Should Uterine Tandem Applicators Ever Be Placed Without Ultrasound Guidance? No: A Brief Report and Review of the Literature. Issue 5 (1st July 2011)

• Record Type: Journal Article
• Authors: Small, William; Strauss, Jonathan B.; Hwang, Catherine S.; Cohen, Leeber; Lurain, John
• Is Part Of: International journal of gynecological cancer. Volume 21:Issue 5(2011)
• Page Start: 941
• Page End: 944
• Publication Date: 2011-07-01
• Subjects: Cervical cancer -- Brachytherapy -- Radiotherapy -- Ultrasound; Generative organs, Female -- Cancer -- Periodicals; 616.99465
• DOI: 10.1097/IGC.0b013e31821bca53
• Languages: English
• ISSNs: 1048-891X

Abstract

Abstract : Background: Brachytherapy is an integral component of the curative treatment of locally advanced cervical cancer. Optimal applicator placement is associated with improvements in local control and treatment-related toxicity. Uterine perforation by the tandem is common and often undetected by orthogonal radiographs. The role of ultrasound in guiding tandem placement remains controversial. Methods: A 55-year-old woman with International Federation of Gynecology and Obstetrics stage IIB cervix cancer underwent placement of a Fletcher-Suit-Delcos tandem and ovoids applicator. Postoperative computed tomography was used for treatment planning. Results: The applicator appeared to be appropriately placed on clinical exam and orthogonal radiographs. Postoperative computed tomography revealed the tandem had perforated the anterior uterine wall. In a second procedure, the tandem was placed correctly under intraoperative ultrasonography. Conclusions: A review of the literature finds a relatively high rate of uterine perforation of the uterus that is undetected by orthogonal radiographs or clinical examination. Multiple reports support the use of real-time ultrasound for patients with especially challenging anatomy. As this report illustrates, uterine perforation is possible in any patient. Therefore, routine real-time ultrasonography should be considered for all uterine tandem insertions.