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Akbas T, Ugurluer G, Acil M, Arpaci T, Serin M. Intraoperative sonographic guidance for intracavitary brachytherapy of cervical cancer. JOURNAL OF CLINICAL ULTRASOUND : JCU 2018; 46:8-13. [PMID: 28656637 DOI: 10.1002/jcu.22510] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 04/20/2017] [Accepted: 05/21/2017] [Indexed: 05/21/2023]
Abstract
BACKGROUND To describe the role and benefits of intraoperative sonographic (US) guidance in intracavitary brachytherapy of cervical cancer. METHODS The data of 142 patients who received tandem-based intracavitary brachytherapy for cervical cancer between January 2010 and June 2015 were retrospectively reviewed. US guidance was carried out for tandem selection and appropriate application. The complications and applicator conformity were assessed with planning CT. RESULTS Intracavitary brachytherapy was performed under US guidance for 412 insertions in 113 consecutive patients with cervical cancer. Before we started to use US guidance, applications were done in 29 patients: uterine perforation occurred in two patients (6.9%), the tandem length was short in two patients (6.9%), the tandem length was long in four patients (13.8%), and tandem was in myometrium in three patients (10.3%). We then decided to use US guidance routinely. With US guidance, only 1 of 113 patients had uterine perforation (0.9%), tandem length was short in only one patient (0.9%), and tandem was in myometrium in one patient (0.9%). CONCLUSIONS Real-time US provided safe and effective guidance for intracavitary brachytherapy of cervical cancer resulting in decreased rates of perforations and misplacement of applicators. © 2017 Wiley Periodicals, Inc. J Clin Ultrasound 46:8-13, 2018.
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Affiliation(s)
- Tugana Akbas
- Acibadem University, Vocational School of Health Services, Acibadem Adana Hospital, Adana, Turkey
| | - Gamze Ugurluer
- Department of Radiation Oncology, Acibadem University, School of Medicine, Acibadem Adana Hospital, Adana, Turkey
| | - Meltem Acil
- Department of Anesthesiology, Acibadem University, School of Medicine, Acibadem Adana Hospital, Adana, Turkey
| | - Taner Arpaci
- Acibadem University, Vocational School of Health Services, Acibadem Adana Hospital, Adana, Turkey
| | - Meltem Serin
- Department of Radiation Oncology, Acibadem University, School of Medicine, Acibadem Adana Hospital, Adana, Turkey
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Ghirardi V, Bizzarri N, Remorgida V, Venturini PL, Ferrero S. Intraoperative Transrectal Ultrasonography for Hysteroscopic Metroplasty: Feasibility and Safety. J Minim Invasive Gynecol 2015; 22:884-8. [DOI: 10.1016/j.jmig.2015.03.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Revised: 03/05/2015] [Accepted: 03/07/2015] [Indexed: 01/09/2023]
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Kamel MA, El-Tawab SS, Aboel Enein L, El-Ashkar OS, El-Meniawy NA. Efficacy of Transrectal Three-Dimensional Ultrasound-Guided Hysteroscopic Metroplasty. J Gynecol Surg 2014. [DOI: 10.1089/gyn.2013.0134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Mostafa A.M. Kamel
- Department of Obstetrics and Gynecology, Shatby Maternity University Hospital, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Sally S. El-Tawab
- Department of Obstetrics and Gynecology, Shatby Maternity University Hospital, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Loai Aboel Enein
- Obstetrics and Gynecology Hospital, Aim Shams University, Cairo, Egypt
| | - Osama S. El-Ashkar
- Department of Obstetrics and Gynecology, Shatby Maternity University Hospital, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Nehal A. El-Meniawy
- Department of Obstetrics and Gynecology, Shatby Maternity University Hospital, Faculty of Medicine, Alexandria University, Alexandria, Egypt
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Transrectal Ultrasound-Guided Hysteroscopic Myomectomy of Submucosal Myomas With a Varying Degree of Myometrial Penetration. J Minim Invasive Gynecol 2013; 20:672-85. [DOI: 10.1016/j.jmig.2013.05.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2013] [Revised: 05/01/2013] [Accepted: 05/02/2013] [Indexed: 11/17/2022]
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Uterine perforation - 5-year experience in 3-D image guided gynaecological brachytherapy at Institute of Oncology Ljubljana. Radiol Oncol 2013; 47:154-60. [PMID: 23801912 PMCID: PMC3691089 DOI: 10.2478/raon-2013-0030] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Accepted: 03/01/2013] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Accurate applicator placement is a precondition for the success of gynaecological brachytherapy (BT). Unrecognized uterine perforation can lead to bleeding, infection, high doses to pelvic organs and underdosage of the target volume, resulting in acute morbidity, long-term complications and reduced chance of cure. We aimed to assess the incidence and clinical characteristics of our cases with uterine perforation, review their management and impact on the treatment course. PATINETS AND METHODS In all patients, treated with utero-vaginal image guided BT for gynaecological cancer between January 2006 and December 2011, the CT/MR images with the applicator in place were reviewed. The incidence of uterine perforations was recorded. Clinical factors that may have predisposed to increased risk of perforation were recorded. Management of perforations and their impact on treatment course was assessed. RESULTS 219 patients (428 applications) were suitable for analysis. Uterine perforation was found in 13 (3.0%) applications in 10 (4.6%) patients. The most frequent perforation site was posterior uterine wall (n = 9), followed by anterior wall (n = 2) and fundus (n = 2). All cases were managed conservatively, without complications. Prophylactic antibiotics were administered in 8 cases. In 4 patients, abdominal and/or transrectal ultrasound (US) guidance was used on subsequent applications for applicator insertion; adequate applicator placement was achieved and treatment completed as planned in all cases. CONCLUSIONS 3D imaging for BT planning enables accurate identification of uterine perforations. The incidence of perforations at our department is one of the lowest reported in the literature. US guidance of applicator insertion is useful and feasible, allowing to complete the planned treatment even in challenging cases.
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Sharma DN, Rath GK, Thulkar S, Kumar S, Subramani V, Julka PK. Use of transrectal ultrasound for high dose rate interstitial brachytherapy for patients of carcinoma of uterine cervix. J Gynecol Oncol 2010; 21:12-7. [PMID: 20379442 DOI: 10.3802/jgo.2010.21.1.12] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2009] [Revised: 12/14/2009] [Accepted: 01/02/2010] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Transrectal ultrasound (TRUS) has been widely used for guiding prostate implants, but not much for interstitial brachytherapy (IBT) of cervix cancer. The aim of our study is to report our experience with TRUS guided high dose rate (HDR) IBT in patients with carcinoma of uterine cervix. METHODS During the year 2005-2006, 25 patients of cervical cancer not suitable for intracavitary radiotherapy (ICRT), were enrolled in this prospective study. We used B-K Medical USG machine (Falcon 2101) equipped with a TRUS probe (8658) having a transducer of 7.5 MHz for IBT. Post procedure, a CT scan was done for verification of needle position and treatment planning. Two weekly sessions of HDR IBT of 8-10 Gy each were given after pelvic external beam radiation therapy. RESULTS A total of 40 IBT procedures were performed in 25 patients. Average duration of implant procedure was 50 minutes. There was no uterine perforation in any of 11 patients in whom central tandem was used. CT scan did not show needle perforation of bladder/rectum in any of the patients. During perioperative period, only 1 procedure (2.5%) was associated with hematuria which stopped within 6 hours. Severe late toxicity was observed in 3 (12%) patients. Overall pelvic control rate was 64%. CONCLUSION Our experience suggests that TRUS is a practical and effective imaging device for guiding the IBT procedure of cervical cancer patients. It helps in accurate placements of needles thus avoiding the injury to normal pelvic structures.
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Affiliation(s)
- Daya Nand Sharma
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
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Sahinler I, Cepni I, Oksuz DC, Cepni K, Koksal S, Koca A, Atkovar G, Okkan S. Tandem application with transvaginal ultrasound guidance. Int J Radiat Oncol Biol Phys 2004; 59:190-6. [PMID: 15093916 DOI: 10.1016/j.ijrobp.2003.10.028] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2003] [Revised: 09/08/2003] [Accepted: 10/15/2003] [Indexed: 12/01/2022]
Abstract
PURPOSE Intrauterine tandem placement can be difficult in brachytherapy for cervical cancer. A prospective study was planned to investigate transvaginal ultrasound (TVU) guidance for intrauterine tandem insertions in the treatment of cervix cancer. METHODS AND MATERIALS Between January 1997 and January 2002, TVU was used after pelvic external beam radiotherapy in 48 cervical cancer patients with a high complication risk because the cervical canal orifice could not be identified and/or the patients could not undergo hysterometry. The TVU findings were graded as 1-4, with a higher number indicating greater difficulty in implantation. The tandem was inserted using the guidance of the TVU findings. Tandem application difficulties were graded in accordance with the number of implantation trials. The relations between tandem applicability and possible factors were analyzed. RESULTS By TVU, the difficulties in tandem insertion were graded as Grade 1 in 5 cases, Grade 2 in 23 cases, Grade 3 in 17 cases, and Grade 4 in 3 cases. The tandem was inserted in 19 patients on the first try, 12 patients on the second try, 12 patients on the third try, and 2 patients on the fourth try. However, the cervical canal could not be opened in 3 patients. Factors such as median age, stage, chemotherapy, diameter of the tandem applicators, time between external beam radiotherapy and brachytherapy, and the rate of tumor regression were not statistically significant. The ultrasound grade (p = 0.02) and diameter of the tandem applicator (p = 0.007) were statistically significant. Perforation and sepsis were not observed. CONCLUSION TVU guidance before brachytherapy has a positive contributory effect in reducing the morbidity rate of patients considered high risk.
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Affiliation(s)
- Ismet Sahinler
- Department of Radiation Oncology, Istanbul University Cerrahpasa Medical School, Istanbul, Turkey.
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Irvin W, Rice L, Taylor P, Andersen W, Schneider B. Uterine perforation at the time of brachytherapy for carcinoma of the cervix. Gynecol Oncol 2003; 90:113-22. [PMID: 12821351 DOI: 10.1016/s0090-8258(03)00230-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The reported incidence of uterine perforation by tandems at the time of vaginal brachytherapy for management of cervical cancer ranges from 1.75% to 10% per application. The potential ramifications of afterloading a tandem that is outside the uterine cavity within the pelvis are sufficiently severe, in terms of bowel injury, that a reliable means of determining tandem positioning at the time of placement is essential. METHODS We examined a representative patient that underwent tandem placement for Federation Internationale of Gynecologic Oncologist (FIGO) stage Ib1 cervical Squamous Cell Carcinoma (SCCA). The information provided by conventional radiographic assessment and clinical impression was not helpful in ultimately determining tandem placement. RESULTS Direct endoscopic visualization provided accurate and irrefutable evidence of tandem location and positioning prior to leaving the operating room. CONCLUSION A variety of techniques have been described to assist in accurate placement of the uterine tandem prior to afterloading, when utilizing definitive chemoradiation in the management of cervical carcinoma. These include postoperative plain films or computerized tomography, versus intraoperative transabdominal or transrectal ultrasound guidance at the time of placement. Postoperative techniques that confirm perforation necessitate a second visit to the operating room, a second general anesthetic, as well as a treatment delay that may impact negatively upon central control rates in the long term. Intraoperative techniques have their limitations as well, particularly in the obese patient. With difficult or questionable insertions, direct endoscopic evaluation at the time of tandem insertion is the only means of knowing definitively the location of the tandem prior to leaving the operating room.
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Affiliation(s)
- William Irvin
- Division of Gynecologic Oncology, University of Virginia Health System, Charlottesville, VA 22908, USA.
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Scanlan KA, Propeck PA, Lee FT. Invasive procedures in the female pelvis: value of transabdominal, endovaginal, and endorectal US guidance. Radiographics 2001; 21:491-506. [PMID: 11259711 DOI: 10.1148/radiographics.21.2.g01mr21491] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Transabdominal, endovaginal, and endorectal ultrasonographic (US) guidance is indispensable for a multitude of invasive procedures in the female pelvis. Transabdominal uterine US performed with a fluid-filled bladder is appropriate and convenient for guidance of difficult dilation and curettage procedures. Transabdominal intraoperative US can be employed to guide several procedures for which the more expensive intraoperative hysteroscopic procedure is now used. Aspiration of symptomatic ovarian cysts that appear benign at US with an endovaginally guided small-gauge needle is simple and effective. Simple noninfected pelvic fluid collections may be aspirated transvaginally for both diagnosis and therapy by using endovaginal guidance. Endovaginal US demonstrates the anatomic relationships of a pelvic abscess to adjacent structures, allowing safe access for transvaginal drainage. By using an endovaginal transducer with a needle guide, cervical and vaginal cuff masses may be easily sampled. An obstructed uterus may be accessed by puncturing obstructive tissue with a trocar-containing needle guided by an endorectal probe. US guidance for placement of a central brachytherapy tandem is performed via the abdominal approach after the bladder has been distended with sterile water. Endorectal US transducers may be effectively used to guide placement of interstitial brachytherapy needles in pelvic soft-tissue masses.
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Affiliation(s)
- K A Scanlan
- Salem Radiology Consultants, 2925 Ryan Dr SE, Salem, OR 97301, USA.
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Bar-Hava I, Rabinerson D, Kaplan B, Orvieto R, Levy T, Shalev Y, Ben-Rafael Z, Dekel A. Real-time intraoperative ultrasound guidance: the transrectal approach. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2001; 17:150-152. [PMID: 11251925 DOI: 10.1046/j.1469-0705.2001.00258.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
OBJECTIVE To assess the role of real-time transrectal ultrasound guidance in complicated gynecologic procedures. DESIGN In 1998-99, real-time guidance with transrectal ultrasound was utilized in our department to assist the gynecologic surgeon in two procedures: completing the evacuation of the uterine cavity after identification of uterine wall perforation during first trimester termination of pregnancy, and drainage of infected vaginal vault hematoma following hysterectomy. RESULTS The technique was applied for 11 patients, six abortions and five infected hematomas. All the procedures were completed without any further complications and the patients were discharged on the following day. Follow-up was uneventful. CONCLUSIONS On-line intraoperative transrectal ultrasound can effectively provide real-time assistance to the gynecologic surgeon during complicated pelvic procedures.
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Affiliation(s)
- I Bar-Hava
- Department of Obstetrics and Gynecology, Rabin Medical Center, Petah Tiqva, Israel
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Fleischer AC. New applications of pelvic sonography. UROLOGIC RADIOLOGY 1991; 13:9-15. [PMID: 1853512 DOI: 10.1007/bf02924587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
This review discusses and illustrates the many applications of transvaginal sonography in gynecology. TVS has improved the accuracy of evaluation of pelvic masses and affords a means for accurate guided aspiration. The accuracy of follicular monitoring and aspiration is also enhanced with transvaginal sonography. The possible applications of transvaginal sonography as a means for screening for early ovarian carcinoma is also discussed as well as applications involving evaluation of the uterus and endometrium.
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Affiliation(s)
- A C Fleischer
- Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee 37232-2675
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