Abstract
Purpose
The purpose of the study was to determine the incidence of uterine perforations, review
the associated complications, and propose guidelines for management of perforations
after brachytherapy.
Methods and Materials
A retrospective chart review was conducted for all patients with cervical cancer who
received single or multiple high-dose-rate brachytherapy implants between April 2006
and May 2017 at a single academic institution. CT and MRI images were retrospectively
evaluated to record incidences of uterine perforation of tandem during brachytherapy.
Acute and long-term complications during and after treatment were scored using the
Common Terminology Criteria for Adverse Events, Version 4.0, of the National Cancer
Institute.
Results
A total of 123 patients were included in the study. Perforations were observed in
22 patients (17.9%) with 31 (6.4%) of the 482 total implants. Of the different categories
of adverse events, only the rate of acute infectious complications among those with
perforations (n = 3, 13.6%) versus those without perforations (n = 3, 3.0%) was significant
(p = 0.040). Two of the three perforated patients with acute infections had mild urinary
tract infections, and all resolved without complications or treatment delays. The
remaining one patient had a frank perforation of the anterior uterine wall with a
subsequent Grade 3 pyometra infection despite administration of prophylactic antibiotics
and 1-week treatment delay. This case was eventually resolved with cervical dilation
and evacuation of fluid. Long-term complications were not different between the two
arms.
Conclusions
Patients with cervical cancer with uterine perforations may be able to safely proceed
with brachytherapy treatment without delay or need for prophylactic antibiotics in
the acute setting. Further validating data would be able to assist in establishing
a new standard of care and help prevent unnecessary and harmful breaks during treatment.
Keywords
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Article Info
Publication History
Published online: March 17, 2021
Accepted:
February 2,
2021
Received in revised form:
February 1,
2021
Received:
June 24,
2020
Footnotes
Disclosures: William Small, Jr, MD reports other from Merck, Zeiss, and NRG Oncology outside the submitted work.
Funding: This research was partially funded by a Student Training in Approaches to Research (STAR) student grant from Loyola University Chicago.
Identification
Copyright
© 2021 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.
