title: Toxicity associated with bowel or bladder puncture during gynecologic interstitial brachytherapy.
abstract: OBJECTIVE
  Interstitial brachytherapy for gynecologic malignancies is associated with significant toxicity. Some reports have correlated this toxicity with needle puncture of the visceral organs. This study examined our experience with interstitial brachytherapy and investigated the relationship between the visceral puncture and toxicity.
  
  
  METHODS
  The outcomes of 36 patients treated with interstitial brachytherapy for gynecologic malignancies at a single institution between 2002 and 2007 were reviewed. Computed tomography was used to guide needle placement based solely on tumor coverage. No attempts were made to avoid visceral puncture; however, the source dwell times were minimized in these areas.
  
  
  RESULTS
  At a median follow-up of 21 months, the crude locoregional control rate was 78%. Bowel puncture was noted in 26 patients and bladder puncture in 19. The mean operating time was 50 min, and 86% of patients were discharged in <or=3 days. The incidence of acute and late toxicity was similar between patients with and without visceral puncture according to the log-rank analysis of Kaplan-Meier curves. No patients with bowel puncture experienced Grade 2 or greater acute gastrointestinal toxicity and only 1 had Grade 3 or greater late gastrointestinal toxicity. No patients with bladder puncture experienced greater than Grade 2 acute genitourinary toxicity and only 2 had late Grade 3 or greater genitourinary toxicity.
  
  
  CONCLUSIONS
  The operating time, length of hospital stay, and treatment-induced morbidity in this cohort compared favorably to series using techniques to avoid visceral puncture. Additionally, visceral puncture did not correlate with the occurrence of acute or late toxicity. These data suggest that visceral puncture in the absence of source loading carries a low risk of morbidity.
authors.affiliation: Department of Radiation Oncology, Rush University, Chicago, IL 60612, USA. Anand_Shah@rush.edu
authors.forename: Anand P
authors.initials: AP
authors.lastname: Shah
authors.forename: Jonathan B
authors.initials: JB
authors.lastname: Strauss
authors.forename: Benjamin T
authors.initials: BT
authors.lastname: Gielda
authors.forename: Thomas W
authors.initials: TW
authors.lastname: Zusag
mesh_terms: D001918:Brachytherapy / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D005833:Genital Neoplasms, Female / Q000000981:diagnostic imaging / Q000532:radiotherapy*; D006801:Humans; D007422:Intestines / Q000000981:diagnostic imaging / Q000293:injuries* / Q000528:radiation effects; D007902:Length of Stay; D011832:Radiation Injuries / Q000000981:diagnostic imaging / Q000209:etiology; D015641:Radiography, Interventional / Q000379:methods; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D001743:Urinary Bladder / Q000000981:diagnostic imaging / Q000293:injuries* / Q000528:radiation effects; D014951:Wounds, Stab / Q000150:complications*