Pain and symptom assessment during multiple fractions of gynecologic high-dose-rate brachytherapy

Wiebe, Ericka; Surry, Kathleen; Derrah, L.; Murray, T.; Hammond, A.; Yaremko, Brian; D’Souza, David

doi:10.1016/j.brachy.2011.04.001

Cited by 19 publications

(21 citation statements)

References 18 publications

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“…Of the survey responders, 70% obtained a CT scan during the implantation process (18) whereas in 2014, 95% report using CT (Grover et al IJROBP accepted, personal communication). An increasing number of radiation centers have switched over the past decade from two-dimensional (2D) treatment planning to IBBT (11, 13–22). Use of image guidance is more complex and time consuming and, resultantly, has not been universally adopted (23, 24).…”

Section: Introductionmentioning

confidence: 99%

American Brachytherapy Task Group Report: A pooled analysis of clinical outcomes for high-dose-rate brachytherapy for cervical cancer

et al. 2017

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PURPOSE Advanced imaging used in combination with brachytherapy (BT) has revolutionized the treatment of patients with cervical cancer. We present a comprehensive review of the literature for definitive radiation with high-dose-rate (HDR) BT. In addition, we investigate potential outcome improvement with image-based brachytherapy (IBBT) compared to studies using traditional Point A dosing. This review extensively investigates acute and late toxicities. METHODS AND MATERIALS This study reviews the literature from 2000 to 2015 with an emphasis on modern approaches including concurrent chemotherapy (chemoRT), radiation, and HDR BT and IBBT. Descriptive statistics and pelvic control (PC), disease-free survival (DFS), and overall survival (OS) outcomes were calculated using weighted means to report pooled analysis of outcomes. RESULTS Literature search yielded 16 prospective, 51 retrospective studies that reported survival outcomes, and 13 retrospective studies that focused on acute and late toxicity outcomes regardless of applicator type. There are 57 studies that report Point A dose specification with 33 having chemoRT, and 10 studies that use IBBT, 8 with chemoRT. Patients receiving radiation and chemoRT with HDR BT in the prospective studies, with >24 months followup, rates of PC were: for RT: 73%, SD: 11; CRT: 82%, SD: 8; DFSdRT: 55%, SD: 10; CRT: 65%, SD: 7; OSdRT: 66%, SD: 7; CRT: 70%, SD: 11. In the retrospective studies, the PC rates (weighted means) for the radiation and chemoradiation outcomes are 75% vs. 80%, and for DFS, the values were 55% vs. 63%, respectively. Comparing patients receiving chemoRT and IBBT to traditional Point A dose specification, there is a significant improvement in PC (p < 0.01) and DFS (p < 0.01) with IBBT. The range of genitourinary late toxicity reported for radiation was Grade 3: 1–6% and for chemoRT 2–20%. The range of late gastrointestinal toxicity for radiation was Grade 3: 4–11% and for chemoRT, 1–11%. For the late gynecologic toxicity, only 1 of the 16 prospective trials report a Grade 1–2 of 17% for radiation and 9% for chemoRT effects. CONCLUSIONS We present concise outcomes of PC, DFS, OS, and toxicity for cervical cancer patients treated with chemoradiation and HDR BT. Our data suggest an improvement in outcomes with the use of IBBT compared with traditional Point A dose prescriptions. In conclusion, HDR BT is a safe, effective modality when combined with IBBT.

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Section: Introductionmentioning

confidence: 99%

American Brachytherapy Task Group Report: A pooled analysis of clinical outcomes for high-dose-rate brachytherapy for cervical cancer

et al. 2017

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“…There were 22 remaining articles. Five studies were randomised controlled studies (RCTs), 16,17,18,19,20 two case control studies, 21,22 nine cohort studies, 11,12,23,24,25,26,27,28,29 five qualitative studies 30,31,32,33,34 and 1 systematic literature review. 35…”

Section: Resultsmentioning

confidence: 99%

“…10 However, only two of the seven pharmacological studies describe analgesia and anaesthesia techniques which would be applicable to centres which deliver HDR brachytherapy with a longer time period with applicators in place. 11,23 Effective pain management for short procedures taking less than 2 hours in total is unlikely to be applicable for this longer duration technique, or when interstitial needles are added. Local anaesthetic spray onto the cervix or conscious sedation would not provide the required duration of analgesia, especially if interstitial needles are introduced.…”

Section: Discussionmentioning

confidence: 99%

“…Some centres keep patients in hospital overnight with applicators/needles remaining in place and repeat treatments over 2-3 days. 11 Although the patient does not need to remain in isolation in a radiation treatment room like the old LDR treatments, it does mean they have to remain immobile in bed for a long time. However, their treatment may be completed in one hospital visit and only require one theatre and anaesthetic procedure.…”

Section: Introductionmentioning

confidence: 99%

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The experiences of women receiving brachytherapy for cervical cancer: A systematic literature review

Humphrey¹,

Bennett

Cramp

2018

Radiography

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Objectives: To determine women's experiences of brachytherapy for cervical cancer. Key findings: Nineteen studies were included for data extraction/synthesis. Twelve studies focussed on psychological issues, seven on pharmacological aspects of women's experiences. Themes of anxiety, distress, pain, informational needs and non-pharmacological interventions were found. Nine out of ten psychological studies described brachytherapy as a distressing experience causing anxiety and distress for most women. Non-pharmacological interventions were found to be effective and inexpensive adjuncts. Peri and post-operative pharmacological management was variable, but duration of procedure was an important factor. Conclusion: Brachytherapy for gynaecological cancer causes varying levels of pain, anxiety and distress. To improve women's experiences there needs to be better pain management, patient information and the development of non-pharmacological interventions. Future recommendations are to develop clinical support guidelines, audit the quality of services and develop effective interventions to improve women's experiences of brachytherapy for locally advanced cervical cancer.

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“…The authors suggest that this finding might be related to the effects of conscious sedation having possibly worn off by the end of treatment 2 . A study of assorted gynecologic cancer patients found that pain was highest after transfer to the ct scanner (μ = 3.3) 13 . In our population of rectal cancer patients, it appears that the point of maximal pain occurred immediately after insertion of the applicator.…”

Section: Discussionmentioning

confidence: 99%

The Experience of Pain and Anxiety in Rectal Cancer Patients During High-Dose-Rate Brachytherapy

et al. 2014

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Pain and symptom assessment during multiple fractions of gynecologic high-dose-rate brachytherapy

Cited by 19 publications

References 18 publications

American Brachytherapy Task Group Report: A pooled analysis of clinical outcomes for high-dose-rate brachytherapy for cervical cancer

American Brachytherapy Task Group Report: A pooled analysis of clinical outcomes for high-dose-rate brachytherapy for cervical cancer

The experiences of women receiving brachytherapy for cervical cancer: A systematic literature review

The Experience of Pain and Anxiety in Rectal Cancer Patients During High-Dose-Rate Brachytherapy

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