Analysis of Applicator Insertion Related Acute Side Effects for Cervical Cancer Treated With Brachytherapy

Abstract

PurposeTo report applicator insertion-related acute side effects during brachytherapy (BT) procedure for cervical cancer patients.Materials and MethodsBetween November 2017 and December 2019, 407 BT fractions were performed in 125 patients with locally advanced cervical cancer. Acute side effects recorded comprised anesthesia-related side effects, mechanical-related side effects and infection, whose frequency and degree were recorded. Pain was assessed using numeric rating scale; vaginal bleeding volume was counted by weighing gauze pieces used in packing. The BT procedure comprised eight stages: anesthesia, applicator insertion, image acquisition, transport, waiting for treatment, dose delivery, applicator removal, and removed which denoted 0.5–12.0 h period after removal, with time of each stage recorded. Factors influencing acute side effects were assessed by Spearman correlation and Mann–Whitney U test.ResultsThe most common acute side effect was pain, followed by vaginal bleeding. The mean scores for pain were highest during removal time, 4.9 ± 1.6 points. The mean vaginal bleeding volume was 44.4 ml during removal time. Mean total procedure time was 218.8 (175–336) min, having positive relationship with frequency of acute side effects. The total procedure time with acute side effects was longer than that without acute side effects. The longest procedure time was waiting time, 113.0 (91.0–132.0) min. More needles generated higher pain scores and larger volume of vaginal bleeding.ConclusionPain and vaginal bleeding were the most common acute side effects, especially during removal time, which physicians should focus on. Shortening patients’ waiting time helps to reduce the total procedure time, thus, reduce acute side effects. While meeting dose requirement, less needles are helpful to reduce acute side effects.

Simultaneous catheter and multicriteria optimization for HDR cervical cancer brachytherapy with a complex intracavity/interstitial applicator

“…Using more catheters increases plan quality (i.e., EMBRACE II acceptance rate in soft constraints in Figure 3), but with the trade-off of increased risk of inducing more pain, bleeding, and infections. 29 Overall, there is no gain in using SC+MCO versus CC+MCO to meet hard constraints, as the acceptance rate saturates at 98.3% for both approaches. While the IC/IS catheter optimization problem in HDR GYN brachytherapy is related to the one in HDR prostate, there are fundamental differences.…”

“…Catheter optimization also enables the possibility to reduce the number of catheters while maintaining high plan quality 19 . This could be advantageous given that higher pain scores and larger volume of vaginal bleeding were observed with increased number of IS catheters 29 . A lower number of catheters could also reduce the risk of errors, and reduce the overall procedure time and cost.…”

Clinical study of analgesia in brachytherapy for cervical cancer

“…Most patients with cervical cancer experience negative emotions, such as anxiety and fear, before brachytherapy. Additionally, pain during brachytherapy leads to resistance to or even refusal of subsequent treatment 10,11 . Therefore, developing an ideal analgesic for brachytherapy is important.…”

“…Additionally, pain during brachytherapy leads to resistance to or even refusal of subsequent treatment. 10,11 Therefore, developing an ideal analgesic for brachytherapy is important. To date, no consensus has been reached on the most effective analgesic modality for brachytherapy, which varies between centers.…”

Mulheres submetidas à braquiterapia pélvica: significados da terapêutica e dos seus efeitos

“…Os efeitos adversos agudos, em geral, são transitórios, e os efeitos adversos tardios se iniciam cerca de três meses após o término do tratamento, e afetam o sistema reprodutor, gastrointestinal e geniturinário. Assim, a mulher convive com a estenose vaginal, incontinências, diarreias, fístulas, sangramentos, dentre outros que interferem na qualidade de vida (Chen et al, 2021;Silva et al, 2021).…”