Dosimetric Difference of Urinary Bladder and Rectum in Patients Undergoing Intracavitary Brachytherapy for Cervical Cancer under Procedural Sedation and General Anesthesia: A Survey at Bugando Cancer Center and Ocean Road Cancer Institute

Abstract

Background: High-Dose-Rate Intracavitary Brachytherapy (HDR-ICBT) is a commonly employed treatment modality for cervical cancer, delivering a high dose of radiation directly to the tumor site while minimizing exposure to surrounding healthy tissues. Anaesthesia administration during HDR-ICBT varies, with some centres using Sedation (CS) and others employing General Anaesthesia (GA). Despite the widespread use of these anaesthesia techniques, their potential impact on dosimetric outcomes, particularly in the urinary bladder and rectum, remains an area of interest and investigation. Objective: This study aimed to determine the dosimetric difference in the urinary bladder and rectum doses among cervical cancer patients undergoing HDR-ICBT under CS and GA. The study was conducted at Bugando Cancer Centre (BCC) and Ocean Road Cancer Institute (ORCI) to compare the dosimetric outcomes between the two anaesthesia techniques. Methods: A total of 273 patients who underwent HDR-ICBT for cervical cancer were included in the study. Patients were divided into two groups based on the anaesthesia technique used during the procedure: 143 patients received GA, and 130 patients received CS. Dosimetric parameters of the urinary bladder and rectum doses were collected and analysed using descriptive statistics and the independent samples t-test. Results: The findings demonstrated a statistically significant dosimetric difference in the mean urinary bladder dose between patients treated under GA and CS (p < 0.001). Patients under GA received a significantly lower mean urinary bladder dose compared to those under CS. However, no statistically significant difference was observed in the mean rectum dose between the two anaesthesia groups (p = 0.689). Conclusion: The study reveals that the choice of anesthesia technique significantly impacts the urinary bladder dose during HDR-ICBT for cervical cancer. Patients receiving GA had a lower mean urinary bladder dose compared to those under CS. However, no significant dosimetric difference was observed in the mean rectum dose between the two anesthesia groups. These findings emphasize the importance of considering anesthesia techniques during treatment planning to optimize dosimetric outcomes and patient safety in HDR-ICBT. Further investigation and long-term follow-up are warranted to validate and expand upon these results. Collaboration between radiation oncologists and anesthesia teams is crucial to enhance treatment efficacy and minimize potential complications during HDR-ICBT for cervical cancer