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

Abstract

IntroductionIntracavitary 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. MethodsRetrospective 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. ResultsThe 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). ConclusionICBT under CS is dosimetrically non-inferior to SA, which makes it an alternative option.

Factors affecting the dosimetry of high-dose rate intracavitary brachytherapy in cervical cancer

“…14 In the anaesthesia group, the maximum dose to the bladder was significantly more, but the mean dose was comparable in an analysis by P C Bana et al 15 A previous study by the same author with a smaller sample size and addressing only the dosimetric effect of anaesthesia had shown no significant difference in all the dosimetric parameters between the CS and SA groups. 19…”

Analgesia in Intracavitary Cervical Brachytherapy Applications

“…Bu derlemede ülkemizde de önemli bir sağlık sorunu olan serviks kanseri tanılı hastalarda intrakaviter brakiterapi uygulamasında analjezi tiplerini ve gerekliliği tartışmak istedik. brakiterapi planlaması doz bilgilerini karşılaştırmışlar ve her iki uygulama arasından istatistiksel fark saptamamışlardır (5).…”

Anesthesia for Intracavitary Brachytherapy: a 19-month Experience at the Philippine General Hospital during the COVID-19 Pandemic

“…To date, various sedation regimens for brachytherapy among cervical cancer patients have been published including propofol infusion + fentanyl or remifentanil, midazolam + propofol infusion + fentanyl + oxycodone as well as promethazine + tramadol infusion. 14,19,20 This can be attributed to the institution's resources and anesthesiologist's preference. It is worth emphasizing that among the different sedation regimens listed, it consistently included a shortacting sedative and an analgesic in the form of an opioid.…”