title: The effect of laparoscopic guidance on gynecologic interstitial brachytherapy.
abstract: OBJECTIVE
  To compare laparoscopic-assisted interstitial brachytherapy (LAIB) with traditional interstitial brachytherapy (TrIB) in the treatment of gynecologic malignancies.
  
  
  METHODS
  Retrospective review (Canadian Task Force classification II-3).
  
  
  METHODS
  University hospital.
  
  
  METHODS
  A total of 42 women undergoing interstitial brachytherapy for a gynecologic malignancy.
  
  
  METHODS
  Interstitial brachytherapy by traditional method versus laparoscopic guidance.
  
  
  RESULTS
  In all, 42 women underwent interstitial brachytherapy with a mean follow-up of 24 months. In all, 28 patients underwent TrIB and 14 underwent LAIB. The mean operating department time was 177 minutes for LAIB and 91 minutes for TrIB (p<.001). No intraoperative complications existed in either group. Of the 14 patients undergoing LAIB, 2 (14%) had carcinomatosis, and the brachytherapy was aborted. Of patients who proceeded with LAIB, 64% had clinically significant pelvic adhesions necessitating lysis of adhesions. Mean radiation doses were similar for both external beam (LAIB=54 Gy, TrIB=50 Gy; p=.12) and brachytherapy (LAIB=29 Gy, TrIB=30 Gy; p=.8). No difference existed in the mean follow-up between groups (p=.7). In regard to long-term grade 3/4 radiation toxicity, 1 (10%) patient undergoing LAIB had a rectovaginal fistula. Six (27%) patients (p=.39; 95% CI 9%-43%) undergoing TrIB experienced high-grade toxicity, including 2 rectovaginal fistulas, 1 rectal stricture, 1 necrotizing fasciitis, 1 urinary incontinence, and 1 soft-tissue necrosis.
  
  
  CONCLUSIONS
  The LAIB procedure appears safe, but substantially increases operating department time. No significant decrease in late high-grade toxicities were detected in comparison with TrIB. The LAIB procedure allows for both lysis of adhesions and identification of unknown carcinomatosis.
authors.affiliation: Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin 53792, USA.
authors.forename: David B
authors.initials: DB
authors.lastname: Engle
authors.forename: Kristin A
authors.initials: KA
authors.lastname: Bradley
authors.forename: Rick J
authors.initials: RJ
authors.lastname: Chappell
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Conner
authors.forename: Ellen M
authors.initials: EM
authors.lastname: Hartenbach
authors.forename: David M
authors.initials: DM
authors.lastname: Kushner
mesh_terms: D000328:Adult; D000368:Aged; D001918:Brachytherapy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D010535:Laparoscopy; D008875:Middle Aged; D012189:Retrospective Studies; D002583:Uterine Cervical Neoplasms / Q000532:radiotherapy*