Bayrak Mehmet, Abakay Candan D
Department of Gynecologic Oncology, Uludag University Hospital, Bursa, Turkey.
Department of Radiation Oncology, Uludag University Hospital, Bursa, Turkey.
J Contemp Brachytherapy. 2021 Apr;13(2):167-171. doi: 10.5114/jcb.2021.105284. Epub 2021 Apr 14.
Intracavitary brachytherapy (ICBT) is a part of standard treatment for loco-regionally advanced cervical cancers. ICBT requires a tandem applicator insertion through cervical canal into uterine cavity. Accurate placement through cervical canal, which is distorted by cancer, is crucial to successful treatment. The objective of this study was to investigate actual complication rate of a Smit sleeve insertion performed by experienced gynecologists in a tertiary referral center.
Clinical data of 328 patients with cervical cancer treated using ICBT, between January 2013 and August 2019, were retrospectively evaluated. Predisposing factors that could have increased the risk of uterine perforation were recorded. Pre-operative ultrasound was carried out for visualization of uterine curvature and selection of an appropriate Smith sleeve length. All applications were performed by a gynecologic oncology fellow or an expert gynecologist.
317 patients were suitable for analysis. Only one (0.3%) applicator placement resulted in uterine perforation. In two patients, Smit sleeve dislocated after first brachytherapy and reinserted. Adequate applicator placement was achieved, and treatment was completed as planned in 316 cases.
A cervical sleeve technic, which reduced the need for multiple insertions and placement of this instrument by an expert gynecologist minimize the risk of complication relative to historical controls.
腔内近距离放射治疗（ICBT）是局部晚期宫颈癌标准治疗的一部分。ICBT需要通过宫颈管插入串联施源器至子宫腔。在因癌症而变形的宫颈管中准确放置施源器对于成功治疗至关重要。本研究的目的是调查在三级转诊中心由经验丰富的妇科医生进行史密斯套管插入术的实际并发症发生率。
回顾性评估2013年1月至2019年8月期间接受ICBT治疗的328例宫颈癌患者的临床资料。记录可能增加子宫穿孔风险的诱发因素。术前进行超声检查以观察子宫弯曲度并选择合适的史密斯套管长度。所有操作均由妇科肿瘤学住院医师或专家妇科医生进行。
317例患者适合分析。仅1例（0.3%）施源器放置导致子宫穿孔。2例患者在首次近距离放射治疗后史密斯套管移位并重新插入。316例实现了施源器的充分放置，并按计划完成了治疗。
相对于历史对照，一种宫颈套管技术减少了专家妇科医生多次插入和放置该器械的需求，将并发症风险降至最低。
