Rectum separation in patients with cervical cancer for treatment planning in primary chemo-radiation.
OBJECTIVE
To proof feasibility of hydrogel application in patients with advanced cervical cancer undergoing chemo-radiation in order to reduce rectal toxicity from external beam radiation as well as brachytherapy.


METHODS
Under transrectal sonographic guidance five patients with proven cervical cancer underwent hydro gel (20 cc) instillation into the tip of rectovaginal septum adherent to posterior part of the visible cervical tumor. Five days after this procedure all patients underwent T2 weighted transversal and sagittal MRI for brachytherapy planning. MRI protocol included T2 weighted fast spin echo (FSE) imaging in sagittal, coronal and para-axial orientation using an 1.5 Tesla MRI. Separation of anterior rectal wall and cervix was documented.


RESULTS
Hydrogel application was uneventful in all patients and no toxicity was reported. Separation ranged from 7 to 26 mm in width (median 10 mm). The length of the separation varied between 18 and 38 mm (median 32 mm). In all patients displacement was seen in the posterior vaginal fornix, and/or at the deepest part of uterine cervix depending on the extension of the cul-de-sac in correlation to the posterior wall of the uterus. In patients with bulky tumor and/or deep (vaginal) extend of peritoneal cavity tumour was seen mainly cranial from the rectovaginal space and therefore above the hydrogeI application. Only in the extra-peritoneal (lower) part of the cervix a good separation could be achieved between the rectum and cervix.


CONCLUSIONS
Hydrgel instillation in patients with cervial cancer undergoing chemoradiation is safe and feasible. Because of the loose tissue of the cul-de-sac and its intra- and extraperitoneal part, hydrogel instillation of 20 cc did not result in a sufficient separation of the cervix from anterior wall.
Department of Radiooncology, Charité University Medicine, Augustenburger Platz 1, 13353, Berlin, Germany. simone.marnitz@charite.de
Simone
S
Marnitz
Volker
V
Budach
Friederike
F
Weisser
Elena
E
Burova
Bernhard
B
Gebauer
Filiberto Guiseppe
FG
Vercellino
Christhardt
C
Köhler
D000328:Adult; D000368:Aged; D001918:Brachytherapy / Q000379:methods; D002277:Carcinoma / Q000628:therapy*; D059248:Chemoradiotherapy / Q000379:methods; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D020136:Hydrogel, Polyethylene Glycol Dimethacrylate / Q000008:administration & dosage / Q000494:pharmacology; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D059351:Organ Sparing Treatments / Q000379:methods*; D058958:Organs at Risk / Q000528:radiation effects; D010865:Pilot Projects; D011880:Radiotherapy Planning, Computer-Assisted; D061089:Radiotherapy, Image-Guided / Q000379:methods; D012007:Rectum / Q000187:drug effects / Q000528:radiation effects; D002583:Uterine Cervical Neoplasms / Q000628:therapy*
D020136:Hydrogel, Polyethylene Glycol Dimethacrylate