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J Minim Invasive Gynecol. 2008 Sep-Oct;15(5):541-6. doi: 10.1016/j.jmig.2008.06.001. Epub 2008 Jul 26.

The effect of laparoscopic guidance on gynecologic interstitial brachytherapy.

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  • 1Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin 53792, USA.

Abstract

STUDY OBJECTIVE:

To compare laparoscopic-assisted interstitial brachytherapy (LAIB) with traditional interstitial brachytherapy (TrIB) in the treatment of gynecologic malignancies.

DESIGN:

Retrospective review (Canadian Task Force classification II-3).

SETTING:

University hospital.

PATIENTS:

A total of 42 women undergoing interstitial brachytherapy for a gynecologic malignancy.

INTERVENTIONS:

Interstitial brachytherapy by traditional method versus laparoscopic guidance.

MEASUREMENTS AND MAIN RESULTS:

In all, 42 women underwent interstitial brachytherapy with a mean follow-up of 24 months. In all, 28 patients underwent TrIB and 14 underwent LAIB. The mean operating department time was 177 minutes for LAIB and 91 minutes for TrIB (p<.001). No intraoperative complications existed in either group. Of the 14 patients undergoing LAIB, 2 (14%) had carcinomatosis, and the brachytherapy was aborted. Of patients who proceeded with LAIB, 64% had clinically significant pelvic adhesions necessitating lysis of adhesions. Mean radiation doses were similar for both external beam (LAIB=54 Gy, TrIB=50 Gy; p=.12) and brachytherapy (LAIB=29 Gy, TrIB=30 Gy; p=.8). No difference existed in the mean follow-up between groups (p=.7). In regard to long-term grade 3/4 radiation toxicity, 1 (10%) patient undergoing LAIB had a rectovaginal fistula. Six (27%) patients (p=.39; 95% CI 9%-43%) undergoing TrIB experienced high-grade toxicity, including 2 rectovaginal fistulas, 1 rectal stricture, 1 necrotizing fasciitis, 1 urinary incontinence, and 1 soft-tissue necrosis.

CONCLUSION:

The LAIB procedure appears safe, but substantially increases operating department time. No significant decrease in late high-grade toxicities were detected in comparison with TrIB. The LAIB procedure allows for both lysis of adhesions and identification of unknown carcinomatosis.

PMID:
18657479
[PubMed - indexed for MEDLINE]
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