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

Divyesh Kumar,Pooja Bansal,Bhavana Rai,Sushmita Ghoshal,G Y Srinivasa,Arun S Oinam,Ankita Gupta

doi:10.1186/s43046-019-0003-2

Abstract

BackgroundCarcinoma cervix is amongst the leading causes of mortality and morbidity in women population worldwide. High-dose-rate intracavitary brachytherapy (HDR-ICBT) post external beam radiation therapy (EBRT) is the standard of care in managing locally advanced stage cervical cancer patients. HDR-ICBT is generally performed under general anaesthesia (GA) in operation theatre (OT), but due to logistic reasons, sometimes, it becomes difficult to accommodate all patients under GA. Since prolonged overall treatment time (OTT) makes the results inferior, taking patients in day care setup under procedural sedation (PS) can be an effective alternative. In this audit, we tried to retrospectively analyse the dosimetric difference, if any, in patients who underwent ICBT at our centre, under either GA in OT or PS in day care.ResultsThirty five patients were analysed 16/35 (45.71%) patients underwent HDR-ICBT under GA while 19/35 (54.28%) patients under PS. In both groups, a statistically significant difference was observed between the dose received by 0.1 cc as well as 2 cc of rectum (p < 0.05), while the bladder and sigmoid colon had comparable dosages.ConclusionThough our dosimetric analysis highlighted better rectal sparing in patients undergoing HDR-ICBT under GA when compared to patients under PS, PS can still be considered an effective alternative, especially in centres dealing with significant patient load. Further studies are required for firm conclusion.

Highlights

Carcinoma cervix is amongst the leading causes of mortality and morbidity in women population worldwide
All patients who had received external beam radiation therapy (EBRT) of 46 Gy in 23 fractions using the 3-dimensional conformal radiotherapy (3DCRT) technique over four and a half weeks with concurrent chemotherapy followed by HDRICBT of 9 Gy per session for 2 sessions as per the departmental protocol were included for analysis
All patients underwent EBRT to a total dose of 46 Gy in 23 fractions with concurrent cisplatin (40 mg/m2) over four and a half weeks followed by 2 sessions of Intracavitary brachytherapy (ICBT) (9Gy high dose rate (HDR) per session) with a gap of 1 week between the sessions

Summary

Introduction

Carcinoma cervix is amongst the leading causes of mortality and morbidity in women population worldwide. Since prolonged overall treatment time (OTT) makes the results inferior, taking patients in day care setup under procedural sedation (PS) can be an effective alternative. Concurrent chemoradiation with high-dose-rate intracavitary brachytherapy (HDR-ICBT) is the standard of care in patients with locally advanced cervical cancer [3]. HDR brachytherapy has largely replaced LDR brachytherapy due to its distinct advantages of small source and applicator size, short treatment times, and better control of source positioning and dose distribution. These factors favourably allow HDR brachytherapy to be delivered on an outpatient basis where in multiple fractions of

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