Decrease in uterine perforations with ultrasound image-guided applicator insertion in intracavitary brachytherapy for...

Area of Science:

• Gynecologic Oncology
• Medical Imaging
• Radiation Oncology

Background:

• Cervical cancer treatment often involves intracavitary brachytherapy.
• Uterine perforation is a potential complication during brachytherapy insertion.
• Minimizing procedural risks is crucial for patient safety and treatment efficacy.

Purpose of the Study:

• To compare uterine perforation rates during intracavitary brachytherapy for cervical cancer.
• To evaluate the impact of ultrasound (US) image guidance on perforation rates.

Main Methods:

• Systematic literature search of PubMed and EMBASE databases.
• Meta-analysis of 12 studies including 1757 insertions and 766 patients.
• Calculation of pooled uterine perforation rates using random-effects models.

Main Results:

• Overall perforation rate was 4.56% per insertion and 7.39% per patient.
• Unguided insertions had a 10.54% perforation rate per insertion vs. 1.06% with US guidance (p<0.01).
• Perforation rates per patient were 16.67% unguided vs. 2.54% with US guidance (p<0.01).

Conclusions:

• Ultrasound guidance significantly reduces uterine perforation rates during intracavitary brachytherapy.
• The rate of uterine perforation per insertion is 90% lower with US-guided insertion.
• Posterior wall and uterine fundus are common perforation sites; no acute clinical consequences were reported.