. Bhim Rao Ambedkar Institute Rotary Cancer Hospital, All India Institute of Radiotherapy, New Delhi, India
| | - Subhash Gupta
- Department of Radiotherapy, Dr. Bhim Rao Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Sushma Bhatnagar
- Department of Onco-Anaesthesia and Palliative medicine, Dr. Bhim Rao Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
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Setiawan CT, Landrigan-Ossar M. Pediatric Anesthesia Outside the Operating Room: Case Management. Anesthesiol Clin 2020; 38:587-604. [PMID: 32792186 DOI: 10.1016/j.anclin.2020.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Anesthesiology teams care for children in diverse locations, including diagnostic and interventional radiology, gastroenterology and pulmonary endoscopy suites, radiation oncology units, and cardiac catheterization laboratories. To provide safe, high-quality care, anesthesiologists working in these environments must understand the unique environmental and perioperative considerations and risks involved with each remote location and patient population. Once these variables are addressed, anesthesia and procedural teams can coordinate to ensure that patients and families receive the same high-quality care that they have come to expect in the operating room. This article also describes some of the considerations for anesthetic care in outfield locations.
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Affiliation(s)
- Christopher Tan Setiawan
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, TX, USA; Department of Anesthesiology, Children's Medical Center, 1935 Medical District Drive, Dallas, TX 75235, USA
| | - Mary Landrigan-Ossar
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA; Harvard Medical School, Boston, MA, USA.
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Kissel M, Andraud M, Duhamel AS, Boulle G, Romano E, Achkar S, Bourdais R, Ta MH, Pounou A, Kumar T, Celestin B, Bordenave L, Billard V, Haie-Meder C, Chargari C. Hypnosedation for endocavitary uterovaginal applications: A pilot study. Brachytherapy 2020; 19:462-469. [PMID: 32359938 DOI: 10.1016/j.brachy.2020.03.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 03/18/2020] [Accepted: 03/25/2020] [Indexed: 11/16/2022]
Abstract
PURPOSE Implantations for uterovaginal brachytherapy are usually performed under general or spinal anesthesia, which are not without risk. As it is a rather short procedure and since postoperative pain is minimal, hypnosedation was proposed to selected patients requiring endocavitary applications as part of their routine treatment. METHODS AND MATERIALS Consecutive patients requiring intracavitary uterovaginal brachytherapy from January to October 2019 were included if they accepted the procedure. A premedication was systematically administered. Hypnosedation was based on an Ericksonian technique. The procedure was immediately interrupted if the patient requested it, in cases of extreme anxiety or pain. Procedure was in that case rescheduled with a "classical" anesthesia technique. RESULTS A total of 20 patients were included. Four patients had to be converted toward a general anesthesia: one because of a fibroma on the probe's way and three young patients with a very anteverted/retroverted uterus that was painful at every mobilization. Mean and maximum pain scores during implant were 2.9/10 and 5.1/10, respectively. The most painful maneuver was cervical dilation for 45% of the patients, followed by mold insertion in 40% of cases. About 85% of the patients declared that hypnosis helped them relax; 90% of the patients would recommend the technique. No procedure-related complication occurred. CONCLUSION With a 70% success rate (correct implant with mean pain and anxiety scores < 5), one can conclude that uterovaginal brachytherapy implantation under hypnosedation is feasible and received a high satisfaction rate from the patients. This technique may reduce overall treatment time in a context of difficult access to the OR and to anesthesiologists, while reducing anesthetic drugs resort and postoperative nausea.
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Affiliation(s)
- Manon Kissel
- Radiation Oncology Department, Brachytherapy Unit, Gustave Roussy, Villejuif, France.
| | - Mickaël Andraud
- Radiation Oncology Department, Brachytherapy Unit, Gustave Roussy, Villejuif, France
| | - Anne-Sophie Duhamel
- Radiation Oncology Department, Brachytherapy Unit, Gustave Roussy, Villejuif, France
| | - Geoffroy Boulle
- Radiation Oncology Department, Brachytherapy Unit, Gustave Roussy, Villejuif, France
| | - Edouard Romano
- Radiation Oncology Department, Brachytherapy Unit, Gustave Roussy, Villejuif, France
| | - Samir Achkar
- Radiation Oncology Department, Brachytherapy Unit, Gustave Roussy, Villejuif, France
| | - Rémi Bourdais
- Radiation Oncology Department, Brachytherapy Unit, Gustave Roussy, Villejuif, France
| | - Minh-Hanh Ta
- Radiation Oncology Department, Brachytherapy Unit, Gustave Roussy, Villejuif, France
| | - Arthur Pounou
- Radiation Oncology Department, Brachytherapy Unit, Gustave Roussy, Villejuif, France
| | - Tamizhanban Kumar
- Radiation Oncology Department, Brachytherapy Unit, Gustave Roussy, Villejuif, France
| | | | | | | | - Christine Haie-Meder
- Radiation Oncology Department, Brachytherapy Unit, Gustave Roussy, Villejuif, France
| | - Cyrus Chargari
- Radiation Oncology Department, Brachytherapy Unit, Gustave Roussy, Villejuif, France
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Petitt MS, Ackerman RS, Hanna MM, Chen L, Mhaskar RS, Fernandez DC, Patel SY. Anesthetic and analgesic methods for gynecologic brachytherapy: A meta-analysis and systematic review. Brachytherapy 2020; 19:328-336. [DOI: 10.1016/j.brachy.2020.01.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 12/30/2019] [Accepted: 01/19/2020] [Indexed: 12/18/2022]
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Kumar D, Srinivasa GY, Gupta A, Rai B, Oinam AS, Bansal P, Ghoshal S. Comparative study to evaluate dosimetric differences in patients of locally advanced carcinoma cervix undergoing intracavitary brachytherapy under two different anaesthesia techniques: an audit from a tertiary cancer centre in India. J Egypt Natl Canc Inst 2019; 31:5. [PMID: 32372231 DOI: 10.1186/s43046-019-0003-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 08/29/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Carcinoma cervix is amongst the leading causes of mortality and morbidity in women population worldwide. High-dose-rate intracavitary brachytherapy (HDR-ICBT) post external beam radiation therapy (EBRT) is the standard of care in managing locally advanced stage cervical cancer patients. HDR-ICBT is generally performed under general anaesthesia (GA) in operation theatre (OT), but due to logistic reasons, sometimes, it becomes difficult to accommodate all patients under GA. Since prolonged overall treatment time (OTT) makes the results inferior, taking patients in day care setup under procedural sedation (PS) can be an effective alternative. In this audit, we tried to retrospectively analyse the dosimetric difference, if any, in patients who underwent ICBT at our centre, under either GA in OT or PS in day care. RESULTS Thirty five patients were analysed 16/35 (45.71%) patients underwent HDR-ICBT under GA while 19/35 (54.28%) patients under PS. In both groups, a statistically significant difference was observed between the dose received by 0.1 cc as well as 2 cc of rectum (p < 0.05), while the bladder and sigmoid colon had comparable dosages. CONCLUSION Though our dosimetric analysis highlighted better rectal sparing in patients undergoing HDR-ICBT under GA when compared to patients under PS, PS can still be considered an effective alternative, especially in centres dealing with significant patient load. Further studies are required for firm conclusion.
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Affiliation(s)
- Divyesh Kumar
- Department of Radiotherapy and Oncology, Regional Cancer Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - G Y Srinivasa
- Department of Radiotherapy and Oncology, Regional Cancer Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ankita Gupta
- Department of Radiotherapy and Oncology, Regional Cancer Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Bhavana Rai
- Department of Radiotherapy and Oncology, Regional Cancer Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
| | - Arun S Oinam
- Department of Radiotherapy and Oncology, Regional Cancer Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Pooja Bansal
- Department of Biostatistics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sushmita Ghoshal
- Department of Radiotherapy and Oncology, Regional Cancer Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Frankart AJ, Meier T, Minges TL, Kharofa J. Comparison of spinal and general anesthesia approaches for MRI-guided brachytherapy for cervical cancer. Brachytherapy 2018; 17:761-767. [DOI: 10.1016/j.brachy.2018.05.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Revised: 04/30/2018] [Accepted: 05/02/2018] [Indexed: 10/16/2022]
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Optimal perioperative anesthesia management for gynecologic interstitial brachytherapy. J Contemp Brachytherapy 2017; 9:216-223. [PMID: 28725244 PMCID: PMC5509989 DOI: 10.5114/jcb.2017.68767] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 04/30/2017] [Indexed: 11/25/2022] Open
Abstract
Purpose To propose an optimal perioperative pain management clinical care pathway for interstitial brachytherapy for gynecologic cancer based on our interdepartmental experience. Material and methods We conducted a retrospective review of 23 women who underwent 32 interstitial brachytherapy procedures for gynecological cancers, analyzing patient demographics, type of anesthetic, medications, postoperative pain scores, adverse events, and delays in discharge. We measured the association of postoperative nausea and/or vomiting (PONV) with hydromorphone use, and postoperative pain scores and total narcotic administration with type of anesthesia. Results In 91% of patients postoperative pain was managed with an epidural infusion plus, as needed (PRN), IV or patient controlled analgesia (PCA) narcotics. The most common postoperative adverse event was PONV (53%), followed by delirium (22%). Hospital discharge was delayed, at least by one night, in 26% of patients. Use of a basal rate on the PCA was associated with all cases of delayed discharge from over-sedation and PONV. The use of 5 mg or more of intravenous (IV) hydromorphone during the first 24-hours postoperatively was associated with PONV (p = 0.01). Use of a basal PCA was associated with delirium (p = 0.03). Postoperative pain scores were not significantly associated with the type of anesthesia. Conclusions Interstitial gynecologic brachytherapy requires a multidisciplinary effort for optimal perioperative management. Our study outlines the appropriate preoperative, intraoperative, and postoperative anesthesia clinical care pathway. Decreased narcotic use during hospitalization and utilization of a patient-directed infusion may decrease side effects and allow for a more efficient hospital discharge.
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Novel anesthetic technique for combined intracavitary and interstitial brachytherapy for cervix cancer in an outpatient setting. J Contemp Brachytherapy 2017; 9:236-241. [PMID: 28725247 PMCID: PMC5509986 DOI: 10.5114/jcb.2017.68469] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 05/20/2017] [Indexed: 11/23/2022] Open
Abstract
Purpose To determine the feasibility and safety of outpatient combined intracavitary and interstitial brachytherapy for cervix cancer with sedation and local anesthesia. Material and methods We included patients diagnosed with non-metastatic cervix cancer and have completed brachytherapy between December 2015 and December 2016. Moderate to deep sedation was achieved using intravenous midazolam, propofol, fentanyl, and oxycodone. Local anesthesia was achieved with 2% lignocaine gel and a paracervical block containing a mixture of 1% ropivacaine, 2% lignocaine, and 1 : 1,000 adrenaline. Ceftriaxone and ondansetron were given prophylactically. Physiologic monitoring was performed throughout and pain scores were recorded using the Numeric Rating Scale. Follow-up was conducted at 8 weeks from the last fraction of brachytherapy. The feasibility and safety endpoints were a post-anesthesia discharge score (PADS) of 9 or above, and no grade 3 or above adverse events, respectively. Results A total of thirty-five brachytherapy insertions were carried out on nine patients. The median age of the patients was 56 years (range, 40-65). Eight patients had American Society of Anesthesiologists’ physical status of I or II, and one had a status of III. The mean duration of the insertion was 39 minutes (standard deviation [SD] = 14), during which no adverse events occurred. There was no significant nausea or vomiting post-sedation. The median pain scores post-insertion and during recovery were 0 (range, 0-6) and 0 (range, 0-7), respectively. At discharge, all patients had pain scores of 0 and maximum PADS of 10. The mean time to discharge was 4.1 hours (SD = 0.95). There were no brachytherapy-related admissions or complications. Conclusions Outpatient combined intracavitary and interstitial brachytherapy for cervix cancer with sedation and local anesthesia is feasible and safe. This could potentially lead to significant cost savings.
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Ota T, Makihara M, Tsukuda H, Kajikawa R, Inamori M, Miyatake N, Tanaka N, Tokunaga M, Hasegawa Y, Tada T, Fukuoka M. Pain Management of Malignant Psoas Syndrome Under Epidural Analgesia During Palliative Radiotherapy. J Pain Palliat Care Pharmacother 2017; 31:154-157. [DOI: 10.1080/15360288.2017.1301617] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Thanthong S, Rojthamarat S, Worasawate W, Vichitvejpaisal P, Nantajit D, Ieumwananontachai N. Comparison of efficacy of meperidine and fentanyl in terms of pain management and quality of life in patients with cervical cancer receiving intracavitary brachytherapy: a double-blind, randomized controlled trial. Support Care Cancer 2017; 25:2531-2537. [PMID: 28315010 DOI: 10.1007/s00520-017-3662-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 03/06/2017] [Indexed: 12/29/2022]
Abstract
OBJECTIVE The aim of this study was to compare the effectiveness of two sedative regimens, a benzodiazepine with either meperidine or fentanyl, in relieving pain in patients with cervical cancer undergoing intracavitary brachytherapy in terms of pain score and quality of life. METHODS Forty unselected outpatients undergoing brachytherapy (160 fractions) were enrolled with informed consent and randomized to receive a benzodiazepine with either meperidine or fentanyl. The perceived pain score according to a standard 10-item numeric rating scale was collected every 15 min during the procedure, and the perceived quality of life was determined at the end of each procedure using the EuroQol five-dimension questionnaire. The patients and medical staff members directly involved with the procedure were blinded to the medication used. RESULTS The patients' pain levels were mild in both analgesic groups. Meperidine appeared to be slightly more effective than fentanyl, although the differences in the average pain score and quality of life were not statistically significant. CONCLUSION Both meperidine and fentanyl in combination with benzodiazepine were effective in relieving pain and discomfort in patients undergoing brachytherapy. TRIAL REGISTRATION NCT02684942, ClinicalTrials.gov.
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Affiliation(s)
- Saengrawee Thanthong
- Department of Radiation Oncology, Chulabhorn Hospital, Chulabhorn Royal Academy, 54 Kamphang Phet 6 Rd, Lak Si, Bangkok, 10210, Thailand.
| | - Sirikorn Rojthamarat
- Department of Radiation Oncology, Chulabhorn Hospital, Chulabhorn Royal Academy, 54 Kamphang Phet 6 Rd, Lak Si, Bangkok, 10210, Thailand
| | - Wipra Worasawate
- Department of Anesthesiology, Chulabhorn Hospital, Chulabhorn Royal Academy, Bangkok, Thailand
| | | | - Danupon Nantajit
- Department of Radiation Oncology, Chulabhorn Hospital, Chulabhorn Royal Academy, 54 Kamphang Phet 6 Rd, Lak Si, Bangkok, 10210, Thailand
| | - Nantakarn Ieumwananontachai
- Department of Radiation Oncology, Chulabhorn Hospital, Chulabhorn Royal Academy, 54 Kamphang Phet 6 Rd, Lak Si, Bangkok, 10210, Thailand
- Department of Radiology, Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Amsbaugh AK, Amsbaugh MJ, El-Ghamry MN, Derhake BM. Optimal epidural analgesia for patients diagnosed as having gynecologic cancer undergoing interstitial brachytherapy. J Clin Anesth 2016; 35:509-515. [DOI: 10.1016/j.jclinane.2016.08.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2016] [Accepted: 08/14/2016] [Indexed: 11/28/2022]
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Otter S, Franklin A, Ajaz M, Stewart A. Improving the efficiency of image guided brachytherapy in cervical cancer. J Contemp Brachytherapy 2016; 8:557-565. [PMID: 28115963 PMCID: PMC5241377 DOI: 10.5114/jcb.2016.64452] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 11/16/2016] [Indexed: 11/21/2022] Open
Abstract
Brachytherapy is an essential component of the treatment of locally advanced cervical cancers. It enables the dose to the tumor to be boosted whilst allowing relative sparing of the normal tissues. Traditionally, cervical brachytherapy was prescribed to point A but since the GEC-ESTRO guidelines were published in 2005, there has been a move towards prescribing the dose to a 3D volume. Image guided brachytherapy has been shown to reduce local recurrence, and improve survival and is optimally predicated on magnetic resonance imaging. Radiological studies, patient workflow, operative parameters, and intensive therapy planning can represent a challenge to clinical resources. This article explores the ways, in which 3D conformal brachytherapy can be implemented and draws findings from recent literature and a well-developed hospital practice in order to suggest ways to improve the efficiency and efficacy of a brachytherapy service. Finally, we discuss relatively underexploited translational research opportunities.
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Affiliation(s)
- Sophie Otter
- St Luke’s Cancer Centre, Royal Surrey County Hospital, Guildford
| | - Adrian Franklin
- St Luke’s Cancer Centre, Royal Surrey County Hospital, Guildford
| | - Mazhar Ajaz
- St Luke’s Cancer Centre, Royal Surrey County Hospital, Guildford
- University of Surrey, Guildford, United Kingdom
| | - Alexandra Stewart
- St Luke’s Cancer Centre, Royal Surrey County Hospital, Guildford
- University of Surrey, Guildford, United Kingdom
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New approach to relieving pain and distress during high-dose-rate intracavitary irradiation for cervical cancer. Brachytherapy 2015; 14:642-7. [DOI: 10.1016/j.brachy.2015.04.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Revised: 03/29/2015] [Accepted: 04/16/2015] [Indexed: 11/19/2022]
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Kirchheiner K, Czajka-Pepl A, Ponocny-Seliger E, Scharbert G, Wetzel L, Nout RA, Sturdza A, Dimopoulos JC, Dörr W, Pötter R. Posttraumatic Stress Disorder After High-Dose-Rate Brachytherapy for Cervical Cancer With 2 Fractions in 1 Application Under Spinal/Epidural Anesthesia: Incidence and Risk Factors. Int J Radiat Oncol Biol Phys 2014; 89:260-7. [DOI: 10.1016/j.ijrobp.2014.02.018] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Revised: 02/05/2014] [Accepted: 02/12/2014] [Indexed: 11/26/2022]
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Sharma DN, Chaudhari P, Sharma S, Gupta L, Jagadesan P, Rath GK, Julka PK. Comparison of high-dose-rate intracavitary brachytherapy dosimetry with and without anesthesia in patients with cervical carcinoma. J Appl Clin Med Phys 2014; 15:4670. [PMID: 24710456 PMCID: PMC5875476 DOI: 10.1120/jacmp.v15i2.4670] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2013] [Revised: 11/03/2013] [Accepted: 10/30/2013] [Indexed: 11/30/2022] Open
Abstract
This study compares the dosimetry of high‐dose‐rate intracavitary brachytherapy (HDR‐ICBT) performed with and without general anesthesia/spinal anesthesia (GA/SA) in patients with cervical carcinoma. We retrospectively retrieved the records of 138 HDR‐ICBT applicator insertions performed in 46 patients: 69 performed with GA/SA (anesthesia group known as AG) in 23 patients, and 69 performed without GA/SA (nonanesthesia group known as NAG) in 23 patients. The intracavitary brachytherapy (ICBT) application was done with central tandem and two vaginal ovoids. For each ICBT plan, a high‐dose‐rate (HDR) dose of 7 Gy was prescribed to point A. From each plan, the doses to Point B right (BR), Point B left (BL), bladder and rectal reference points (Bladderref and Rectalref) were recorded and compared in the two groups. Student's t‐test was applied to find out the significance of difference. The two groups were comparable in terms of demography and clinical characteristics. Mean Point BL doses in AG and NAG were 1.89 Gy (27% of Point A dose) and 1.82 Gy (26% of Point A dose), respectively. Mean Point BR doses in AG and NAG were 1.91 Gy (27% of Point A dose) and 1.85 Gy (26% of point A), respectively (p‐value 0.7). The mean dose to Bladderref in AG and NAG was 5.03 Gy and 4.90 Gy, respectively (p‐value 0.6). The mean dose to Rectalref was significantly higher in AG than NAG (5.09 Gy vs. 4.49 Gy, p‐value 0.01). Although based on conventional 2D dosimetry planning, our study has demonstrated that avoiding GA/SA does not result in inferior HDR‐ICBT dosimetry. PACS number: 87.53.Jw, 87.50.cm
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Does multimodal analgesia premedication improve the management of carcinoma cervix brachytherapy? Pain Res Manag 2012; 17:353-4. [PMID: 23061087 DOI: 10.1155/2012/154875] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Hannoun-Lévi JM, Hennequin C, Pommier P, Izar F, Thomas L, Le Scodan R, Lesaunier F, Nguyen T, Heymann S, Truc G, Peiffert D. Enquête nationale sur la curiethérapie dans le cancer du sein : état des lieux et perspectives en 2009. Cancer Radiother 2010; 14:176-82. [DOI: 10.1016/j.canrad.2010.01.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2009] [Revised: 11/19/2009] [Accepted: 01/19/2010] [Indexed: 11/26/2022]
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Saddle block analgesia for high-dose-rate brachytherapy: A prospective study. Brachytherapy 2009; 8:335-8. [DOI: 10.1016/j.brachy.2009.01.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2008] [Revised: 01/21/2009] [Accepted: 01/26/2009] [Indexed: 11/23/2022]
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Median Effective Local Anesthetic Doses of Plain Bupivacaine and Ropivacaine for Spinal Anesthesia Administered Via a Spinal Catheter for Brachytherapy of the Lower Abdomen. Reg Anesth Pain Med 2008. [DOI: 10.1097/00115550-200801000-00002] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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