Department of Radiation Oncology, Medical University of South Carolina, Charleston, SC, USA.
Ultrasound Obstet Gynecol. 2011 Feb;37(2):241-4. doi: 10.1002/uog.8805.
Tandem placement as part of low-dose-rate (LDR) brachytherapy boost for cervical cancer may be complicated by uterine perforation. The objective of this study was to describe a 10-year experience of using intraoperative ultrasound guidance in an attempt to minimize the risk of uterine perforation.
Operative and inpatient records were reviewed to identify cases in which intraoperative ultrasound guidance was employed in order to assist tandem placement, and to determine whether clinical or radiographic findings subsequently suggested uterine perforation. Demographic factors were collected in order to determine the baseline risk of perforation within this population.
Between 1998 and 2008, 71 patients underwent 110 ultrasound-guided placements of tandem applicators. The median age was 48 (range, 26-88) years, and 20% were older than 60 years. Disease stage was FIGO IB1 (n = 10), IB2 (n = 13), IIA (n = 4), IIB (n = 19), IIIA (n = 2), IIIB (n = 16), IVA (n = 5) and IVB (n = 2). The median gravidity was 3 (range 1-10) and median parity was 3 (range 0-10). Seven patients had a preimplant history of pelvic infection, four had a history of intrauterine contraceptive device use, and 10 had a prior history of Cesarean section delivery. Only one patient experienced infection that may have been attributable to tandem placement-associated uterine perforation. At median survivor follow-up of 34 months, 19 patients had died. The estimated 3-year disease-free and overall survival rates for the entire population were 60% and 66%, respectively.
Within the present population, intraoperative ultrasound guidance of tandem placement was associated with no confirmed cases of uterine perforation.
宫颈癌低剂量率（LDR）近距离放疗推量时行 tandem 插植可能会导致子宫穿孔。本研究的目的是描述 10 年来使用术中超声引导以尽量降低子宫穿孔风险的经验。
回顾性分析术中超声引导 tandem 插植的手术和住院病历，确定是否存在临床或影像学提示子宫穿孔的病例。收集人口统计学因素，以确定该人群穿孔的基线风险。
1998 年至 2008 年，71 例患者共进行了 110 次经超声引导的 tandem 施源器放置。中位年龄为 48 岁（范围 26-88 岁），20%的患者年龄大于 60 岁。疾病分期为 FIGO IB1（n=10）、IB2（n=13）、IIA（n=4）、IIB（n=19）、IIIA（n=2）、IIIB（n=16）、IVA（n=5）和 IVB（n=2）。中位孕次为 3（范围 1-10），中位产次为 3（范围 0-10）。7 例患者有盆腔感染史，4 例有宫内节育器使用史，10 例有剖宫产史。仅有 1 例患者发生感染，可能与 tandem 置管相关的子宫穿孔有关。中位随访时间 34 个月时，19 例患者死亡。全组人群 3 年无疾病生存率和总生存率分别为 60%和 66%。
在本研究人群中，术中超声引导 tandem 插植未发现有明确的子宫穿孔病例。
