Paracervical Blocks Facilitate Timely Brachytherapy Amidst COVID-19

Brunnhoelzl, Daniel; Hanania, Alexander N.; Echeverria, Alfredo; Sunde, Jan; Tran, Connie; Ludwig, Michelle

Structured Abstract Purpose The COVID-19 pandemic presents serious challenges for brachytherapists, and in the time-sensitive case of locally advanced cervical cancer (LACC), the need for curative brachytherapy (BT) is critical for survival. Given the high-volume of LACC in our safety-net hospital, we developed a strategy in close collaboration with our gynecology oncology and anesthesia colleagues to allow for completely clinic-based ICBT. Methods This technical report will highlight our experience with the use of paracervical blocks (PCB) and oral multimodal analgesia (MMA) for appropriately selected cervical ICBT cases, allowing for completely clinic-based treatment. Results 18 of 19 (95%) screened patients were eligible for in-clinic ICBT. The excluded patient had significant vaginal fibrosis. 38 of 39 intracavitary implants were successfully transitioned for entirely in-clinic treatment utilizing PCB and oral MMA (97% success rate). One case was aborted due to inadequate analgesia secondary to a significantly delayed case start time (PO medication effect diminished). 95% of patients reported no pain at the conclusion of the procedure. The median (IQR) D2cc for rectum and bladder were 64.8 (58.6-70.2) Gy and 84.1 (70.9-89.4) Gy, respectively. Median (IQR) CTV High Risk D90 was 88.0 (85.6-89.8) Gy. Conclusions In a multi-disciplinary effort, we have successfully transitioned many ICBT cases to the clinic with the use of PCB local anesthesia and oral multimodality therapy in direct response to the current pandemic, thereby mitigating exposure risk to patients and staff as well as reducing overall health care burden.