Department of Radiation Oncology, The Ohio State University College of Medicine, Arthur G. James Comprehensive Cancer Center, Columbus, Ohio.
Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
Pract Radiat Oncol. 2013 Oct-Dec;3(4):263-8. doi: 10.1016/j.prro.2012.11.004. Epub 2012 Dec 8.
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.
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.
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.
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.
评估以下内容：（1）从全身麻醉（GA）到患者自控镇痛（PCA）以及从阴道纱布填塞（VGP）到阴道球囊填塞（VBP）方法转变对高剂量率（HDR）腔内近距离放疗的膀胱和直肠的剂量学影响；（2）PCA 与 GA 的耐受性。
选择并回顾了 2009 年 1 月至 2010 年 8 月间连续治疗的 17 例宫颈癌患者，这些患者接受了 T&O（T&O）HDR 近距离放疗，共进行了 73 次治疗。患者采用常规 VGP（n = 49）或 VBP（n = 24）填塞。由于不同的镇静方法可能会影响直肠和膀胱剂量学参数，因此根据填塞方法（VBP 或 VGP）和镇静方法（GA 或 PCA）将所有应用分组。通过治疗记录和剂量-体积直方图获得国际辐射单位和测量委员会（ICRU）和 D2cc 直肠和膀胱剂量，并记录和比较各自的处方剂量百分比。对于接受 PCA 的患者，记录了 0-10 分的疼痛评分。
所有接受 PCA 的患者均能够耐受并完成该过程，中位疼痛评分为 0（范围，0-2）。在 PCA 下使用 VBP 方法填塞（n = 21）与 GA 下使用 VGP 填塞（n = 40）的膀胱 D2cc 剂量显著较低（处方剂量的 85.7%与 104.8%），直肠 ICRU 剂量点（处方剂量的 55.4%与 65.2%），P =.0371 和.039。两组之间的 ICRU 膀胱点和直肠 D2cc 无显著差异。
我们的结果表明，PCA 是 T&O 近距离放疗中控制疼痛的可行方法。VBP 和 PCA 与 T&O 近距离放疗兼容，并且膀胱和直肠的剂量学结果相当，甚至更好。
