Chen Jiajun, Zhang Ning, Liu Ying, Han Dongmei, Mao Zhuang, Yang Wei, Cheng Guanghui
Department of Radiation Oncology, China-Japan Union Hospital of Jilin University, Changchun, China.
Front Oncol. 2021 Jun 7;11:677052. doi: 10.3389/fonc.2021.677052. eCollection 2021.
To report applicator insertion-related acute side effects during brachytherapy (BT) procedure for cervical cancer patients.
Between November 2017 and December 2019, 407 BT fractions were performed in 125 patients with locally advanced cervical cancer. Acute side effects recorded comprised anesthesia-related side effects, mechanical-related side effects and infection, whose frequency and degree were recorded. Pain was assessed using numeric rating scale; vaginal bleeding volume was counted by weighing gauze pieces used in packing. The BT procedure comprised eight stages: anesthesia, applicator insertion, image acquisition, transport, waiting for treatment, dose delivery, applicator removal, and removed which denoted 0.5-12.0 h period after removal, with time of each stage recorded. Factors influencing acute side effects were assessed by Spearman correlation and Mann-Whitney U test.
The most common acute side effect was pain, followed by vaginal bleeding. The mean scores for pain were highest during removal time, 4.9 ± 1.6 points. The mean vaginal bleeding volume was 44.4 ml during removal time. Mean total procedure time was 218.8 (175-336) min, having positive relationship with frequency of acute side effects. The total procedure time with acute side effects was longer than that without acute side effects. The longest procedure time was waiting time, 113.0 (91.0-132.0) min. More needles generated higher pain scores and larger volume of vaginal bleeding.
Pain and vaginal bleeding were the most common acute side effects, especially during removal time, which physicians should focus on. Shortening patients' waiting time helps to reduce the total procedure time, thus, reduce acute side effects. While meeting dose requirement, less needles are helpful to reduce acute side effects.
报告宫颈癌患者近距离放射治疗（BT）过程中施源器插入相关的急性副作用。
2017年11月至2019年12月期间，对125例局部晚期宫颈癌患者进行了407次BT治疗。记录的急性副作用包括麻醉相关副作用、机械相关副作用和感染，并记录其发生频率和程度。使用数字评分量表评估疼痛；通过称量填塞用纱布块来计算阴道出血量。BT治疗过程包括八个阶段：麻醉、施源器插入、图像采集、转运、等待治疗、剂量输送、施源器移除以及移除后0.5 - 12.0小时的观察期，并记录每个阶段的时间。通过Spearman相关性分析和Mann - Whitney U检验评估影响急性副作用的因素。
最常见的急性副作用是疼痛，其次是阴道出血。移除时疼痛的平均评分最高，为4.9±1.6分。移除时阴道平均出血量为44.4毫升。平均总治疗时间为218.8（175 - 336）分钟，与急性副作用的发生频率呈正相关。有急性副作用的总治疗时间长于无急性副作用的情况。最长的治疗时间是等待时间，为113.0（91.0 - 132.0）分钟。施源器针数越多，疼痛评分越高，阴道出血量越大。
疼痛和阴道出血是最常见的急性副作用，尤其是在移除施源器时，医生应予以关注。缩短患者的等待时间有助于减少总治疗时间，从而减少急性副作用。在满足剂量要求的同时，减少施源器针数有助于降低急性副作用。
