Radiation Oncology/Cervix/Brachytherapy – Wikibooks, open books for an open world

Intracavitary brachytherapy[edit]

Three techniques:

  • Paris system
  • Stockholm system
  • Manchester system
  • Madison system (HDR)

Manchester system[edit]

  • Level A dose definitions:
    Allegedly, Level A corresponds to the paracervical triangle within the medial fringe of the broad ligament the place the uterine vessels cross the ureter
    • Authentic definition: draw a line connecting the superior elements of the vaginal ovoids and measuring 2 cm superior alongside the tandem after which 2 cm perpendicular to this. (weak point: failure of localization radiographs to point out the floor of the ovoids’ caps)
    • Revised definition #1: 2 cm above the exterior cervical os and a couple of cm lateral to midline
    • Revised definition #2 (1953, Tod & Meredith): 2 cm above the distal finish of the bottom supply within the tandem and a couple of cm lateral to the tandem
    • Frequent variation: use flange at cervical os
  • Level B – 5 cm lateral from the midline on the identical degree as Level A

The Manchester applicators consisted of a rubber tandem and two ellipsoid “ovoids” with diameters 2, 2.5, and three cm. No shielding in ovoids, so wanted beneficiant packing anteriorly and posteriorly. Used radium. Used 17.5, 20, and 22.5 mg Ra for the small, medium, and enormous ovoids, respectively.

Designed such that:

  • Level A dose price was roughly 0.53 Gy/hr for all allowed applicator loadings
  • Vaginal contribution to Level A was restricted to 40% of the entire dose
  • The rectal dose needs to be 80% or much less of the Level A dose

Prescribed 80 Gy to level A in two purposes, whole of 144 hours, within the absence of exterior beam.

Weak point: vast variation in Level A in respect to the ovoids. Level A typically happens in a high-gradient area of the isodose distribution. Subsequently, minor variations in place can lead to massive variations in dose.

References:

  • No PMID – M. Tod and W. Meredith, A dosage system to be used within the therapy of most cancers of the uterine cervix. Br J Radiol 11 (1938), pp. 809–824.
  • Revised (1953) – PMID 13042092 — “M. Tod and W. Meredith, Therapy of most cancers of the cervix uteri—a revised “Manchester technique.”. Br J Radiol 26 (1953), pp. 252–257.

Fletcher applicator[edit]

Derives from the Manchester system. Added inside shielding within the colpostats. Afterloading means. Colpostat has 2 cm diameter that may be elevated to 2.5 or Three cm by the addition of plastic caps. Minicolpostats are 1.6 cm and have a flat inside floor and haven’t any shielding. Use 15, 20, and 25 mg Ra for small, medium, and enormous colpostats; use 10 for the minis. Tandems can be found in three curvatures. Flange on the tandem avoids slippage previous the cervical os, and a keel helps preserve it from rotating. A yoke attaches the tandem and colpostats to take care of correct place. Loading of the tandem is 20 – 10 – 10 mgRaEq with Cs-137.

Plastic Fletcher applicators can be found to be suitable with CT simulation or MRI.

The Madison system (College of Wisconsin)[edit]

  • PMID 1526873, 1992 — “Excessive dose price intracavitary brachytherapy for carcinoma of the cervix: the Madison system: I. Medical and radiobiological concerns.” Stitt JA et al. Int J Radiat Oncol Biol Phys. 1992;24(2):335-48.
  • PMID 1526874, 1992 — “Excessive dose price intracavitary brachytherapy for carcinoma of the cervix: the Madison system: II. Procedural and bodily concerns.” Thomadsen BR et al. Int J Radiat Oncol Biol Phys. 1992;24(2):349-57.

American Brachytherapy Society (ABS)[edit]

Advocate prescribing to Level H – Draw a line connecting the mid-dwell positions of the ovoids and discover the purpose this line intersects the tandem. Comply with 2 cm superior (alongside the tandem) plus the radius of the ovoids, then 2 cm perpendicular to the tandem. Notice: That is principally 2 cm above the highest of the ovoids.

  • ABS Normal Rules for regionally superior carcinoma of the cervix. (2012) PMID: 22265436 — “American Brachytherapy Society consensus tips for regionally superior carcinoma of the cervix. Half I: normal ideas.” Viswanathan et al. Brachytherapy. 2012 Jan-Feb; 11(1):33-46.
  • ABS HDR tips. (2012) PMID: 22265437 — “American Brachytherapy Society consensus tips for regionally superior carcinoma of the cervix. Half II: high-dose-rate brachytherapy.” Viswanathan et al. Brachytherapy. 2012 Jan-Feb; 11(1):47-52.
  • ABS LDR and Pulsed-dose price tips. (2012) – PMID: 22265438 — “American Brachytherapy Society Consensus Pointers for regionally superior carcinoma of the cervix. Half III: low-dose-rate and pulsed-dose-rate brachytherapy.” Lee et al. Brachytherapy. 2012 Jan-Feb; 11(1)53-7.

European Society for Therapeutic Radiation Oncology (ESTRO)[edit]

  • ESTRO
    • 2006 PMID 16403584 — “Suggestions from gynaecological (GYN) GEC ESTRO working group (II): ideas and phrases in 3D image-based therapy planning in cervix most cancers brachytherapy-3D dose quantity parameters and elements of 3D image-based anatomy, radiation physics, radiobiology.” (Potter R, Radiother Oncol. 2006 Jan;78(1):67-77. Epub 2006 Jan 5.)
      • Suggestions for 3D dose-volume parameters
    • 2005 PMID 15763303 — “Suggestions from Gynaecological (GYN) GEC-ESTRO Working Group (I): ideas and phrases in 3D picture based mostly 3D therapy planning in cervix most cancers brachytherapy with emphasis on MRI evaluation of GTV and CTV.” (Haie-Meder C, Radiother Oncol. 2005 Mar;74(3):235-45.)
      • Specification of image-guided GTV and CTV

Good Insertion Traits[edit]

  • AP View
    • Tandem midline, unrotated
    • Tandem halfway between colpostats
    • Keel (flange) in shut proximity to gold seed markers
    • Colpostats excessive within the fornices alongside cervix, ideally ~1/Three above flange
  • Lateral View
    • Tandem bisects the colpostat
    • Adequate anterior and posterior packing
    • Foley balloon firmly tugged down

Interstitial brachytherapy[edit]

  • UC Irvine; 2013 (1996-2009) PMID 22763030 — “Outcomes of high-dose-rate interstitial brachytherapy within the therapy of regionally superior cervical most cancers: long-term outcomes.” (Pinn-Bingham M, Int J Radiat Oncol Biol Phys. 2013 Mar 1;85(3):714-20. doi: 10.1016/j.ijrobp.2012.05.033. Epub 2012 Jul 3.)
    • Retrospective. 116 sufferers, cervical most cancers (91% Stage IIB-IVA). Mixture EBRT 50.Four with 2 interstitial implants HDR 36 Gy. Interstitial hyperthermia in 61%. Concurrent chemotherapy 81%
    • Consequence: LRC 85%. 3-year DFS Stage IB 59%, II 67%, Stage III 71%, Stage IVA 57%. 5-year DFS 60%, OS 44%
    • Toxicity: acute and late toxicities acceptable
    • Conclusion: Domestically superior cervical most cancers can obtain glorious outcomes with HDR interstitial brachytherapy

Dose Prescriptions

  • Level A
    • Early stage illness (nonbulky Stage I-II): 80-85 Gy
    • Superior stage illness (cumbersome or Stage IIIB): 85-90 Gy
  • Pelvic Sidewall – LDR equal of 50-55 Gy (early stage) or 55-60 Gy (superior stage)
    • Early stage illness (nonbulky Stage I-II): 50-55 Gy
    • Superior stage illness (cumbersome or Stage IIIB): 55-60 Gy
  • ABS LDR (2002) – PMID 11777620 — “The American Brachytherapy Society suggestions for low-dose-rate brachytherapy for carcinoma of the cervix.” Nag S et al. Int J Radiat Oncol Biol Phys. 2002 Jan 1;52(1):33-48.
  • ABS LDR and Pulsed-dose price tips. (2012) – PMID: 22265438 — “American Brachytherapy Society Consensus Pointers for regionally superior carcinoma of the cervix. Half III: low-dose-rate and pulsed-dose-rate brachytherapy.” Lee et al. Brachytherapy. 2012 Jan-Feb; 11(1)53-7.

HDR vs LDR[edit]

Equal doses[edit]

HDR dose LDR equal
6 Gy x 4 32 Gy
6 Gy x 5 40 Gy
  • Taiwan (1996) – PMID 8631555 — “Willpower of the suitable fraction quantity and measurement of the HDR brachytherapy for cervical most cancers.” Liu WS et al. Gynecol Oncol. 1996 Feb;60(2):295-300.
  • Detroit (1991) – PMID 1938550 — “Comparability of excessive and low dose price distant afterloading for cervix most cancers and the significance of fractionation.” Orton CG et al. Int J Radiat Oncol Biol Phys. 1991 Nov;21(6):1425-34.
    • Evaluation of 17,000 cervix most cancers pts in 56 establishments utilizing HDR.
    • Conversion of dose from LDR to HDR, use dose issue of 0.54.

Calculation instruments:

  • Medical College of Vienna

Radiobiology[edit]

BED for HDR and LDR:

  • HDR:
  • LDR:

The place N = variety of fractions, d = dose per fraction, R = dose price, t = therapy time (i.e. length), μ = sublethal harm restore fixed, and α/β = attribute parameter of the cell survival curve from the linear quadratic mannequin.

(from ABS, PMID 10924990)

Drawback: What dose/fraction of HDR delivered in six fractions might be equal by way of tumor management to 60 Gy delivered to Level A at 0.55 Gy h−1?

Resolution: Assume α/β (tumor) = 10 Gy, μ (tumor) = 0.46 h−1.

Then: BED (LDR) = 60[1 + (2 × 0.55)/(0.46 × 10)] = 74.3

Equating this to the BED for six HDR fractions with dose/fraction d provides:

74.3 = 6d(1 + d/10)

Fixing this quadratic equation for d provides: d = 7.20 Gy.

Conclusion: 6 fractions of seven.20 Gy with HDR is equal by way of tumor management to 60 Gy delivered at 0.55 Gy h−1.

Different references:

  • PMID 10661360 (2000) — “A easy technique of acquiring equal doses to be used in HDR brachytherapy.” Nag S et al. Int J Radiat Oncol Biol Phys. 2000 Jan 15;46(2):507-13.

Medical Comparability[edit]

  • Meta-analysis; 2010 PMID 20614461 — “Excessive dose price versus low dose price intracavity brachytherapy for regionally superior uterine cervix most cancers. (Wang X, Cochrane Database Syst Rev. 2010 Jul 7;(7):CD007563. doi: 10.1002/14651858.CD007563.pub2.)
    • Cochrane assessment. Four research, 1265 sufferers.
    • Consequence: no distinction in 3-, 5-, and 10-year OS or DSS. No distinction for native management, locoregional recurrence, or distant metastases
    • Toxicity: No distinction for bladder or rectosigmoid toxicity, elevated threat for small bowel (RR 3.4, p=0.04)
    • Conclusion: As a result of potential benefits of HDR, we advocate HDR for all scientific levels of cervix most cancers
  • India, 1994 (1986-89) – PMID 8276647 — “Low dose price vs. excessive dose price brachytherapy within the therapy of carcinoma of the uterine cervix: a scientific trial.” Patel FD et al. Int J Radiat Oncol Biol Phys. 1994 Jan 15;28(2):335-41.
    • 482 pts. Randomized two teams (Group I – early stage, brachy solely. Group II – EBRT + BT) to HDR vs LDR.
    • 5-yr LC 79.7% (LDR) vs 75.8% (HDR). OS: Stage I – 73% vs 78%, Stage II – 62% and 64%, Stage III – 50% and 43. Rectal problems decrease for HDR (19.9% vs 6.4%)

ABS Pointers[edit]

  • HDR (2000) – PMID 10924990 — “The American Brachytherapy Society suggestions for high-dose-rate brachytherapy for carcinoma of the cervix.” Nag S et al. Int J Radiat Oncol Biol Phys. 2000 Aug 1;48(1):201-11.
    • Normal suggestions
      • Brachytherapy should be included as a element of radiation remedy for cervical carcinoma
      • Good applicator placement should be achieved
      • Relative dose of EBRT vs. BT will depend on tumor quantity, means to displace bladder and rectum, tumor regression throughout EBRT, and institutional desire
      • Complete therapy length needs to be
      • HDR needs to be interdigitated with EBRT, such that EBRT isn’t given on day of BT. If vaginal geometry is perfect, begin BT throughout week #Three and provides BT as soon as per week. If tumor quantity does not permit this, carry out 2 BT implants per week after completion of EBRT to remain inside Eight week therapy length restrict
    • Exterior Beam RT
      • HDR fraction measurement and quantity will depend on EBRT dose (see desk under), although particular person HDR fraction measurement needs to be <7.5 Gy/fx attributable to considerations about late toxicity
      • There is no such thing as a consensus about midline blocks. If used, needs to be 4-5cm vast and shouldn’t lengthen to the highest of the pelvic subject if used at <40 Gy. Care should be taken to not protect widespread illiac and presecral nodes.
      • Midline block place needs to be reassessed after every implant
    • Chemotherapy
      • Chemotherapy needs to be administered concurrently with EBRT, however not with BT
    • Insertion method
      • A number of insertions needs to be used to permit progressive quantity discount and thus simpler illness protection
      • Optimum applicator placement is essential, and needs to be completed with ultrasound and fluoroscopic steering
      • Applicable applicator should be chosen for illness geometry: commonplace ovoids, ring, or Henschke applicator
      • If an applicator can’t be accommodated, interstitial implant needs to be used
      • Acutely aware sedation needs to be used at any time when potential; affected person discomfort can result in suboptimal packing
      • Cervical markers needs to be positioned for identification of cervical place and to find out relationship of vaginal applicators to the cervix
      • Bladder and rectum needs to be displaced away from the applicators
      • Exterior fixation units (e.g. perineal bar or clamp/base plate) needs to be used to stop motion
      • Good high quality radiographs needs to be obtained for therapy planning and dosimetry with every insertion
      • Each effort needs to be made to reduce affected person and applicator motion
    • Dose specification
      • Ideally, dose needs to be prescribed to particular person affected person’s therapy quantity, however there may be inadequate data within the literature to ascertain a greater delineated goal than Level A
      • ABS recommends prescribing to Level H outlined as level of intersection of mid-dwell positions of the ovoids with the tandem. Then transfer superiorly radius of the ovoids (to high of ovoids) + 2 cm, after which 2 cm perpendicularly
    • Dose optimization
      • Reaching good dose distribution requires each good dose insertion and dose optimization
      • Tandem optimization: begin 1 cm inferiorly to the superior-most dwell place. End 1 cm superior to the floor of the vaginal equipment. Optimization factors ought to fall no additional than 1 cm aside alongside the tandem, and in each lateral instructions
      • Vaginal optimization ought to fall on the vaginal floor or specified depth (often 0.5 cm), and may fall in each lateral instructions as to not intrude with tandem optimization
    • Dose calculations to organs in danger
      • ICRU 38 doesn’t persistently specify location of maximu dose to the organs
      • True dose delivered needs to be calculated utilizing delicate tissue (CT or MRI) planning if obtainable
      • Nominal rectal and bladder factors can be utilized as per ICRU definitions, and may obtain <80% of dose to Level H. Absolute dose needs to be LDR-equivalent <75 Gy for rectum and <80 Gy for bladder
      • Regional lymph nodes: BT element is small in comparison with EBRT dose, however needs to be calculated. ICRU 38 Pelvic Wall Level specification needs to be used. Manchester Level B ought to not be used
    • Dose suggestions
      • See desk under as a information
      • Level A: LDR equal of 80-85 Gy (early stage illness, nonbulky Stage I-II) or 85-90 Gy (superior stage, Stage IIIB or > Four cm).
      • Pelvic Sidewall: LDR equal of 50-55 Gy (early stage) or 55-60 Gy (superior stage)
      • Bodily dose delivered might be much less for HDR than for LDR attributable to dose-rate impact
    • High quality assurance
      • AAPM TG 59 suggestions needs to be adopted
    • Interstitial brachytherapy
      • Really helpful for scientific conditions when geometry for intracavitary BT is suboptimal (e.g. cumbersome lesions, slim vaginal apex, lack of ability to enter the cervical os, extension to the lateral parametria or pelvic sidewall, and decrease vaginal extension)
      • Please see the manuscript for additional suggestions

Instructed doses together with EBRT:

EBRT dose # HDR fractions HDR dose/fx
20 6 7.5
20 7 6.5
20 8 6.0
45 5 6.0
45 6 5.4
  • ABS HDR tips. (2012) PMID: 22265437 — “American Brachytherapy Society consensus tips for regionally superior carcinoma of the cervix. Half II: high-dose-rate brachytherapy.” Viswanathan et al. Brachytherapy. 2012 Jan-Feb; 11(1):47-52.
  • Picture-guided brachytherapy working group
    • 2004 PMID 15519788 — “Proposed tips for image-based intracavitary brachytherapy for cervical carcinoma: Report from Picture-Guided Brachytherapy Working Group.” Nag et al. Int J Radiat Oncol Biol Phys. 2004 Nov 15;60(4):1160-72.

HDR Implant Steps[edit]

  • Carry out preliminary bimanual examination for geometry whereas affected person present process EBRT
  • Induce anesthesia (think about normal, acutely aware sedation, or spinal)
  • Take into account antibiotic protection (e.g. Ancef 1 gram)
  • Place in lithotomy place
  • Examination beneath anesthesia to evaluate geometry for implant
    • If not, abort and think about interstitial implant
  • Prep with betadine and drape (think about “urine cather” to catch stray devices)
  • Place Foley with 7 cc diluted distinction (2 ml distinction + 5 ml saline)
  • Fill bladder with saline, utilizing 4-5 huge syringes (200-300 ml)
  • Open vagina with proper angle retractors; weighted speculum might tear friable vaginal mucosa after concurrent chemo-RT
  • Use tenaculum to understand anterior lip of cervix, and keep pressure
  • Place 2-Three gold seeds ~5mm into cervix (on x-ray, they are going to be ~1cm superior to the inferior-most facet of the cervix)
  • Use sound to estimate cervix depth, beneath ultrasound steering to keep away from perforation
    • As soon as sound is in fundus, grasp uncovered portion with a clamp on the cervix, and measure the sound to estimate depth
    • Commonest location for perforation is posterior endocervix or decrease uterine phase
  • Dilate cervix
    • Depart dilator in place till prepared for tandem, to stop cervical spasm
  • Take into account Smit sleeve (often 60 mm sleeve)
  • Insert tandem beneath ultrasound steering
    • Select size and angle of tandem based mostly on sound data
    • If uterus is retroverted, place tandem to comply with the cavity after which gently rotate into anterior place to antervert
  • Take away tenaculum
  • Insert ovoids or ring
    • Lubricating them might assist insertion
    • Select largest measurement that can match to make the most of inverse sq.; nevertheless, too massive an ovoid could also be displaced inferiorly, away from the tumor
    • Might have ovoids of two totally different sizes if the tumor is asymmetrical
    • Usually insert proper ovoid, then left ovoid, then lock in place
    • If built-in tungsten shields, might present ~15% dose discount to the anterior rectal wall
  • Confirm steady implant placement with ultrasound
  • Empty bladder, however preserve Foley in place
  • Pack anteriorly and posteriorly to ovoids
    • Usually 1 inch gauze is used, with DeBakey forceps and/or fingers
    • Use lubrication (e.g. premarin cream, surgilube) on the gauze
    • Purpose for ground and ceiling, however not cephalad to ovoids, so the cervix is not displaced
    • Posterior packing initially to preferentially spare rectum
    • Place a sew within the gauze on the finish, to facilitate removing
  • Movies in O.R. to guage implant high quality (see above)
  • If admitting, think about:
    • Exercise: mattress relaxation
    • Nursing:
      • Foley to gravity
      • Compression units to bilateral decrease extremities
      • Incentive spirometry to bedside; use 10x/hr whereas awake
      • Head of mattress at or under 30 levels
    • Food plan: clear, advance to low residue as tolerated
    • IVF: NS @ 75 ml/hr
    • Meds:
      • Lovenox 40 mq QD or heparin 5000 items SC Q8
      • Ache administration (PCA pump or protection for breakthrough ache)
      • Lomotil 1 tab Q6
      • Restoril 15 mg Qhs
      • Pepcid 20 mg PO BID
      • Affected person’s routine drugs
    • Ship to radiation oncology when steady
  • Dictate OP word (e.g. Ms X was taken to the working room, the place she was place beneath (normal, spinal) anesthesia. (ABX) was given. The bladder was crammed with sterile saline resolution and the uterus was evaluated by ultrasound. The tandem was inserted beneath ultrasound steering. The ovoids had been positioned beneath direct visualization. The location of the implant was verfied with ultrasound. Vaginal vault was secured with gauze packing. (There have been no problems). The affected person was taken to the restoration room in a steady situation.)
  • CT sim
    • Insert dummy sources
    • Take into account rectal tube with 20-30 ml barium distinction

Medical Proof[edit]

  • Osaka (Japan)(1983-1989) — HDR fractional dose 7.5 Gy/fx vs. 6.Zero Gy/fx
    • Randomized. 165 sufferers with cervix adenoCA, Stage IA-IV. Handled with 2 separated dose schedules relying on stage. Arm 1) EBRT + BT utilizing 7.5 Gy/fx (both 37.5/5 or 30/Four or 22.5/3) vs. Arm 2) EBRT + BT utilizing 6.Zero Gy/fx (both 36/6 or 30/5 or 18/3).
    • 5-years; 1994 PMID 7974179 — “A potential randomized examine in regards to the level A dose in high-dose price intracavitary remedy for carcinoma of the uterine cervix. The ultimate outcomes.” (Chatani M, Strahlenther Onkol. 1994 Nov;170(11):636-42.)
      • Consequence: 5-year CSS: Stage I 100% vs. 100%, Stage II 82% vs. 85%, Stage III 62% vs. 52%, Stage IV 22% vs. 31% (all NS). No distinction in LRF or DM
      • Toxicity: No distinction
      • Conclusion: No distinction between the 2 therapy schedules; small variety of fractions at 7.5 Gy/fx could also be advantageous attributable to brief length

Dose limits[edit]

  • Factors laid out in ICRU Report 38
    • Please see the ICRU report web page on extra element about definitions
    • Bladder level – on the floor of a Foley balloon crammed with 7 cc of distinction; situated at middle of balloon on AP movie, posterior floor of the balloon on a line by means of midballoon on lateral movie
    • Rectum level – 0.5 cm posterior to the posterior vaginal wall on the degree of the bisection of the T&O. May additionally use barium + air distinction in rectum
    • Vaginal mucosa – at floor of ovoids
    • Pelvic sidewall, and exterior, widespread, and para-aortic LN factors needs to be reported in accordance with ICRU defintions
  • Medical College of Vienna
    • Late uncomfortable side effects; 2011 PMID 20385450 — “Dose-volume histogram parameters and late uncomfortable side effects in magnetic resonance image-guided adaptive cervical most cancers brachytherapy.” (Georg P, Int J Radiat Oncol Biol Phys. 2011 Feb 1;79(2):356-62. Epub 2010 Apr 10.)
      • Retrospective. 141 sufferers, EBRT and IGBT, +/- chemotherapy. DVH parameters D2cc, D1cc, D0.1cc for rectum, sigmoid, and bladder, as nicely ICRU rectum and bladder level doses calculated and transformed to EQD2. Median F/U 4.2 years
      • Consequence: 5-year toxicity rectum 12%, sigmoid 3%, bladder 23%. Imply D2cc rectum 65 Gy (+/- 12 Gy), sigmoid 62 Gy (+/- 12 Gy), and bladder 95 Gy (+/- 22 Gy).
      • Conclusion: D2cc and D1cc have good predictive worth for rectal toxicity. Advocate rectum D2cc max 75 Gy, sigmoid no suggestion, bladder D2cc max 100 Gy
    • Vaginal toxicity; 2010 PMID 20561694 — “Dose quantity parameter D2cc doesn’t correlate with vaginal uncomfortable side effects in particular person sufferers with cervical most cancers handled inside an outlined therapy protocol with very excessive brachytherapy doses.” (Fidarova EF, Radiother Oncol. 2010 Oct;97(1):76-9. Epub 2010 Jun 17.)
      • Vaginal D2cc didn’t correlate with presence or grade of uncomfortable side effects

Acute problems[edit]

  • PMID 10725629 (1960-1992) – “Perioperative and postoperative problems of intracavitary radiation for FIGO stage I-III carcinoma of the cervix.” Jhingran A et al. Int J Radiat Oncol Biol Phys. 2000; 46 (5):1177-83
    • Retrospective. 7662 intracavitary procedures in 4043 sufferers for FIGO I-III cervical CA
    • 2.8% uterine perforation price, 14% have fever >101 C throughout at the very least 1 admission, 0.1% deadly thromboembolism price. Perforation didn’t have an effect on DSS in stage I, II, however did result in worse prognosis in stage III.

Late problems[edit]

  • PMID 7635768, 1995 (1960-89) — “Time course and incidence of late problems in sufferers handled with radiation remedy for FIGO stage IB carcinoma of the uterine cervix.” Eifel PJ et al. Int J Radiat Oncol Biol Phys. 1995 Jul 30;32(5):1289-300.
    • Retrospective. 1784 pts, FIGO stage IB. Grade Three or greater problems occurred in 7.7% at Three yrs and 9.3% at 10 yrs. After 10 yrs, 0.34% per yr, so at 20 yrs, 14.4% threat. Danger of rectal problems was the best, greater than urinary problems.
    • Conclusion: low threat of main problems utilizing brachytherapy.

Miscellaneous[edit]

  • Patterns of care examine (2005, 1996-99) – PMID 16099599 — “Patterns of brachytherapy apply for sufferers with carcinoma of the cervix (1996-1999): a patterns of care examine.” Erickson B et al. Int J Radiat Oncol Biol Phys. 2005 Nov 15;63(4):1083-92.

Exterior hyperlinks[edit]

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