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AbstractAbstract
[en] Introduction: Correct insertion of uterine tandem in intracavitary brachytherapy may be challenging because of cervical distortion induced by the tumor or post-therapeutic fibrosis. Patients and methods: All consecutive patients addressed for a gynecological malignancy requiring an intracavitary brachytherapy at Centre Francois Baclesse (Caen, France) from 2013 to 2017 were included. Results: 184 patients were included, accounting for 325 procedures. 101 implants were sub-optimal (14.5% insertion failures, 10.8% sub-serosal insertion and 5.8% uterine perforation on post-implant CT-scan), for 88 patients (48% of patients). Risk factors were age, uterine retroversion and myometrium invasion. Such an event was associated with decreased local control (p limit of significance: OR=1.95 [0.96 - 3.97], p=0.059) but without any impact on overall survival. Brachytherapy completion and total dose to the tumor were significantly associated with local relapse-free survival. Discussion: One can see in our cohort that insertion failure or uterine perforation as such weren't associated with decreased local control. Nevertheless, local relapse-free survival was significantly worse after an abortion of brachytherapy procedure due to insertion difficulties if patients were addressed for an external radiotherapy boost, because of suboptimal doses delivered to central pelvis. Conclusion: Intra-uterine tandem insertion failures are a genuine issue in intracavity brachytherapy. Real-time ultrasound guidance could be useful to reduce uterine perforation rates. (author)
[fr]
Introduction: La catheterisation cervicale en vue d'une curietherapie utero-vaginale (CUV) peut s'averer difficile du fait de la distorsion cervicale induite par la tumeur et les remaniements post-therapeutiques. Materiel et methodes: Les patientes adressees au Centre Francois Baclesse de 2013 a 2017 en vue d'une CUV et ayant beneficie d'au moins une tentative de catheterisation cervicale ont ete incluses. Resultats: 184 patientes ont ete incluses pour 325 implantations. 101 implantations n'etaient pas correctes (14.5% d'echec de catheterisation, 10.8% d'implantation partielle dans le myometre et 5.8% de perforation uterine constates sur le scanner de simulation post-implant), pour 88 patientes soit 48% de la cohorte. Les facteurs de risque etaient l'age, la retroversion uterine et l'envahissement du myometre. La survenue d'un tel evenement etait associee a une diminution du controle local a la limite de la significativite: OR=1.95 [0.96 - 3.97], p=0.059, mais sans impact sur la survie globale. La realisation de la curietherapie et la dose totale etaient significativement associees a la survie sans rechute locale. Discussion: On constate que l'echec de catheterisation ou la perforation uterine en tant que tels n'etaient pas associes a une diminution du controle local. Toutefois les patientes redirigees vers une poursuite en radiotherapie externe suite a la survenue d'un tel evenement avaient une perte de chance en termes de controle local, par defaut d'une escalade de dose suffisante sur la tumeur. Conclusion: Les difficultes de catheterisation sont une reelle problematique en CUV. L'echographie per-implantatoire pourrait etre utile pour reduire le taux d'echecs. (auteur)Original Title
Echec de catheterisation cervicale en curietherapie utero-vaginale: facteurs de risque, complications et valeur pronostique
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26 Oct 2018; 61 p; 89 refs.; Available from the INIS Liaison Officer for France, see the INIS website for current contact and E-mail addresses; These de docteur en medecine
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