Intraoperative sonographic guidance for intracavitary brachytherapy of cervical cancer.

BACKGROUND: To describe the role and benefits of intraoperative sonographic (US) guidance in intracavitary brachytherapy of cervical cancer. METHODS: The data of 142 patients who received tandem-based intracavitary brachytherapy for cervical cancer between January 2010 and June 2015 were retrospectively reviewed. US guidance was carried out for tandem selection and appropriate application. The complications and applicator conformity were assessed with planning CT. RESULTS: Intracavitary brachytherapy was performed under US guidance for 412 insertions in 113 consecutive patients with cervical cancer. Before we started to use US guidance, applications were done in 29 patients: uterine perforation occurred in two patients (6.9%), the tandem length was short in two patients (6.9%), the tandem length was long in four patients (13.8%), and tandem was in myometrium in three patients (10.3%). We then decided to use US guidance routinely. With US guidance, only 1 of 113 patients had uterine perforation (0.9%), tandem length was short in only one patient (0.9%), and tandem was in myometrium in one patient (0.9%). CONCLUSIONS: Real-time US provided safe and effective guidance for intracavitary brachytherapy of cervical cancer resulting in decreased rates of perforations and misplacement of applicators. © 2017 Wiley Periodicals, Inc. J Clin Ultrasound 46:8-13, 2018.