宫颈癌近距离放射治疗疼痛管理的研究进展

doi:10.13481/j.1671-587x.20190140

摘要/Abstract

摘要： 放射治疗是宫颈癌根治性治疗手段之一，近距离放射治疗是其重要组成部分，涉及施源器植入、患者影像资料采集、治疗计划等待和施源器拔出等不同阶段。近距离放射治疗中引起的疼痛影响患者的舒适度以及术者的操作，甚至可能影响局部控制和正常组织反应，严重时可导致患者的预后不良和生活质量降低。目前，随着对肿瘤患者疼痛管理的重视，尤其是肿瘤治疗中引起疼痛的处理，加强近距离治疗中的疼痛管理显得尤为重要。但目前尚无近距离放射治疗中镇痛相关的指南及共识，本文总结分析近年来国内外对宫颈癌近距离治疗中疼痛管理的相关报道及临床经验，分别对宫颈癌患者近距离放射治疗前、治疗中和治疗后疼痛管理进行综述，以期为同行提供可靠的临床参考。

关键词: 宫颈肿瘤, 近距离放射治疗, 疼痛管理, 镇痛

中图分类号:

R737.33

卢银亮, 朱永刚, 张宁, 汤玉环, 程光惠. 宫颈癌近距离放射治疗疼痛管理的研究进展[J]. 吉林大学学报(医学版), 2019, 45(01): 211-216.

参考文献

[1] KARLSSON J,DREIFALDT A C,MORDHORST L B, et al. Differences in outcome for cervical cancer patients treated with or without brachytherapy[J]. Brachytherapy, 2017, 16(1):133-140.
[2] WANG W,HOU X,YAN J, et al. Outcome and toxicity of radical radiotherapy or concurrent Chemoradiotherapy for elderly cervical cancer women[J]. BMC Cancer, 2017, 17(1):510.
[3] KWEKKEBOOM K L,DENDAAS N R,STRAUB M, et al. Patterns of pain and distress during high-dose-rate intracavity brachytherapy for cervical cancer[J]. J Support Oncol, 2009, 7(3):108-114.
[4] WARNOCK C. Patients' experiences of intracavity brachytherapy treatment for gynaecological cancer[J]. Eur J Oncol Nurs, 2005, 9(1):44-55.
[5] ROLLISON B,STRANG P. Pain, nausea and anxiety during intra-uterine brachytherapy of cervical carcinomas[J]. Support Care Cancer, 1995, 3(3):205-207.
[6] WIEBE E,SURRY K,DERRAH L, et al. Pain and symptom assessment during multiple fractions of gynecologic high-dose-rate brachytherapy[J]. Brachytherapy, 2011,10(5):352-356.
[7] BHANABHAI H,SAMANT R,E C, et al. Pain assessment during conscious sedation for cervical cancer high-dose-rate brachytherapy[J]. Curr Oncol, 2013, 20(4):e307-310.
[8] CORN B W,HANLON A L,PAJAK T F, et al. Technically accurate intracavitary insertions improve pelvic control and survival among patients with locally advanced carcinoma of the uterine cervix[J]. Gynecol Oncol, 1994, 53(3):294-300.
[9] WATANABE NEMOTO M,NOZAKI-TAGUCHI N,TOGASAKI G, et al. New approach to relieving pain and distress during high-dose-rate intracavitary irradiation for cervical cancer[J]. Brachytherapy, 2015, 14(5):642-647.
[10] BANSAL R,KHAN JOAD A S,SAXENA M, et al. Oral midazolam is a safe and effective premedication in adult outpatients undergoing brachytherapy for cancer cervix under general anaesthesia:A prospective randomised, double blind placebo-controlled study[J]. Indian J Anaesth, 2015,59(7):437-439.
[11] KAMER S,OZSARAN Z,CELIK O, et al. Evaluation of anxiety levels during intracavitary brachytherapy applications in women with gynecological malignancies[J]. Eur J Gynaecol Oncol, 2007, 28(2):121-124.
[12] HILLER J G,ISMAIL H M,HOFMAN M S, et al. Neuraxial anesthesia reduces lymphatic flow:proof-of-concept in first in-human study[J]. Anesth Analg, 2016, 123(5):1325-1327.
[13] SMITH M D, TODD J G,SYMONDS R P. Analgesia for pelvic brachytherapy[J]. Br J Anaesth, 2002, 88(2):270-276.
[14] VISWANATHAN A N,CREUTZBERG C L,CRAIGHEAD P, et al. International brachytherapy practice patterns:a survey of the Gynecologic Cancer Intergroup (GCIG)[J]. Int J Radiat Oncol Biol Phys, 2012, 82(1):250-255.
[15] JONES B,TAN L T,BLAKE P R, et al. Results of a questionnaire regarding the practice of radiotherapy for carcinoma of the cervix in the UK[J]. Br J Radiol, 1994, 67(804):1226-1230.
[16] PETRIC P,HUDEJ R,HANUNA O, et al. MRI-assisted cervix cancer brachytherapy pre-planning, based on application in paracervical anaesthesia:final report[J]. Radiol Oncol, 2014, 48(3):293-300.
[17] PROUD C. The use of oral transmucosal fentanyl citrate during high-dose-rate gynecologic brachytherapy[J]. Clin J Oncol Nurs, 2007, 11(4):561-567.
[18] XU-WELLIVER M,LIN L L. Evaluation of a balloon-based vaginal packing system and patient-controlled analgesia for patients with cervical cancer undergoing high-dose-rate intracavitary brachytherapy[J]. Pract Radiat Oncol, 2013, 3(4):263-268.
[19] LEONG Y H,TAN K H S,AI CHOO B, et al. Novel anesthetic technique for combined intracavitary and interstitial brachytherapy for cervix cancer in an outpatient setting[J]. J Contemp Brachytherapy, 2017, 9(3):236-241.
[20] TAN P W, KOH V Y, TANG J L. Outpatient combined intracavitary and interstitial cervical brachytherapy:barriers and solutions to implementation of a successful programme-a single institutional experience[J]. J Contemp Brachytherapy, 2015, 7(3):259-263.
[21] TANGSIRIWATTHANA T,SANGKOMKAMHANG U S,LUMBIGANON P, et al. Paracervical local anaesthesia for cervical dilatation and uterine intervention[J]. Cochrane Database Syst Rev, 2009(1):CD005056.
[22] ANBUMANI S,ANCHINEYAN P,NARAYANASAMY A, et al. Treatment planning methods in high dose rate interstitial brachytherapy of carcinoma cervix:a dosimetric and radiobiological analysis[J]. ISRN Oncol, 2014, 2014:125020.
[23] TSUJINO K. The impact of general anesthesia usage during hdr intracavitary brachytherapy for cervical cancer on the quality of applicationsujino 2011[J]. Hyogo Cancer Center, 2011(2):S453-S454.
[24] LIM K H,LU J J,WYNNE C J, et al. A study of complications arising from different methods of anesthesia used in high-dose-rate brachytherapy for cervical cancer[J]. Am J Clin Oncol, 2004, 27(5):449-451.
[25] SHARMA D N,CHAUDHARI P,SHARMA S, et al. Comparison of high-dose-rate intracavitary brachytherapy dosimetry with and without anesthesia in patients with cervical carcinoma[J]. J Appl Clin Med Phys, 2014, 15(2):4670.
[26] JANAKI M G,NIRMALA S,KADAM A R, et al. Epidural analgesia during brachytherapy for cervical cancer patients[J]. J Cancer Res Ther, 2008, 4(2):60-63.
[27] VISWANATHAN A N,THOMADSEN B. American Brachytherapy Society consensus guidelines for locally advanced carcinoma of the cervix. Part I:general principles[J]. Brachytherapy, 2012, 11(1):33-46.
[28] ROESSLER B,SIX L M,GUSTORFF B. Anaesthesia for brachytherapy[J]. Curr Opin Anaesthesiol, 2008, 21(4):514-518.
[29] BENRATH J,KOZEK-LANGENECKER S,HVPFL M, et al. Anaesthesia for brachytherapy-51/2 yr of experience in 1622 procedures[J]. Br J Anaesth, 2006, 96(2):195-200.
[30] WOJCIESZEK E,REMBIELAK A,BIALAS B, et al. Anaesthesia for radiation therapy-Gliwice experience[J]. Neoplasma, 2010, 57(2):155-160.
[31] WEITMANN H D,GUSTORFF B,VAUPEL P, et al. Oxygenation status of cervical carcinomas before and during spinal anesthesia for application of brachytherapy[J]. Strahlenther Onkol, 2003, 179(9):633-640.
[32] KIRCHHEINER K,CZAJKA-PEPL A,PONOCNY-SELIGER E, et al. Posttraumatic stress disorder after high-dose-rate brachytherapy for cervical cancer with 2 fractions in 1 application under spinal/epidural anesthesia:incidence and risk factors[J]. Int J Radiat Oncol Biol Phys, 2014, 89(2):260-267.
[33] JAIN R,MISHRA S, BHATNAGARS. Comparison of different anaesthetic techniques for high-dose-rate intracavitory radiotherapy for carcinoma cervix[J]. Int J Anesthesiol, 2008,17(1):8.
[34] MICHALEK-SAUBERER A, KOZEK-LANGENECKER S A,HEINZL H, et al. Median effective local anesthetic doses of plain bupivacaine and ropivacaine for spinal anesthesia administered via a spinal catheter for brachytherapy of the lower abdomen[J]. Reg Anesth Pain Med, 2008, 33(1):4-9.
[35] AMSBAUGH A K,AMSBAUGH M J,EL-GHAMRYM N, et al. Optimal epidural analgesia for patients diagnosed as having gynecologic cancer undergoing interstitial brachytherapy[J]. J Clin Anesth, 2016, 35:509-515.
[36] NIELSEN A A,LIYANAGE T A,LEISEROWITZ G S, et al. Optimal perioperative anesthesia management for gynecologic interstitial brachytherapy[J]. J Contemp Brachytherapy, 2017, 9(3):216-223.
[37] DAWKINS C J. An analysis of the complications of extradural and caudal block[J]. Anaesthesia, 1969, 24(4):554-563.
[38] NAG S, ERICKSON B,THOMADSEN B, et al. The American Brachytherapy Society recommendations for high-dose-rate brachytherapy for carcinoma of the cervix[J]. Int J Radiat Oncol Biol Phys, 2000, 48(1):201-211.
[39] CHEN H C, LEUNG S W,WANG C J, et al. Local vaginal anesthesia during high-dose-rate intracavitary brachytherapy for cervical cancer[J]. Int J Radiat Oncol Biol Phys, 1998, 42(3):541-544.
[40] COUTAUX A,SALOMON L,ROSENHEIM M, et al. Care related pain in hospitalized patients:a cross-sectional study[J]. Eur J Pain, 2008, 12(1):3-8.
[41] MENDEZ L C,CHOI S,D'ALIMONTE L, et al. Opioid consumption and pain in gynecological cancer patients treated with interstitial brachytherapy[J]. Brachytherapy, 2017, 16(4):870-876.