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Outpatient combined intracavitary and interstitial cervical brachytherapy: barriers and solutions to implementation of a successful programme - a single institutional experience.

Tan PW, Koh VY, Tang JI - J Contemp Brachytherapy (2015)

Bottom Line: This procedure is often resource intensive, requiring inpatient stay and magnetic resonance imaging (MRI) planning.In departments where such resources are limited, there is a poor uptake of interstitial brachytherapy.This article discusses the technique of combined intracavitary and interstitial brachytherapy in an outpatient setting, and explores the issues and barriers for implementation and suggestions to overcome such barriers.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiation Oncology, National University Cancer Institute Singapore, Singapore.

ABSTRACT
Involvement of parametrial disease in locally advanced cervical patients poses a challenge for women undergoing brachytherapy. Current use of the Fletcher suit applicator may not adequately cover the high risk clinical target volume (HR CTV), especially in the parametrial region due to the physical qualities of brachytherapy from the inverse square law and the need to respect organs at risk (OAR) constraints, and leads to lower local control rates. Combined intracavitary and interstitial brachytherapy with the use of 1 or 2 interstitial needles allows adequate coverage of the HR CTV and the clinical evidence have demonstrated a correlation with better clinical results. This procedure is often resource intensive, requiring inpatient stay and magnetic resonance imaging (MRI) planning. In departments where such resources are limited, there is a poor uptake of interstitial brachytherapy. This article discusses the technique of combined intracavitary and interstitial brachytherapy in an outpatient setting, and explores the issues and barriers for implementation and suggestions to overcome such barriers.

No MeSH data available.


Paracervical block. Paracervical anaesthetic block is placed at the 2, 4, 8, 10 o'clock position in the cervical parametrium area as denoted by the white dots
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Figure 0002: Paracervical block. Paracervical anaesthetic block is placed at the 2, 4, 8, 10 o'clock position in the cervical parametrium area as denoted by the white dots

Mentions: Twenty-four hours prior to the procedure, oral fleet is given to the patient to ensure adequate bowel preparation. By reducing the chance of fecal material or flatus in the bowel, this reduces the likelihood of the bowel being adjacent to the HR CTV region [12]. On the day of the procedure, the patient is fasted 6 hours before to allow for moderate sedation using a combination of oxycodone 5 mg capsules and midazolam given by the anesthetist. After positioning the patient in a lithotomy position, a formal examination of the cervix and the parametrium and a per rectum is done digitally to assess the extent of the tumor. With the speculum in place, a paracervical block is then performed, injecting 2% lignocaine into the 2, 4, 8, 10 o'clock positions in the cervical parametrium area (Figure 2). This is to anaesthetize the adjacent area to facilitate the insertion of the interstitial needles in the parametrium [16].


Outpatient combined intracavitary and interstitial cervical brachytherapy: barriers and solutions to implementation of a successful programme - a single institutional experience.

Tan PW, Koh VY, Tang JI - J Contemp Brachytherapy (2015)

Paracervical block. Paracervical anaesthetic block is placed at the 2, 4, 8, 10 o'clock position in the cervical parametrium area as denoted by the white dots
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4499522&req=5

Figure 0002: Paracervical block. Paracervical anaesthetic block is placed at the 2, 4, 8, 10 o'clock position in the cervical parametrium area as denoted by the white dots
Mentions: Twenty-four hours prior to the procedure, oral fleet is given to the patient to ensure adequate bowel preparation. By reducing the chance of fecal material or flatus in the bowel, this reduces the likelihood of the bowel being adjacent to the HR CTV region [12]. On the day of the procedure, the patient is fasted 6 hours before to allow for moderate sedation using a combination of oxycodone 5 mg capsules and midazolam given by the anesthetist. After positioning the patient in a lithotomy position, a formal examination of the cervix and the parametrium and a per rectum is done digitally to assess the extent of the tumor. With the speculum in place, a paracervical block is then performed, injecting 2% lignocaine into the 2, 4, 8, 10 o'clock positions in the cervical parametrium area (Figure 2). This is to anaesthetize the adjacent area to facilitate the insertion of the interstitial needles in the parametrium [16].

Bottom Line: This procedure is often resource intensive, requiring inpatient stay and magnetic resonance imaging (MRI) planning.In departments where such resources are limited, there is a poor uptake of interstitial brachytherapy.This article discusses the technique of combined intracavitary and interstitial brachytherapy in an outpatient setting, and explores the issues and barriers for implementation and suggestions to overcome such barriers.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiation Oncology, National University Cancer Institute Singapore, Singapore.

ABSTRACT
Involvement of parametrial disease in locally advanced cervical patients poses a challenge for women undergoing brachytherapy. Current use of the Fletcher suit applicator may not adequately cover the high risk clinical target volume (HR CTV), especially in the parametrial region due to the physical qualities of brachytherapy from the inverse square law and the need to respect organs at risk (OAR) constraints, and leads to lower local control rates. Combined intracavitary and interstitial brachytherapy with the use of 1 or 2 interstitial needles allows adequate coverage of the HR CTV and the clinical evidence have demonstrated a correlation with better clinical results. This procedure is often resource intensive, requiring inpatient stay and magnetic resonance imaging (MRI) planning. In departments where such resources are limited, there is a poor uptake of interstitial brachytherapy. This article discusses the technique of combined intracavitary and interstitial brachytherapy in an outpatient setting, and explores the issues and barriers for implementation and suggestions to overcome such barriers.

No MeSH data available.