J Gynecol Oncol.  2010 Mar;21(1):12-17. 10.3802/jgo.2010.21.1.12.

Use of transrectal ultrasound for high dose rate interstitial brachytherapy for patients of carcinoma of uterine cervix

• Sharma DN
• Rath GK
• Thulkar S
• Kumar S
• Subramani
• Julka PK

• KMID: 2173503
• DOI: http://doi.org/10.3802/jgo.2010.21.1.12

Abstract

OBJECTIVE
Transrectal ultrasound (TRUS) has been widely used for guiding prostate implants, but not much for interstitial brachytherapy (IBT) of cervix cancer. The aim of our study is to report our experience with TRUS guided high dose rate (HDR) IBT in patients with carcinoma of uterine cervix. METHODS: During the year 2005-2006, 25 patients of cervical cancer not suitable for intracavitary radiotherapy (ICRT), were enrolled in this prospective study. We used B-K Medical USG machine (Falcon 2101) equipped with a TRUS probe (8658) having a transducer of 7.5 MHz for IBT. Post procedure, a CT scan was done for verification of needle position and treatment planning. Two weekly sessions of HDR IBT of 8-10 Gy each were given after pelvic external beam radiation therapy. RESULTS: A total of 40 IBT procedures were performed in 25 patients. Average duration of implant procedure was 50 minutes. There was no uterine perforation in any of 11 patients in whom central tandem was used. CT scan did not show needle perforation of bladder/rectum in any of the patients. During perioperative period, only 1 procedure (2.5%) was associated with hematuria which stopped within 6 hours. Severe late toxicity was observed in 3 (12%) patients. Overall pelvic control rate was 64%. CONCLUSION: Our experience suggests that TRUS is a practical and effective imaging device for guiding the IBT procedure of cervical cancer patients. It helps in accurate placements of needles thus avoiding the injury to normal pelvic structures.

Keyword

Interstitial brachytherapy; Cervical neoplasms; Transrectal ultrasound

MeSH Terms

Brachytherapy
Cervix Uteri
Female
Hematuria
Humans
Needles
Perioperative Period
Prospective Studies
Prostate
Transducers
Uterine Cervical Neoplasms
Uterine Perforation

Figure

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  Fig. 1 Transrectal ultrasound axial image showing the cervical tumor region with central tandem in the cervical os.

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  Fig. 2 Longitudinal image demonstrating the stainless steel brachytherapy needle (bright shadow) which is about to pierce the gut wall.

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  Fig. 3 Transrectal ultrasound image showing the brachytherapy needles in the cervical tumor region (dotted line) covering it adequately.

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  Fig. 4 Isodose distribution of the patient created by CT based planning. Thick red line depicts the target area obtained by line joining the outermost needles. The thin red line represents the prescription isodose (100% isodose line).

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