Comparison of high‐dose‐rate intracavitary brachytherapy dosimetry with and without anesthesia in patients with cervical carcinoma

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 false(normalBRfalse), Point B left false(normalBLfalse), 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

How well do elderly patients with cervical cancer tolerate definitive

“…Patients were assessed for brachytherapy 1 wk after completion of external beam radiotherapy. Three high-dose-rate (HDR) brachytherapy insertions were planned with a prescribed dose of 7 Gy to point A one week apart (cumulative EQD2 = 79.3 Gy10) [ 13 ]. Until June 2013, conventional X-ray based planning was performed with rectal and bladder point doses being constrained to 75–80% of the prescribed point A doses.…”

Improving the efficiency of image guided brachytherapy in cervical cancer

“…It was long assumed that the use of anesthesia allowed more optimal vaginal packing, which in turn would decrease the dose to organs at risk. However, in the pre-IGBT era, it was shown in a retrospective study using dose to point A and B that dosimetry was not significantly affected whether patients have an anesthetic (spinal or GA) or not [18]. The mean dose to the bladder reference point was not significantly different either but the mean dose to rectal reference point was significantly higher in the anesthetic group (5.09 Gy vs. 4.49 Gy, p = 0.01).…”

The effect of general anaesthesia versus conscious sedation in dosimetric distribution of intracavitary radiotherapy in cervical cancer patients

“…It is generally assumed that lack of GA may result in inferior dosimetry but the dose distributions as per parameters analysed are good and satisfactory in conscious sedation and are very comparable with general anaesthesia. Similar study was conducted by Sharma et al In their study 12 , total 138 procedures were done, 69 in anaesthesia group (AG) and 69 in non-anaesthesia group (NAG). For each ICRT 7 Gy prescribed to point A.…”