Skip Navigation LinksHome > February 2014 - Volume 24 - Issue 2 > Uterine Perforation During 3-Dimensional Image-Guided Brachy...
International Journal of Gynecological Cancer:
doi: 10.1097/IGC.0000000000000048
Cervical Cancer

Uterine Perforation During 3-Dimensional Image-Guided Brachytherapy in Patients With Cervical Cancer: Baskent University Experience

Onal, Cem MD*; Guler, Ozan Cem MD*; Dolek, Yemliha MSci*; Erbay, Gurcan MD

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Objectives: This study aimed to determine the incidence and characteristics of uterine perforation at our department using 3-dimensional computed tomography (CT)–based brachytherapy (BRT). The characteristics of the patients presenting with perforation and impact of the perforation on the treatment course were also analyzed.

Materials and Methods: The clinical and radiologic data of 200 patients with biopsy-proven cervical cancer treated using CT-based BRT were retrospectively evaluated. All patients had undergone tandem-based intracavitary BRT, and 67 patients had undergone magnetic resonance imaging (MRI) before BRT.

Results: Of the 200 patients, 17 (8.5%) had uterine perforation. Of the 626 applications with CT images, 30 (4.8%) resulted in uterine perforation. The median age of patients with perforation was higher (68 years; range, 44–89 years) than that of the patients without perforation (59 years; range, 21–87 years), and the mean (SD) tumor size at diagnosis was larger in patients with perforation (7.0 [1.5] cm) than in patients without perforation (5.0 [1.5] cm). The most frequent perforation site was the posterior uterine wall (8 patients), followed by the fundus (5 patients) and anterior wall (4 patients). Of the 7 patients with a retroverted uterus, 4 had uterine perforation during BRT. In 67 patients with MRI delivered before BRT, only 3 (4%) had uterine perforation, and 2 of the 3 patients with uterine perforation had a retroverted uterus. However, of the 133 patients with no MRI evaluation before BRT, 14 (11%) had uterine perforation. No life-threatening complications or signs of intraperitoneal tumor cell seeding were observed.

Conclusions: Older age, larger tumors, a retroverted uterus, and a stenotic cervical os were all predisposing factors for uterine perforation during BRT. Preoperative MRI is a feasible and safe method to decrease the risks of uterine perforation and could be used preoperatively in centers where intraoperative ultrasonography is not used in routine practice.

© 2014 by the International Gynecologic Cancer Society and the European Society of Gynaecological Oncology.


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