Paracervical blocks facilitate timely brachytherapy amidst COVID-19

Area of Science:

• Oncology
• Radiation Oncology
• Gynecologic Oncology

Background:

• The COVID-19 pandemic created challenges for brachytherapy delivery, particularly for locally advanced cervical cancer requiring timely treatment.
• Safety-net hospitals face high volumes of cervical cancer cases, necessitating adaptable treatment strategies.

Purpose of the Study:

• To describe a strategy for performing intracavitary brachytherapy (ICBT) entirely within a clinic setting.
• To evaluate the feasibility and success of using paracervical blocks (PCBs) and oral multimodal analgesia (MMA) for clinic-based cervical ICBT.

Main Methods:

• Developed a protocol for clinic-based ICBT in collaboration with gynecology oncology and anesthesia.
• Utilized paracervical blocks (PCBs) and oral multimodal analgesia (MMA) for pain management.
• Screened and selected patients eligible for the clinic-based procedure.

Main Results:

• 18 of 19 (95%) screened patients were eligible for in-clinic ICBT.
• 38 of 39 (97%) ICBT procedures were successfully completed in the clinic using PCBs and oral MMA.
• 95% of patients reported no pain post-procedure, with acceptable radiation doses to organs at risk (rectum, bladder) and target volumes (CTV high-risk).

Conclusions:

• Clinic-based ICBT using PCBs and oral MMA is a feasible and effective strategy for managing locally advanced cervical cancer.
• This approach mitigates exposure risks for patients and staff during the pandemic.
• The multidisciplinary strategy reduces the overall healthcare burden while ensuring critical cancer treatment delivery.