Role of Computed Tomography Image Guidance in Two-dimensional Brachytherapy of Cervical Cancer

  Objective  To evaluate the value of computed tomography (CT) image guidance in two-dimensional brachytherapy of cervical cancer.

  Methods  A total of 92cervical cancer patients who were treated by Fletcher applicator in our hospital from April to August 2013 were enrolled in this prospective study. CT scan was required for all patients before the performance of first brachytherapy. We measured the length and angle of uterine, recorded the cases of uterus perforation and other poor positions of applicators, and then analyzed by classification.

  Results  Among these 92 cases, uterine perforation occurred in 3 cases (3.3%). All these three patients were asymptomatic and the angles of their uteruses were largest among all patients. Twenty-six cases (28.3%) had poor positions of applicators, which included tandems too close to the bottom of uterine and adjacent to small intestine (n=13), tandems deviated from the center of uterine cavity excluding uterine perforation (n=9), and tandems too far away from the bottom of uterine (n=4). In one case, the position of applicator was appropriate, but the uterus was too small and surrounded by sigmoid colon.

  Conclusions  Asymptomatic uterine perforation and other poor positions of applicators can be found by CT scan during brachytherapy, which provides useful information for adjusting the performance of two-dimensional brachytherapy. As an easy and convenient technique, it can be widely applied in clinical practice.