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Gynecol Oncol. 2018 Dec;151(3):573-578. doi: 10.1016/j.ygyno.2018.10.011. Epub 2018 Oct 15.

Decrease in uterine perforations with ultrasound image-guided applicator insertion in intracavitary brachytherapy for cervical cancer: A systematic review and meta-analysis.

Author information

1
Department of Radiation Oncology, AC Camargo Cancer Center, São Paulo, SP, Brazil; Department of Radiation Oncology, Hospital Central do Exército do Rio de Janeiro (HCE-RJ), Rio de Janeiro, RJ, Brazil. Electronic address: lucasgsapienza@gmail.com.
2
Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
3
Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
4
Department of Statistics and Epidemiology, AC Camargo Cancer Center, São Paulo, SP, Brazil. Electronic address: vinicius.calsavara@accamargo.org.br.
5
Department of Radiation Oncology, Hospital Federal dos Servidores do Estado (HFSE-RJ), Rio de Janeiro, RJ, Brazil.
6
Department of Gynecologic Oncology, AC Camargo Cancer Center, São Paulo, SP, Brazil.

Abstract

PURPOSE:

To estimate uterine perforations rates during intracavitary brachytherapy for cervical cancer with and without ultrasound (US) image guidance.

MATERIALS AND METHODS:

A systematic search of databases (PubMed and EMBASE) was performed. The pooled summary uterine perforation rate (detected by postinsertion CT or MRI) for the un-guided insertion group and the guided insertion group was calculated by using the random-effects model weighted by the inverse variance.

RESULTS:

A total of 690 articles were initially found, resulting in 12 studies that met the inclusion criteria. A total of 1757 insertions and 766 patients were included in the meta-analysis. The overall uterine perforation rate per insertion was 4.56% (95%CI: 2.35-8.67) and per patient was 7.39% (95%CI: 3.92-13.50). The pooled perforation rate per insertion without image guidance was 10.54% (95%CI: 6.12-17.57) versus 1.06% (95%CI: 0.41-2.67) with image guidance (p < 0.01). The pooled perforation rate per patient without guidance was 16.67% (95%CI: 10.01-26.45) versus 2.54% (95%CI: 1.21-5.24) with image guidance (p < 0.01). The ratio of perforations in the un-guided/guided groups was 9.94 and 6.56, per insertion and per patient, respectively. The most common sites of perforation were the posterior wall (>47 events) and the uterine fundus (24 events). None of the studies reported significant acute clinical consequences. Prophylactic antibiotic after perforation was used in 3 of the 4 studies that described the management.

CONCLUSION:

Using postinsertion CT or MRI to detect the perforation, the rate of uterine perforation per insertion in patients who received US-guided intracavitary brachytherapy insertion is 90% lower than with un-guided insertion.

KEYWORDS:

Brachytherapy; Cervical cancer; Gynecological cancer; Image-guided insertion; Meta-analysis; Uterine perforation

PMID:
30333082
DOI:
10.1016/j.ygyno.2018.10.011
[Indexed for MEDLINE]

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