Sedation or Anesthesia Before Cervical Cancer Brachytherapy

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Sedation or Anesthesia Before Cervical Cancer Brachytherapy

Journal Title: Interventions in Gynaecology and Women’s Healthcare - Year 2018, Vol 2, Issue 5

Abstract

Cervical cancer (CC) is a neoplasm with great potential for prevention, but it is still a public health problem in most developing countries. There are no significant differences between the use of high dose rate (HDR-BT) and low dose rate (LDR-BT) brachytherapy when considering overall, disease specific and recurrence free survivals. Cervical dilatation is mandatory for the insertion of intrauterine tandems in any of the techniques cited above. Pain and discomfort may eventually be limiting factors of the outpatient procedure and may lead to unsatisfactory results in terms of adequate position of the applicator set. We reviewed the current sedation and anesthetic options for comfort and safety procedures when performing HDR-BT. Cervical cancer (CC) is a neoplasm with great potential for prevention, but it is still an important public health problem in most developing countries, leading to a significant number of deaths in young women (15-50 years old). In 2012 there has been a total of 528,000 new diagnosis and 266,000 deaths per CC worldwide, accounting for 7.5 % of all deaths from female cancers [1]. High dose rate brachytherapy (HDR-BT) with after-loading equipment has been used in the treatment of CC since the 1960s, in radical and also in post-operative settings. HDR-BT has now been widely used due to its mechanical and computerized control evolution besides cost reduction. It presents very satisfactory results in terms local control of disease, depending on clinical stage, when associated or not to External Beam Radiotherapy (EBRT). A literature review published showed no significant differences between HDR-BT and low dose rate brachytherapy (LDR-BT) when considering overall, disease specific and recurrence free survivals. Local control, recurrence and metastasis incidence rates, plus treatment related complications, were not different when comparing both techniques. Some potential advantages of HDR-BT as the rigid immobilization, possibility of outpatient treatment and individualized treatment, are the basis for recommendations of the use of HDR-BT for all clinical stages of CC [2]. Most centers have dedicated HDR services with a significant number of patients treated as outpatients. In these services, outside specialized or general hospitals, and even inside these, the presence of an anesthetic team is not frequent.

Authors and Affiliations

Antonio Cassio Assis Pellizzon

Keywords

EP ID EP581448
DOI 10.32474/IGWHC.2018.02.000146
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