The role of ultrasound-guided applicator placement in intracavitary brachytherapy for cervical cancer

Abstract

Context: Intracavitary brachytherapy (ICBT) involves insertion of a tandem applicator through the cervical os into the uterine cavity. Proper placement is critical to the success of ICBT: inadequate applicator geometry is associated with significantly impaired local control and operative complications (uterine perforation). One technique for real-time verification of tandem position is intraoperative ultrasonography (USG). Aims: The aim of this study is to evaluate the role of intraoperative transabdominal ultrasound-guided tandem placement in brachytherapy for cervical cancer. Settings and Design: This was a retrospective interventional study. Subjects and Methods: This was a single institutional study conducted from October 2013 to September 2014. Seventy-seven patients (219 intracavitary applications) of locally advanced cervical cancer were treated with routine ultrasound-guided brachytherapy after pelvic external beam radiotherapy (EBRT). Results: In 62 of the study patients, the cervical os could be identified visually. In 13 patients, ultrasound guidance was necessary for accurate os identification and proper tandem placement due to cervical canal stenosis. In another 2, intraoperative ultrasound helped in identifying the patients suitable for interstitial brachytherapy rather than ICBT (as a result of cervical anatomy distortion). At 24 months, disease-free status was achieved by 68.85% of patients. Seven patients developed Grade 1 bladder Radiation Therapy Oncology Group toxicity, and one had Grade 2 toxicity. Ten patients had Grade 1, and three had Grade 2 Rectal toxicities. Conclusions: We encountered no case of tandem malplacement or uterine perforation in our study. The disease control and treatment toxicity were within acceptable limits. USG image-based tandem application provides an accurate, fast, easily available, and cost-effective method for proper brachytherapy applicator placement.