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Paracervical blocks facilitate timely brachytherapy amidst COVID-19.
Brunnhoelzl, Daniel; Hanania, Alexander N; Echeverria, Alfredo; Sunde, Jan; Tran, Connie; Ludwig, Michelle.
  • Brunnhoelzl D; Department of Radiation Oncology, Dan L. Duncan Comprehensive Cancer Center Baylor College of Medicine, Houston, TX.
  • Hanania AN; Department of Radiation Oncology, Dan L. Duncan Comprehensive Cancer Center Baylor College of Medicine, Houston, TX.
  • Echeverria A; Department of Radiation Oncology, Dan L. Duncan Comprehensive Cancer Center Baylor College of Medicine, Houston, TX.
  • Sunde J; Department of Gynecologic Oncology, Baylor College of Medicine, Houston, TX.
  • Tran C; Department of Anesthesia, Baylor College of Medicine, Houston, TX.
  • Ludwig M; Department of Radiation Oncology, Dan L. Duncan Comprehensive Cancer Center Baylor College of Medicine, Houston, TX. Electronic address: Michelle.Ludwig@bcm.edu.
Brachytherapy ; 20(1): 284-289, 2021.
Article in English | MEDLINE | ID: covidwho-695371
ABSTRACT

PURPOSE:

The COVID-19 pandemic presents serious challenges for brachytherapists, and in the time-sensitive case of locally advanced cervical cancer, the need for curative brachytherapy (BT) is critical for survival. Given the high-volume of locally advanced cervical cancer in our safety-net hospital, we developed a strategy in close collaboration with our gynecology oncology and anesthesia colleagues to allow for completely clinic-based intracavitary brachytherapy (ICBT). METHODS AND MATERIALS This technical report will highlight our experience with the use of paracervical blocks (PCBs) and oral multimodal analgesia (MMA) for appropriately selected cervical ICBT cases, allowing for completely clinic-based treatment.

RESULTS:

18 of 19 (95%) screened patients were eligible for in-clinic ICBT. The excluded patient had significant vaginal fibrosis. 38 of 39 intracavitary implants were successfully transitioned for entirely in-clinic treatment utilizing PCBs and oral MMA (97% success rate). One case was aborted due to inadequate analgesia secondary to a significantly delayed case start time (PO medication effect diminished). 95% of patients reported no pain at the conclusion of the procedure. The median (IQR) D2cc for rectum and bladder were 64.8 (58.6-70.2) Gy and 84.1 (70.9-89.4) Gy, respectively. Median (IQR) CTV high-risk D90 was 88.0 (85.6-89.8) Gy.

CONCLUSIONS:

In a multidisciplinary effort, we have successfully transitioned many ICBT cases to the clinic with the use of PCB local anesthesia and oral multimodality therapy in direct response to the current pandemic, thereby mitigating exposure risk to patients and staff as well as reducing overall health care burden.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Brachytherapy / Uterine Cervical Neoplasms / Ambulatory Surgical Procedures / Pain, Procedural / Analgesics / Anesthesia, Local / Anesthesia, Obstetrical Type of study: Observational study / Prognostic study Limits: Female / Humans Language: English Journal: Brachytherapy Journal subject: Radiotherapy Year: 2021 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Brachytherapy / Uterine Cervical Neoplasms / Ambulatory Surgical Procedures / Pain, Procedural / Analgesics / Anesthesia, Local / Anesthesia, Obstetrical Type of study: Observational study / Prognostic study Limits: Female / Humans Language: English Journal: Brachytherapy Journal subject: Radiotherapy Year: 2021 Document Type: Article