title: New approach to relieving pain and distress during high-dose-rate intracavitary irradiation for cervical cancer.
abstract: OBJECTIVE
  To relieve the pain and distress experienced by women who undergo high-dose-rate intracavitary radiotherapy (HDR-ICRT) for cervical cancer and to improve the current status of gynecologic brachytherapy in Japan, a new intravenous anesthetic protocol involving the administration of a combination of propofol and ketamine was developed. The primary aim of this study is to investigate the efficacy and safety of this new anesthetic protocol during HDR-ICRT for cervical cancer.
  
  
  METHODS
  All the patients who were diagnosed with cervical cancer between December 2008 and February 2011, treated with three-channel brachytherapy and subjected to the new sedation protocol, were evaluated. A visual analog scale (VAS) was used to assess the pain during brachytherapy, and we collected VAS score at the next HDR-ICRT. Toxicities were graded using the Common Toxicity Criteria, version 3.
  
  
  RESULTS
  A total of 178 sessions of HDR-ICRT were delivered to 57 patients. The patients' median VAS pain score was 0 (range, 0-10). The most frequent side effect was Grade 1-2 nausea, which occurred in 33 sessions (34%). However, 13 of 14 patients received concurrent cisplatin chemotherapy. None of the patients experienced Grade 3 or 4 adverse events.
  
  
  CONCLUSIONS
  We have demonstrated that our new intravenous anesthetic protocol produces appropriate effects and can be performed by radiation oncologists who were required to finish training in basic life support and the cooperative system of emergency according to in-house guideline.
authors.affiliation: Department of Radiology and Radiation Oncology, Graduate School of Medicine, Chiba University, Chiba, Japan; Department of Radiology, Chiba University Hospital, Chiba, Japan. Electronic address: mwatanabe@hospital.chiba-u.jp.
authors.forename: Miho
authors.initials: M
authors.lastname: Watanabe Nemoto
authors.affiliation: Department of Anesthesiology, Chiba University Hospital, Chiba, Japan.
authors.forename: Natsuko
authors.initials: N
authors.lastname: Nozaki-Taguchi
authors.affiliation: Department of Radiology, Chiba University Hospital, Chiba, Japan.
authors.forename: Gentaro
authors.initials: G
authors.lastname: Togasaki
authors.affiliation: Department of Radiology, Chiba University Hospital, Chiba, Japan.
authors.forename: Aki
authors.initials: A
authors.lastname: Kanazawa
authors.affiliation: Department of Radiology, Chiba University Hospital, Chiba, Japan.
authors.forename: Marie
authors.initials: M
authors.lastname: Kurokawa
authors.affiliation: Department of Radiology, Chiba University Hospital, Chiba, Japan.
authors.forename: Rintarou
authors.initials: R
authors.lastname: Harada
authors.affiliation: Department of Radiology and Radiation Oncology, Graduate School of Medicine, Chiba University, Chiba, Japan; Department of Radiology, Chiba University Hospital, Chiba, Japan.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Kobayashi
authors.affiliation: Department of Anesthesiology, Chiba University Hospital, Chiba, Japan.
authors.forename: Shiroh
authors.initials: S
authors.lastname: Isono
authors.affiliation: Department of Radiology and Radiation Oncology, Graduate School of Medicine, Chiba University, Chiba, Japan; Department of Radiology, Chiba University Hospital, Chiba, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Uno
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000771:Anesthesia, Intravenous / Q000009:adverse effects; D018686:Anesthetics, Intravenous; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001918:Brachytherapy / Q000009:adverse effects*; D002277:Carcinoma / Q000188:drug therapy / Q000532:radiotherapy*; D059248:Chemoradiotherapy / Q000009:adverse effects; D002945:Cisplatin / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007564:Japan; D007649:Ketamine; D008875:Middle Aged; D010146:Pain / Q000209:etiology / Q000517:prevention & control*; D010147:Pain Measurement; D015742:Propofol; D002583:Uterine Cervical Neoplasms / Q000188:drug therapy / Q000532:radiotherapy*
chemical_list: D018686:Anesthetics, Intravenous; D000970:Antineoplastic Agents; D007649:Ketamine; D002945:Cisplatin; D015742:Propofol
keywords: Anesthesia; Cervical cancer; High-dose-rate intracavitary irradiation; Intravenous