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

Daya N Sharma,Goura K Rath,Leena Gupta,Seema Sharma,Pandjatcharam Jagadesan,Pritee Chaudhari,Pramod K Julka

doi:10.1120/jacmp.v15i2.4670

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 (BR), Point B left (BL), 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

Highlights

Intracavitary brachytherapy (ICBT) is an important treatment in the management of cervical carcinoma.[1]
Various forms of anesthesia have been used for inserting the HDR-ICBT applicator: general anesthesia/spinal anesthesia (GA/SA), paracervical block and conscious sedation (CS).(6) Different institutions choose the method of anesthesia which suits its patients and the institute
This might lead to improper ICBT applicator placement and poor vaginal packing, resulting in higher doses to organs at risk (OAR), compromising dosimetry; no such study exists in the literature to date

Summary

Introduction

Intracavitary brachytherapy (ICBT) is an important treatment in the management of cervical carcinoma.[1]. It is a mean to deliver the required dose of brachytherapy to cervical and parametrial region with relative sparing of the adjoining normal structures.[2] Though often combined with external-beam radiation therapy (EBRT) in a curative setting, it can be used alone in very early stage[3] and rarely as palliative or haemostatic treatment[4] to relieve the severe bleeding from cervical tumor not controlled by EBRT. It can be practiced in the form of low-dose-rate (LDR) or pulsed-dose-rate (PDR) or more often HDR. We conducted a study to compare the HDR-ICBT dosimetry with and without GA/SA in patients with cervical carcinoma to find out if the lack of GA/SA affected the dosimetry

Methods

Results

Conclusion