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

Abstract

Background: Majority of Indian patients presents in locally advanced stage and most of them treated by combination of external teletherapy and intracavitary brachytherapy (ICRT). Because of deficient infrastructure, the waiting period is generally long at existing caner canters. Hence ICRT may be done in conscious sedation to treat more patients by avoiding time consuming general anaesthesia. The aim of this study is to know the effect of general anaesthesia vs. conscious sedation in dosimetric distribution in brachytherapy and its feasibility.Methods: Total 80 ICRT applications were randomized to general anaesthesia (GA) and conscious sedation (CS) groups. Fletcher suit type of applicators was used and dose delivery equipment was cobalt 60 high dose rate remote after loading brachytherapy unit. In CS group, injection midazolam 0.5-8mg (median 2.5mg) in the form of slow i.v. infusion was used along with antiemetic support.Results: Total 6 parameters were analyzed. e.g., Dose to point A1, Dose to point A2, Bladder max dose, Bladder mean dose, Rectal max dose and Rectal mean dose. The dose distribution was found similar both groups and it did not depend on type of anaesthesia.Conclusions: The high volume centers of developing countries are most suitable candidate to opt conscious sedation to perform ICRT to treat more cancer cervix patients in same time frame.

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

“…This could be due to the better adequate vaginal packing as a result of better muscle relaxation under GA. A study of comparison of HDR-ICBT dosimetry with and without anaesthesia done by Sharma et al showed that mean dose to the bladder reference point was 5.03 Gy (71.85% of point A dose) in the anaesthesia group compared to 4.90 Gy (70% of point A dose) in patients without anaesthesia (p value 0.6) and mean dose to the rectal point was significantly higher in anaesthesia group compared to patients without anaesthesia (5.09 Gy v/s 4.49 Gy, p value 0.01) [8]. In a similar study done by Rathore et al, mean dose to the bladder was in the range of 17.7-69.3% and 15.54-74.24% in anaesthesia and conscious sedation (CS) groups respectively, mean dose to the rectum was 32.5-77.73% and 21.07-79.16% in the anaesthesia and CS groups respectively, and they concluded that dosimetric parameters in both the groups were similar and did not depend on the type of anaesthesia [9]. Both these studies used 2D conventional planning for dosimetric evaluation; we on the contrary used CT-based volumetric planning for dosimetric evaluation of the OARs.…”