title: Uterine perforation during 3-dimensional image-guided brachytherapy in patients with cervical cancer: Baskent University experience.
abstract: OBJECTIVE
  This study aimed to determine the incidence and characteristics of uterine perforation at our department using 3-dimensional computed tomography (CT)-based brachytherapy (BRT). The characteristics of the patients presenting with perforation and impact of the perforation on the treatment course were also analyzed.
  
  
  METHODS
  The clinical and radiologic data of 200 patients with biopsy-proven cervical cancer treated using CT-based BRT were retrospectively evaluated. All patients had undergone tandem-based intracavitary BRT, and 67 patients had undergone magnetic resonance imaging (MRI) before BRT.
  
  
  RESULTS
  Of the 200 patients, 17 (8.5%) had uterine perforation. Of the 626 applications with CT images, 30 (4.8%) resulted in uterine perforation. The median age of patients with perforation was higher (68 years; range, 44-89 years) than that of the patients without perforation (59 years; range, 21-87 years), and the mean (SD) tumor size at diagnosis was larger in patients with perforation (7.0 [1.5] cm) than in patients without perforation (5.0 [1.5] cm). The most frequent perforation site was the posterior uterine wall (8 patients), followed by the fundus (5 patients) and anterior wall (4 patients). Of the 7 patients with a retroverted uterus, 4 had uterine perforation during BRT. In 67 patients with MRI delivered before BRT, only 3 (4%) had uterine perforation, and 2 of the 3 patients with uterine perforation had a retroverted uterus. However, of the 133 patients with no MRI evaluation before BRT, 14 (11%) had uterine perforation. No life-threatening complications or signs of intraperitoneal tumor cell seeding were observed.
  
  
  CONCLUSIONS
  Older age, larger tumors, a retroverted uterus, and a stenotic cervical os were all predisposing factors for uterine perforation during BRT. Preoperative MRI is a feasible and safe method to decrease the risks of uterine perforation and could be used preoperatively in centers where intraoperative ultrasonography is not used in routine practice.
authors.affiliation: Departments of *Radiation Oncology, Baskent University Faculty of Medicine, Adana; and †Radiology, Baskent University Faculty of Medicine, Ankara, Turkey.
authors.forename: Cem
authors.initials: C
authors.lastname: Onal
authors.forename: Ozan Cem
authors.initials: OC
authors.lastname: Guler
authors.forename: Yemliha
authors.initials: Y
authors.lastname: Dolek
authors.forename: Gurcan
authors.initials: G
authors.lastname: Erbay
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy; D002277:Carcinoma / Q000532:radiotherapy*; D005260:Female; D006801:Humans; D007049:Iatrogenic Disease; D021621:Imaging, Three-Dimensional; D008875:Middle Aged; D015641:Radiography, Interventional / Q000009:adverse effects*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D014421:Turkey; D002583:Uterine Cervical Neoplasms / Q000532:radiotherapy*; D014595:Uterine Perforation / Q000209:etiology*