Potential Decreased Morbidity of Interstitial Brachytherapy for Gynecologic Malignancies Using Laparoscopy: A Pilot Study

Squamous cell carcinoma of the vagina: natural history, treatment modalities and prognostic factors

“…Further efforts to improve BT results include a better visualization of the target and critical normal tissues during the implantation by laparoscopy or laparotomy, besides the use of 3D imaging for preplanning of the implantation and postimplant verification and treatment planning [90,91].…”

Toxicity Associated With Bowel or Bladder Puncture During Gynecologic Interstitial Brachytherapy

“…Similarly, a study of 6 patients treated with IB under laparoscopic guidance found that 5 of the patients had needle perforation of the peritoneum (7). Comparable findings have been reported by other investigators (6)(7)(8)(9). Some investigators have hypothesized that the toxicity associated with IB is related to the puncture of visceral structures.…”

“…Studies have reported favorable toxicity when techniques to avoid visceral puncture are used (6,7). The comparisons of toxicity profiles between institutional experiences are fraught with biases owing to the heterogeneity of disease, stage, and treatment techniques.…”

“…Choi et al (6) reported that 9.5% of needles placed during 14 interstitial procedures required adjustment because of visceral perforation. Similarly, a study of 6 patients treated with IB under laparoscopic guidance found that 5 of the patients had needle perforation of the peritoneum (7).…”

“…Several techniques have been described in an attempt to decrease toxicity by avoiding visceral puncture. Among these are the use of preimplant imaging to determine needle placement (10,11), laparotomy, laparoscopy or intraoperative imaging to visualize and avoid visceral puncture (6)(7)(8)(11)(12)(13)(14), and postimplant imaging to guide repositioning of catheters that perforate visceral organs (9,15).…”