J Gynecol Oncol.  2024 May;35(3):e35. 10.3802/jgo.2024.35.e35.

Development and validation of a novel scoring system to predict the risk of uterine perforation during intracavitary brachytherapy for cervical cancer

• Parvath ESM
• John NO
• Sathyamurthy A
• Ramireddy JK
• Ram TS

• KMID: 2564899
• DOI: http://doi.org/10.3802/jgo.2024.35.e35

Abstract

Objective
To develop and validate a novel scoring system for predicting the risk of uterine perforation during brachytherapy (BT) in cervical cancer patients and to stratify patients based on this score to guide the use of ultrasound guidance during BT.
Methods
Fifty patients with uterine perforation during BT between January 2018 and December 2020 were included. Common reasons for perforation were identified and a scoring system was developed. This was then applied to a cohort of 50 patients without perforation. The 2 cohorts were compared using the χ ² test. To validate the scoring system, all newly diagnosed patients who underwent BT in 2021 were scored, and analysed using χ ² test and receiver operator characteristic curves.
Results
The mean score in the test cohort was 10.16 (range=7–14) and 5.92 (range=5–8) for patients with and without perforation. In the validation cohort, the mean score was 6.9 (range=5–10) and 9.33 (range=7–11) for those with and without perforation. Patients with a score <8 were classified as low risk, while those with a score ≥8 were classified as high risk. Among the criteria evaluated for validation, response to external beam radiotherapy, uterine position, cervico-uterine angle (uterine flexion), identification of cervical os at BT assessment, and the total score were significant predictors, while previous history of perforation, uterine length, and additional uterine anomaly were not.
Conclusion
The novel scoring system is an effective predictor of perforation risk during BT. Implementing this during BT assessment can optimize the need for ultrasound guidance during the procedure.

Keyword

Uterine Perforation; Brachytherapy; Scoring System; Cervical Cancer; Ultrasound