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Routine use of ultrasound guided tandem placement in intracavitary brachytherapy for the treatment of cervical cancer - a South Indian institutional experience.

Rao PB, Ghosh S - J Contemp Brachytherapy (2015)

Bottom Line: Although routine real time ultrasound guided tandem placement has shown better results, it is seldom practised.It is an accurate, fast, easily available, and cost-effective method.Hence, it can be incorporated in intracavitary applications for cervical cancers even in the developing countries where cost, accessibility, and time are important issues.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiotherapy, GSL Cancer Hospital, GSL Medical College, Rajahmundry, Andhra Pradesh, India.

ABSTRACT

Purpose: Intracavitary brachytherapy necessitates the insertion of a tandem applicator through the cervical os into the uterine cavity. Blind insertion of the tandem may result in suboptimal tandem placement. This decreases the control of the tumor locally and may result in uterine perforation. Although routine real time ultrasound guided tandem placement has shown better results, it is seldom practised. The aim of this work is to evaluate the role of routine real-time intraoperative trans-abdominal ultrasound guided tandem placement in intracavitary brachytherapy for the treatment of cervical cancer.

Material and methods: This is a prospective single institutional study conducted from April 2013 to May 2015. A total of 96 patients of locally advanced cervical cancer were treated with routine ultrasound guided brachytherapy amounting to a total of 282 intracavitary applications.

Results: In 78 of the study patients, the cervical os could be easily identified visually, which was then confirmed with ultrasound guidance. In another 12 patients, though the os could be identified visually, uterine sounding was only possible under ultrasound guidance. In another 4 patients, the cervical os could not be identified visually as the cervix was flushed with vagina and ultrasound guidance was necessary for accurate os identification. In 2 of the study patients, intraoperative ultrasound helped in identifying the patients suitable for interstitial brachytherapy rather than intracavitary brachytherapy. Out of the 96 study patients, the length of the uterine canal changed in 15 patients during the subsequent brachytherapy application.

Conclusions: This procedure is strongly advocated for proper placement of the tandem applicator and to avoid perforations. It is an accurate, fast, easily available, and cost-effective method. Hence, it can be incorporated in intracavitary applications for cervical cancers even in the developing countries where cost, accessibility, and time are important issues.

No MeSH data available.


Related in: MedlinePlus

Image of tandem placed in accurate position as visualized on transabdominal ultrasound
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Figure 0001: Image of tandem placed in accurate position as visualized on transabdominal ultrasound

Mentions: All patients underwent bimanual pelvic examination under mild intravenous anesthesia for the evaluation of residual primary tumor and cervical os identification. The os was first tried to identify by uterine sounding with naked eye. This was followed by ultrasound examination to confirm the os position. Foley's catherisation was performed to drain out as much of urine by gently pressing the abdomen. For better visualization of the bladder, 200-300 ml of normal saline was instilled into the urinary bladder retrogradely. The catheter was clamped with the saline filling the urinary bladder. Real-time intraoperative transabdominal ultrasound scanning was done with Philips HD 7 machine (Philips Healthcare, Amsterdam, The Netherlands) with curvilinear 5 MHz probe. The cervical os was then sounded under ultrasound guidance. After cervical os dilatation, the tandem was gently inserted through the os into the uterine cavity (Figure 1). The angulation and length of the tandem were determined from the extent of uterine flexion and the distance of the fundus from the cervical os on ultrasound scanning respectively.


Routine use of ultrasound guided tandem placement in intracavitary brachytherapy for the treatment of cervical cancer - a South Indian institutional experience.

Rao PB, Ghosh S - J Contemp Brachytherapy (2015)

Image of tandem placed in accurate position as visualized on transabdominal ultrasound
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4663212&req=5

Figure 0001: Image of tandem placed in accurate position as visualized on transabdominal ultrasound
Mentions: All patients underwent bimanual pelvic examination under mild intravenous anesthesia for the evaluation of residual primary tumor and cervical os identification. The os was first tried to identify by uterine sounding with naked eye. This was followed by ultrasound examination to confirm the os position. Foley's catherisation was performed to drain out as much of urine by gently pressing the abdomen. For better visualization of the bladder, 200-300 ml of normal saline was instilled into the urinary bladder retrogradely. The catheter was clamped with the saline filling the urinary bladder. Real-time intraoperative transabdominal ultrasound scanning was done with Philips HD 7 machine (Philips Healthcare, Amsterdam, The Netherlands) with curvilinear 5 MHz probe. The cervical os was then sounded under ultrasound guidance. After cervical os dilatation, the tandem was gently inserted through the os into the uterine cavity (Figure 1). The angulation and length of the tandem were determined from the extent of uterine flexion and the distance of the fundus from the cervical os on ultrasound scanning respectively.

Bottom Line: Although routine real time ultrasound guided tandem placement has shown better results, it is seldom practised.It is an accurate, fast, easily available, and cost-effective method.Hence, it can be incorporated in intracavitary applications for cervical cancers even in the developing countries where cost, accessibility, and time are important issues.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiotherapy, GSL Cancer Hospital, GSL Medical College, Rajahmundry, Andhra Pradesh, India.

ABSTRACT

Purpose: Intracavitary brachytherapy necessitates the insertion of a tandem applicator through the cervical os into the uterine cavity. Blind insertion of the tandem may result in suboptimal tandem placement. This decreases the control of the tumor locally and may result in uterine perforation. Although routine real time ultrasound guided tandem placement has shown better results, it is seldom practised. The aim of this work is to evaluate the role of routine real-time intraoperative trans-abdominal ultrasound guided tandem placement in intracavitary brachytherapy for the treatment of cervical cancer.

Material and methods: This is a prospective single institutional study conducted from April 2013 to May 2015. A total of 96 patients of locally advanced cervical cancer were treated with routine ultrasound guided brachytherapy amounting to a total of 282 intracavitary applications.

Results: In 78 of the study patients, the cervical os could be easily identified visually, which was then confirmed with ultrasound guidance. In another 12 patients, though the os could be identified visually, uterine sounding was only possible under ultrasound guidance. In another 4 patients, the cervical os could not be identified visually as the cervix was flushed with vagina and ultrasound guidance was necessary for accurate os identification. In 2 of the study patients, intraoperative ultrasound helped in identifying the patients suitable for interstitial brachytherapy rather than intracavitary brachytherapy. Out of the 96 study patients, the length of the uterine canal changed in 15 patients during the subsequent brachytherapy application.

Conclusions: This procedure is strongly advocated for proper placement of the tandem applicator and to avoid perforations. It is an accurate, fast, easily available, and cost-effective method. Hence, it can be incorporated in intracavitary applications for cervical cancers even in the developing countries where cost, accessibility, and time are important issues.

No MeSH data available.


Related in: MedlinePlus