Brachytherapy in Retroverted Uterus

Brachytherapy in Retroverted Uterus

Dr Nilesh Mahale 19 Mar 2011 07:35

All of us have faced problems during IC brachytherapy for Ca Cervix in patients with retroverted uterus.
There are some reports about benefit of US guidance during placement (London Regional cancer Centre, Nina Mayr et al).

Would like to know about personal experiences of members on this

Also it will be great if somebody can mail me full text of following paper

Brachytherapy management of the retroverted uterus using ultrasound-guided implant applicator placement

Nina A. Mayr12Corresponding Author Informationemail address, Joseph F. Montebello12, Joel I. Sorosky3, Jamie S. Daugherty4, Dan L. Nguyen4, George Mardirossian4, Jian Z. Wang4, Susan M. Edwards4, Wenbin Li4, William T.C. Yuh2
Brachytherapy
Volume 4, Issue 1, Pages 24-29 (2005)

Re: Brachytherapy in Retroverted Uterus

Nikhilesh Patil 20 Mar 2011 00:05

Hi Nilesh, you are correct at London Regional Cancer Program (Canada) we are using Abdominal Ultrasound(AUGS) for every case, it is very simple and easy, does not add too much time if your team is able to do the scan. We have trained our RTT's who do the scan quickly and physicists is also available in the HDR suite to check the position etc., to comment.
Even in experienced hands sometimes we do go in false passage, with AUSG we get that info right there in the operating room (OR) to correct, instead of doing CT and realizing later to abandon the case. We do CT plan for all cases.
Just to let you know, Robarts Research Institute (London,Canada) has developed 3D Ultrasound which is amazing, however we have not got it in OR yet.

Since we do CT plan, for a retroverted uterus case my physicists has done a plan where we placed the tandem in reverse direction becoz of the severe angulation. We choose not to load the top 1.5 cms of the tandem to reduce the rectal dose and still went ahead to deliver the planned 650 cGy to cervix but I think one should not do this if you can do the standard application.Most of the cases you will be able to antevert the uterus with the tandem, I know we all have done that several times during our residency but we did not have AUSG guidance to confirm that neither did we do CT for all cases.
We did that case reverse becoz we were just not able to place the tandem in the standard fashion and the other option would have been interstitial but we did have a consent for interstitial so had to place the tandem in reverse direction or waste OR and anesthesia time which is precious.

Last edited on 20 Mar 2011 02:27 by Nikhilesh Patil Show more

Re: Brachytherapy in Retroverted Uterus

VIMOJ J NAIR 20 Mar 2011 16:09

Seen the intersititial implants videos using TAS guidance by Dr S. Nag, but the issue of retroverted uterus was not thought.
TAS is simple and I guess we rad oncs should try to Master that, especially in pelvic treatments including brachytherapy.

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It is our choices that show what we really are, far more than our abilities.

Re: Brachytherapy in Retroverted Uterus

Nikhilesh Patil 22 Mar 2011 23:44

I agree we should master the art of doing our own ultrasound for select group of cases, but I don't know how many institutes can really afford it.
The problem with TVS is that you cannot do the scan while inserting the applicator, which means no live image as compared to transabdominal. People in USA are also using TRUS however it is not prime time yet for TRUS in GYN.

Re: Brachytherapy in Retroverted Uterus

Santam Chakraborty 23 Mar 2011 00:30

Actually I dont think TAS is that expensive a machine to purchase. We had got one in PGI and despite my repeated asking it was not shifted to the OT citing concerns regarding other departments using it. Now that same machine is in the radiology department. I had played around with the USG while it was there and it is not difficult thing to get a hang off. The key thing as Nikhilesh says is that it does tell u nicely if the tandem is inside the uterus. Another important thing is there is usually no need to purchase a new machine. Most USG machines have wheels and are quite portable.

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Re: Brachytherapy in Retroverted Uterus

Dr Rahul Krishnatry 15 May 2011 03:36

Santam! the USS machine in PGI is now been used collaboratively by two departments of Radiotherapy and Radiology! and now the ICA are done under USS guidance to prevent perforation. this happened after high profile EMBRACE patients were perforated.
in TMH i haven't seen USS machine working for long time, but they say once it was functional and used to guide application regularly in cases of difficult cervical OS identification. mqay be one day it starts working again!

Re: Brachytherapy in Retroverted Uterus

Santam Chakraborty 15 May 2011 04:34

Finally better sense prevailed .. I am glad to know of that one. Interesting that machine has a rectal probe too.. and it can be used for assesing the distance between the rectum and the applicator too :-D

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Last edited on 15 May 2011 04:36 by Santam Chakraborty Show more

Re: Brachytherapy in Retroverted Uterus

Nikhilesh Patil 16 May 2011 02:49

India needs Ultrasound more than the western world. Please try and use it for every case where possible.