Laparoscopy-assisted intracavitary radiotherapy tandem placement for patients with cervical cancer

To determine the requirement and benefit of laparoscopy-assisted surgical procedures for optimal placement of intracavitary radiotherapy (ICR) tandem in patients with cervical cancer patients.

We reviewed a database of 231 cervical cancer patients who underwent radiotherapy and computed tomography-based 3-dimensional ICR planning at our institute between July 2003 and December 2007.

Misplacement of ICR tandem was identified in 12 patients. Optimal placement of ICR tandem was possible in 6 patients under sonographic guidance at the second attempt. Laparoscopy-assisted placement of an ICR tandem was required in 6 patients (2.6%) because of failures of ICR tandem insertion. As a result of this procedure, tandem insertions were corrected in all patients, with the exception of 1 patient who initially presented with fixed pelvic wall disease with an acute angle between the uterine body and the cervical axis. Laparoscopic procedures were tolerable with a median operative time of 68 minutes and an estimated blood loss of less than 20 mL. There were no complications related to the laparoscopic procedures. All the patients remain free of local disease at the time of this writing. There was 1 patient with grade 4 late radiation toxicity of the bowel who developed a rectovaginal fistula 3 months after completion of ICR.

Laparoscopy-assisted placement of an ICR tandem was required in 2.6% of the patients with primary advanced cervical cancer. Laparoscopy-assisted placement of an ICR tandem allows optimal implementation of ICR in difficult cases without causing significant morbidity and without delaying the planned ICR.