New Technique to Avoid General Anesthesia during Brachytherapy for Cancer Cervix

Ashraf H Hassouna*

Aim:To keep the cervical canal dilated after the first high dose rate (HDR) brachytherapy fraction to avoid general anesthesia during subsequent applications.

Patients and Methods: In the first HDR brachytherapy application: examination and cervical dilatation was done under general anesthesia. The proximal 4 cm of urinary Foley catheter was cut (making the new cervical tube), inserted in the cervical canal and fixed to the cervix by 3 simple silk sutures. Uterine tandem was inserted into the uterus through the new cervical tube and procedure was completed as usual. The new  cervical  tube  was  left  in  place  after  the  end  of  the  session.  In  the  subsequent  HDR  brachytherapy applications: uterine tandem was inserted into the uterus through this new cervical tube without general anesthesia.  All  applications  were  evaluated  by  CT  images  and  patients  were  treated  according  to  CT-image-based 3D calculation.

Results: In total: 9 HDR brachytherapy applications were done for 3 cancer cervix patients. For each patient:first  application  was  done  under  general  anesthesia  while  2nd and  3rd applications  were  done without general anesthesia (analgesia or sedation was given if needed). The uterine tandem was inserted easily  and  correctly  with  the  new  cervical  tube  in  place.  No  complications  occurred  during  or  after  the procedures.

Conclusion:  This  is  a  simple  new  technique  facilitating  uterine  tandem  insertion  without  general anesthesia. Using this technique, patients can be protected from general anesthesia hazards (especially in risky patients) and time saved during brachytherapy applications. This new cervical tube is as safe and applicable as the cervical Smit sleeve; however, it is more available and cheaper..

Keywords: Brachytherapy; HDR; Cancer cervix

Published on: Dec 30, 2016 Pages: 25-28

Full Text PDF Full Text HTML DOI: 10.17352/ijrro.000017
CrossMark Publons Harvard Library HOLLIS Search IT Semantic Scholar Get Citation Base Search Scilit OAI-PMH ResearchGate Academic Microsoft GrowKudos Universite de Paris UW Libraries SJSU King Library SJSU King Library NUS Library McGill DET KGL BIBLiOTEK JCU Discovery Universidad De Lima WorldCat VU on WorldCat