Evaluation of a balloon-based vaginal packing system and patient-controlled analgesia for patients with cervical cancer undergoing high-dose-rate intracavitary brachytherapy

Abstract

Purpose: To evaluate the following: (1) the dosimetric impact on the bladder and rectum due to a methodologic shift from general anesthesia (GA) to patient-controlled analgesia (PCA), and from vaginal gauze packing (VGP) to vaginal balloon-based packing (VBP) for high-dose-rate (HDR) intracavitary brachytherapy; and (2) the tolerability of PCA versus GA.

Methods and materials: Seventeen consecutively treated patients with cervical carcinoma who underwent tandem and ovoid (T&O) HDR brachytherapy from January 2009 to August 2010 were selected and reviewed. There were a total of 73 applications. Patients were packed either conventionally with VGP (n = 49) or with VBP (n = 24). Because different sedation methods can influence rectal and bladder dosimetric parameters all applications were grouped by packing method (VBP or VGP) as well as sedation method (GA or PCA). The International Commission on Radiation Units and Measurements (ICRU) and D2cc rectal and bladder doses were obtained from the treatment records and dose-volume histograms, and respective percentage of prescription dose noted and compared. For patients receiving PCA, pain score on a scale of 0-10 was noted.

Results: All patients who used PCA were able to tolerate and complete the procedure with a median pain score of 0 (range, 0-2). Implants packed with the VBP method under PCA (n = 21) versus VGP under GA (n = 40) had significantly lower doses to the bladder D2cc (85.7% vs 104.8% of prescription dose), and rectum ICRU dose point (55.4% vs 65.2% of prescription dose), P = .0371 and .039, respectively. The ICRU bladder point and rectum D2cc between the 2 groups were not significantly different.

Conclusions: Our results demonstrate that PCA is a feasible method for pain control for T&O brachytherapy. VBP and PCA are compatible with T&O brachytherapy and resulted in comparable if not better bladder and rectal dosimetry.