Introduction/Background Brachytherapy is a key step in the treatment of locally advanced cervical cancer (LACC). We aim to report our experience with the use of transrectal ultrasound (TRUS)-guided implantation of brachytherapy applicators.

Methodology A monocentric retrospective study was conducted at the University Hospital of Liège between January 2018 and August 2022, including 141 patients who underwent intracavitary ± interstitial applicator implantation with TRUS guidance for high-dose-rate image-guided adaptive brachytherapy (HDR-IGABT) for a total of 274 procedures. The procedure and the treatment planning with magnetic resonance imaging (MRI) were analyzed. Accuracy of implantation, D95 for high-risk clinical target volume (HR-CTV), organs-at-risk (OAR), dose constraints D2cc (minimal dose of the 2cc with the highest dose), complications and local control were described.

Results The procedure was successfully performed in 273 (99.6%) cases, with only one requiring immediate readjustment due to inappropriate implantation. 266 procedures (97%) were conducted with routine material (ring and tandem applicator +- interstitial needles), and 8 (3%) required adapted material due to intraoperative anatomical difficulties. Based on MRI, we have reported 7 (2.5%) cases of complete uterine perforation through endoluminal applicator and 2 (0.7%) cases of intestinal perforation by interstitial needles. These 9 cases of perforation had no subsequent clinical consequences. The mean D95 HR-CTV was 83.3 Gy, while mean rectum, sigmoid, and bladder D2cc were 60.4, 56.6, and 75.4 Gy, respectively. With a median follow-up of 19.1 months, local control was achieved in 125 patients (88.7%).

Conclusion In this study, all patients with LACC benefited from IGABT, and no procedure withdrawal were necessitated. The use of TRUS intraoperative guidance allows the applicators implantation optimization. This appears to be a reliable and effective method resulting in high local control rates for LACC patients with a low rate of clinically meaningful complications.

Disclosures /