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Ultrasound‐guided tandem placement for low‐dose‐rate brachytherapy in advanced cervical cancer minimizes risk of intraoperative uterine perforation
Author(s) -
Watkins J. M.,
Kearney P. L.,
Opfermann K. J.,
Ackerman S. J.,
Jenrette J. M.,
Kohler M. F.
Publication year - 2011
Publication title -
ultrasound in obstetrics and gynecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.202
H-Index - 141
eISSN - 1469-0705
pISSN - 0960-7692
DOI - 10.1002/uog.8805
Subject(s) - medicine , uterine perforation , perforation , cervical cancer , brachytherapy , population , surgery , uterine cancer , radiation therapy , cancer , family planning , materials science , environmental health , punching , research methodology , metallurgy
Objectives Tandem placement as part of low‐dose‐rate (LDR) brachytherapy boost for cervical cancer may be complicated by uterine perforation. The objective of this study was to describe a 10‐year experience of using intraoperative ultrasound guidance in an attempt to minimize the risk of uterine perforation. Methods Operative and inpatient records were reviewed to identify cases in which intraoperative ultrasound guidance was employed in order to assist tandem placement, and to determine whether clinical or radiographic findings subsequently suggested uterine perforation. Demographic factors were collected in order to determine the baseline risk of perforation within this population. Results Between 1998 and 2008, 71 patients underwent 110 ultrasound‐guided placements of tandem applicators. The median age was 48 (range, 26–88) years, and 20% were older than 60 years. Disease stage was FIGO IB1 (n = 10), IB2 (n = 13), IIA (n = 4), IIB (n = 19), IIIA (n = 2), IIIB (n = 16), IVA (n = 5) and IVB (n = 2). The median gravidity was 3 (range 1–10) and median parity was 3 (range 0–10). Seven patients had a preimplant history of pelvic infection, four had a history of intrauterine contraceptive device use, and 10 had a prior history of Cesarean section delivery. Only one patient experienced infection that may have been attributable to tandem placement‐associated uterine perforation. At median survivor follow‐up of 34 months, 19 patients had died. The estimated 3‐year disease‐free and overall survival rates for the entire population were 60% and 66%, respectively. Conclusions Within the present population, intraoperative ultrasound guidance of tandem placement was associated with no confirmed cases of uterine perforation. Copyright © 2011 ISUOG. Published by John Wiley & Sons, Ltd.