Improving complex brachytherapy efficiency: Multidisciplinary quality assurance and workflow optimization

MRI-guided brachytherapy for locally advanced cervical cancer improves oncological and toxicity outcomes; however, it is a time-intensive process. We hypothesize that integrating MRI with device inserted and moderate sedation with epidural for patients receiving cervical brachytherapy will not increase total treatment time relative to processes that use general or moderate anesthesia without MRI with device inserted.

From 2019-2023, 32 patients with cervical cancer, stage FIGO IB2-IVB, were selected to form 3 cohorts: Cohort 1 (n = 9) received general anesthesia without MRI; cohort 2 (n = 7) received moderate sedation; cohort 3 (n = 6) received epidural, moderate sedation, and MRI. Time differences between groups were compared. Primary endpoints were total treatment time, epidural time, case time, recovery time, MRI time, treatment planning and delivery in minutes. Secondary endpoints included percentage of patients completing treatment within the 56-day package time and receiving brachytherapy within 7 days from external radiation therapy.

MRI imaging with the device in place and epidural use increased median treatment time among cohorts. The use of moderate sedation in the radiation department decreased median total treatment time among cohorts. Median total treatment time [median (IQR)] were not significantly different; 433 (376, 456), 350 (333, 394), 413 (336, 455) min, among cohorts 1, 2 and 3 respectively (p > 0.05). The 56-day package time or median time from external beam radiation therapy to brachytherapy was not significantly different among cohorts (p > 0.05).

Treatment day MRI with device plus the use of epidural and moderate sedation for analgesia does not prolong total treatment time.