Pain control and opioid use as a function of workflow in MRI-guided interstitial cervix brachytherapy

/Objective(s): Pain management during brachytherapy for cervix cancer is challenging. Institutional practice for brachytherapy delivery and pain management varies. Here we retrospectively assessed pain control and opioid use requirements during different MRI-guided interstitial cervix brachytherapy workflows.

/Methods: In this retrospective study, data was collected on ninety-one patients receiving MR-guided interstitial brachytherapy for cervix cancer between June 2022 and June 2024. Abstracted data included: demographics, disease characteristics, pain scores, opioid use, and brachytherapy workflow. Patients were either treated as in-patients or out-patients. In-patients remained overnight to receive a second fraction the following day. Out-patients received a single fraction and were discharged the same day. Out-patients were further divided into intra-operative versus post-operative treatment. For intra-operative treatment the entire procedure was performed under general anesthesia (GA). For post-operative treatment only applicator insertion was under GA. Multivariable linear regression modelling was used for analysis of opioid dose and pain scores.

Ninety-one patients were eligible for inclusion, corresponding to 201 separate insertions. Median age was 51. Majority (69 %) had cT2b disease. Mean CTV_HR volume and D_90% were 32.2 cm³ (standard deviation (SD) 19.4) and 92.2 Gy (SD 2.5), respectively. In-patient stay was associated with increased opioid requirements, higher average pain, and more episodes of uncontrolled pain (p < 0.001). Within those treated as out-patients, intra-operative treatment was associated with lower average pain and fewer episodes of uncontrolled pain (p < 0.001).

In-patient treatment was associated with worse pain control, despite increased opioid use. Within those treated as out-patients, intra-operative treatment further improved pain management.