TY - JOUR T1 - Should Uterine Tandem Applicators Ever Be Placed Without Ultrasound Guidance? No: A Brief Report and Review of the Literature JF - International Journal of Gynecologic Cancer JO - Int J Gynecol Cancer SP - 941 LP - 944 DO - 10.1097/IGC.0b013e31821bca53 VL - 21 IS - 5 AU - William Small AU - Jonathan B. Strauss AU - Catherine S. Hwang AU - Leeber Cohen AU - John Lurain Y1 - 2011/07/01 UR - http://ijgc.bmj.com/content/21/5/941.abstract N2 - Background: Brachytherapy is an integral component of the curative treatment of locally advanced cervical cancer. Optimal applicator placement is associated with improvements in local control and treatment-related toxicity. Uterine perforation by the tandem is common and often undetected by orthogonal radiographs. The role of ultrasound in guiding tandem placement remains controversial.Methods: A 55-year-old woman with International Federation of Gynecology and Obstetrics stage IIB cervix cancer underwent placement of a Fletcher-Suit-Delcos tandem and ovoids applicator. Postoperative computed tomography was used for treatment planning.Results: The applicator appeared to be appropriately placed on clinical exam and orthogonal radiographs. Postoperative computed tomography revealed the tandem had perforated the anterior uterine wall. In a second procedure, the tandem was placed correctly under intraoperative ultrasonography.Conclusions: A review of the literature finds a relatively high rate of uterine perforation of the uterus that is undetected by orthogonal radiographs or clinical examination. Multiple reports support the use of real-time ultrasound for patients with especially challenging anatomy. As this report illustrates, uterine perforation is possible in any patient. Therefore, routine real-time ultrasonography should be considered for all uterine tandem insertions. ER -