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Oncology, Ultrasound, Brachytherapy
T. Akbas, G. Ugurluer, M. Acil, T. Arpaci, M. Serin; Adana/TR
Cervical cancer is a major world health problem and it is the fourth most common cancer in women worldwide,
with 85% of cases occurring in developing countries,
where cervical cancer is a leading cause of cancer death in women [1-3].
The standard treatment for locally advanced cervical cancer (stages IB2 to IVA) is external beam radiation therapy with concurrent chemotherapy followed by brachytherapy (NCCN).
Intracavitary brachytherapy facilitates a high radiation dose to cervical cancer with relative sparing of normal tissues and is an integral component of definitive radiation for this disease .
In intracavitary brachytherapy,
an applicator (a uterine tandem and vaginal ovoids or a ring) is placed in the uterine cavity and vaginal fornices under sedation or anesthesia through the cervical os; this is often done “blindly” by advancing the tandem until sensing the uterine fundus. Intraoperative complications of brachytherapy include vaginal lacerations,
penetration of the tandem into the uterine wall and perforation of the uterus and other pelvic organs with the applicator .
Proper placement is critical to the success of brachytherapy: inadequate geometry has been correlated with significantly impaired local control and operative complications if unrecognized can result in inappropriately high radiation doses to organs at risk .
Applicator placement can be technically challenging and one technique for real time verification of tandem position is intraoperative ultrasonography.
Data suggest that the routine use of intraoperative ultrasonography facilitates ideal tandem placement and decreases the risk of uterine perforation,
thereby diminishing an underappreciated source of toxicity while optimizing disease control .
In this study,
we aimed to describe the role and benefits of intraoperative ultrasound guidance in intracavitary brachytherapy in an attempt to minimize the risk of complications.