Pain and symptom assessment during multiple fractions of gynecologic high-dose-rate brachytherapy

A prospective assessment of tolerability of gynecologic brachytherapy was completed to determine adequacy of analgesia and symptom control for patients undergoing CT-guided brachytherapy, with multiple fractions delivered during a single applicator insertion.

Seventeen patients receiving high-dose-rate brachytherapy for gynecologic cancer (other than vaginal vault) completed ratings of pain intensity, anxiety, and nausea at five key time points before, during, and after brachytherapy. Symptoms were assessed with patient-reported scores using an 11-point numeric rating scale. The patient population included cervical (n=12), endometrial (n=3), and vulvar-vaginal (n=2) malignancies. Patients underwent general anesthesia for applicator placement. Analgesia consisted of subcutaneous route opioid, and oral opioid and/or nonopioid as needed for the duration of the treatment planning and delivery.

The mean scores for pain were highest after patients were transferred to the CT scanner, 3.3±2.6, compared with baseline scores of 0.9±1.7. Pain scores were 2.3±2.3 during the remainder of the procedure, and 2.7±2.1 after the removal of the applicator. The highest mean anxiety scores occurred before the brachytherapy procedure, 4.3±3.4, with resolution of anxiety during the procedure to 1.3±1.6. The mode of nausea scoring during the procedure was 0.

For most of the patients, the delivery of multiple fractions of image-guided high-dose-rate brachytherapy is well tolerated with maximum scores of mild-moderate pain and distress, and no significant nausea. This can be accomplished with applicator placement under general anesthesia and standard medical management.