eISSN: 2081-2841
ISSN: 1689-832X
Journal of Contemporary Brachytherapy
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vol. 15
Original paper

Feasibility of outpatient hybrid brachytherapy for cervical cancer with minimal sedation: Results from a single-institutional protocol

Subhakar Mutyala
1, 2
Gabriella Smith
Hayden Ansinelli
Nitika Thawani
2, 4, 5

Arizona Center for Cancer Care, Scottsdale, AZ, USA
University of Arizona College of Medicine – Phoenix, AZ, USA
Department of Radiation Oncology, University of Arizona, Tucson, AZ, USA
Dignity Health Cancer Institute at St. Joseph’s, Phoenix, AZ, USA
Creighton School of Medicine – Phoenix, AZ, USA
J Contemp Brachytherapy 2023; 15, 1: 43–47
Online publish date: 2023/02/28
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Pain control techniques during high-dose-rate hybrid intracavitary-interstitial brachytherapy (HBT) for cervical cancer vary widely, with many centers opting for general anesthesia (GA) or conscious sedation (CS). Here, we describe a single-institutional series of patients treated with HBT and ASA-defined minimal sedation, utilizing oral analgesic and anxiolytic medications in substitution for GA or CS.

Material and methods:
The charts of patients who underwent HBT treatments for cervical cancer from June 2018 to May 2020 were retrospectively reviewed. Prior to HBT, all patients underwent an exam under anesthesia (EUA), and Smit sleeve placement under general anesthesia or deep sedation. Oral lorazepam and oxycodone/acetaminophen were administered between 30-90 minutes before HBT procedure for minimal sedation. HBT placement was performed on computed tomography (CT) table, with needle advancement under CT-guidance.

Treatments with minimal sedation were attempted in 63 patients. A total of 244 interstitial implants with 453 needles were placed via CT-guidance. Sixty-one patients (96.8%) tolerated the procedure without any additional intervention, while two patients (3.2%) required the use of epidural anesthesia. None of the patients in the series required a transition to general anesthesia for the procedure. Bleeding, which resolved with short-term vaginal packing, occurred in 22.1% of insertions.

In our series, the treatment of HBT for cervical cancer with minimal sedation was feasible at a high percentage (96.8%). The ability to perform HBT without GA or CS could be a reasonable option to provide image-guided adaptive brachytherapy (IGABT) with limited resources, allowing for more widespread use. Further investigations using this technique are warranted.


interstitial brachytherapy, image-guided brachytherapy, cervical cancer, HDR brachytherapy

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