Claire Charra Brunaud

Randomized trial comparing hypnosis versus standard management on patient anxiety and pain during pelvic brachytherapy applicator removal

Removal of brachytherapy applicator is routinely performed under premedication including Kalinox® gas inhalation without general anesthesia. The applicator removal is nevertheless associated with discomfort, anxiety or pain. We assessed the adjunction of formal hypnosis during this procedure. This prospective, randomized, single-center study focused on adult patients undergoing pelvic brachytherapy applicator removal. Patients were randomly assigned to (1:1): standard management including Kalinox® (control group) vs. standard management including Kalinox® accompanied by formal hypnosis (hypnosis group). The primary endpoint was anxiety using the State-Trait Anxiety Inventory (STAI) Y-A form (state anxiety). A secondary endpoint was pain after applicator removal (numerical scale). A total of 68 patients (mean age, 51.9 years) were included (cervical cancer, 86.6%). Before applicator removal, mean (SD) STAI Y-A anxiety score was 45.9 (5.6) in the control group vs. 47.5 (5.9) in the hypnosis group. After applicator removal, the scores were 48.1 (4.3) versus 47.7 (4.2), respectively (p = 0.76). Pain score was not significantly different after applicator removal (p = 0.055) in the hypnosis group compared to the control group: 1.29 (1.72) versus 0.71 (1.51), respectively. There were no significant differences between the 2 groups concerning caregiver satisfaction with patient management (p = 0.27), ease of realization (p = 0.17) and caregiver comfort (p = 0.42). This study failed to demonstrate a substantial benefit of formal hypnosis on anxiety in patients undergoing pelvic brachytherapy applicator removal. But this study suggests that the use of hypnotic communication techniques enables a positive attitude to patient care, thus reinforcing the patient-caregiver relationship.

Good safety of oblique needle insertion using the Venezia applicator for cervical cancer: A single-center cohort study

To evaluate procedural complications associated with the use of the Venezia applicator with oblique needles for treating locally advanced cervical cancer (LACC). We conducted a retrospective analysis of 30 patients treated at our center between November 2019 and August 2024 using the Venezia applicator. All patients underwent combined intracavitary and interstitial brachytherapy with oblique needle implantation. Procedural complications were classified using the Clavien-Dindo classification, focusing on organ perforations and bleeding events. The median age was 54.5 years. Most patients (90%) had squamous cell carcinoma, and the predominant stage FIGO was T3b (46.7%). The median HR-CTV volume was 32.8cc [24.5-39.3] and the median HR-CTV D90 was 86.0 Gy [82.7-90.5]. All organ at risk dose constraints were respected. Oblique needle perforation occurred in 7/30 patients (23.3%) and in 16/130 needles (12.3%), most often in the bladder. The majority (96.7%) experienced no or mild complications (grade 0-1). The most common complication was minor bleeding during applicator removal, controlled with manual compression. One patient experienced grade 2 bleeding requiring transfusion. No grade 3-5 complications were observed. The use of the Venezia applicator with oblique needles for locally advanced cervical cancer (LACC) appears safe and feasible, with a low rate of significant complications. Oblique needle insertion facilitates distal parametrial coverage, making it a valuable tool for challenging tumor extensions.