Prevention of uterine perforation during intracavitary brachytherapy of cervical cancer

Bayrak, Mehmet; Abakay, Candan Demiröz

doi:10.5114/jcb.2021.105284

Cited by 8 publications

(3 citation statements)

References 18 publications

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“…Furthermore, a meta-analysis conducted by Sapienza [62] revealed that patients receiving ultrasonography-guided brachytherapy insertion had a 90% lower rate of uterine perforation per insertion than those receiving unguided insertion. Another important aspect that one can refer to in order to decrease the rate of uterine perforation is that the choice to use ultrasonography as a guide (in ovoid insertion) is tailored to each patient and based on the level of resistance encountered during cervical dilation, with insertion applied only by highly trained personnel (for instance, gynaecologic oncologists), as suggested by Bayrak [63]. Moreover, another method of protection against uterine perforation is the use of a Smit Sleeve (defined as a disposable intrauterine tube that is inserted into the cervical internal os to facilitate precise surgical localisation in cases of cervical cancer).…”

Section: Discussionmentioning

confidence: 99%

Integration of Ultrasound in Image-Guided Adaptive Brachytherapy in Cancer of the Uterine Cervix

Manea,

Chitoran,

Rotaru

et al. 2024

Bioengineering

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Cervical cancer continues to be a public health concern, as it remains the second most common cancer despite screening programs. It is the third most common cause of cancer-related death for women, and the majority of cases happen in developing nations. The standard treatment for locally advanced cervical cancer involves the use of external beam radiation therapy, along with concurrent chemotherapy, followed by an image-guided adaptive brachytherapy (IGABT) boost. The five-year relative survival rate for European women diagnosed with cervical cancer was 62% between 2000 and 2007. Updated cervical cancer treatment guidelines based on IGABT have been developed by the Gynecological working group, which is composed of the Group Européen de Curiethérapie–European Society for Therapeutic Radiology and Oncology. The therapeutic strategy makes use of three-dimensional imaging, which can be tailored to the target volume and at-risk organs through the use of computed tomography or magnetic resonance imaging. Under anaesthesia, the brachytherapy implantation is carried out. Ultrasonography is utilised to assess the depth of the uterine cavity and to facilitate the dilation of the uterine canal during the application insertion. In this study, we examine data from the international literature regarding the application of ultrasound in cervical cancer brachytherapy.

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Section: Discussionmentioning

confidence: 99%

Integration of Ultrasound in Image-Guided Adaptive Brachytherapy in Cancer of the Uterine Cervix

Manea,

Chitoran,

Rotaru

et al. 2024

Bioengineering

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“…As every time the applicator is inserted, there is a risk of perforation, strategies have been tried to reduce the risk. Using a Smit sleeve before brachytherapy is a technique that facilitates accurate tandem placement, and eliminates the risk of malposition of tandem in subsequent insertions, thus reducing the risk of complications [18]. More important is imaging before and after the procedure, which helps to detect inaccurate placement of applicators and aids in dose optimization during computer-based planning process [19,20].…”

Section: Discussionmentioning

confidence: 99%

An audit of uterine perforation and its’ effect on the final outcome in an academic research medical center: An optimized balance between overall treatment time and medical crisis

Verma¹,

Kukreja²,

Ghosh³

et al. 2023

jcb

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Purpose: Intra-cavitary brachytherapy is an integral component of cervical cancer management, and uterine perforation is the most significant complication, which may lead to prolonged overall treatment time and decreased local control in these patients.Material and methods: A retrospective analysis of cervical cancer patients who completed radiotherapy (external beam radiotherapy and brachytherapy) in our department was conducted to determine the incidence, effect on overall treatment time, and final outcome in patients with uterine perforation during brachytherapy procedure.Results: Among 55 women, of the 398 applications, 85 (21.36%) resulted in uterine perforation. Out of these 85 applications, treatment time was extended among 3 (3.5%) applications only, as re-insertion was done nearly after one week, while the remaining 82 (96.5%) applications were completed in time. At the time of analysis, the median follow-up was 12 months, and 32 patients were disease-free, 3 had distant metastatic disease, 2 had residual disease, and 18 were lost to follow-up.Conclusions: In our study, uterine perforation incidence was found to be comparable with other centers worldwide. In asymptomatic and uncomplicated uterine perforation, treatment can be continued with computer-based optimized treatment plans without loading a specific dwell position and without affecting overall treatment time.

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“…Medical imaging is a necessary component of brachytherapy treatments, with magnetic resonance (MR) and computed tomography (CT) imaging being used to acquire diagnostic images of the patient and localize the applicator position for radiation dose planning after it has been internally placed. Two-dimensional (2D) ultrasound (US) imaging is used to provide real-time visual feedback to the oncologist during the applicator and needle insertion to aid with radiation placement and prevent uterine perforation [3]. However, MR and CT imaging may be unavailable within the operating room in many healthcare centers, especially in those regions where the incidence of cervical cancer is high, increasing the reliance on US methods.…”

Section: Introductionmentioning

confidence: 99%

An automated system for registration and fusion of 3D ultrasound images during cervical brachytherapy procedures

Trumpour,

Nasser,

Rodgers

et al. 2024

Medical Imaging 2024: Ultrasonic Imaging and Tomography

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High dose-rate brachytherapy is a typical part of the treatment process for cervical cancer. During this procedure, radioactive sources are placed locally to the malignancy using specialized applicators or interstitial needles. To ensure accurate dose delivery and positive patient outcomes, medical imaging is utilized intra-procedurally to ensure precise placement of the applicator. Previously, the fusion of three-dimensional ultrasound images has been investigated as an alternative volumetric imaging technique during cervical brachytherapy treatments. However, the need to manually register the two three-dimensional ultrasound images offline resulted in excessively large registration errors. To overcome this limitation, we have designed and developed a tracked, automated mechatronic system to inherently register three-dimensional ultrasound images in real-time. We perform a system calibration using an external coordinate system transform and validate the system tracking using a commercial optical tracker. The results of both experiments indicated sub-millimeter system accuracy, indicating the superior performance of our device. Future work for this study includes performing phantom validation experiments and translating our device into clinical work.

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Prevention of uterine perforation during intracavitary brachytherapy of cervical cancer

Cited by 8 publications

References 18 publications

Integration of Ultrasound in Image-Guided Adaptive Brachytherapy in Cancer of the Uterine Cervix

Integration of Ultrasound in Image-Guided Adaptive Brachytherapy in Cancer of the Uterine Cervix

An audit of uterine perforation and its’ effect on the final outcome in an academic research medical center: An optimized balance between overall treatment time and medical crisis

An automated system for registration and fusion of 3D ultrasound images during cervical brachytherapy procedures

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