Toxicity associated with bowel or bladder puncture during gynecologic interstitial brachytherapy

Area of Science:

• Gynecologic Oncology
• Radiation Oncology
• Medical Physics

Background:

• Interstitial brachytherapy is a common treatment for gynecologic malignancies.
• Significant toxicity has been reported, potentially linked to needle puncture of visceral organs.
• This study investigates the relationship between visceral puncture and treatment toxicity.

Purpose of the Study:

• To examine the institutional experience with interstitial brachytherapy for gynecologic malignancies.
• To determine if visceral organ puncture during needle placement correlates with treatment toxicity.
• To evaluate the safety and efficacy of interstitial brachytherapy when visceral puncture is not avoided.

Main Methods:

• Retrospective review of 36 patients treated between 2002 and 2007.
• Computed tomography (CT) guided needle placement focused on tumor coverage.
• Visceral puncture was permitted, with minimized source dwell times in punctured areas.

Main Results:

• A crude locoregional control rate of 78% was achieved at a median follow-up of 21 months.
• Bowel puncture occurred in 26 patients; bladder puncture in 19.
• Incidence of acute and late toxicity was similar between patients with and without visceral puncture.

Conclusions:

• Interstitial brachytherapy with visceral puncture showed favorable operating times, hospital stays, and morbidity compared to techniques avoiding puncture.
• Visceral puncture did not correlate with acute or late toxicity.
• Visceral puncture, without significant source loading in these areas, carries a low risk of morbidity.