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Master Thesis

Échec de cathétérisation cervicale en curiethérapie utéro-vaginale : facteurs de risque, complications et valeur pronostique

Abstract : Introduction: correct insertion of uterine tandem in intracavitary brachytherapy may be challenging because of cervical distortion induced by the tumor or post-therapeutic fibrosis. Patients and methods : all consecutive patients addressed for a gynecological malignancy requiring an intracavitary brachytherapy at Centre François Baclesse (Caen, France) from 2013 to 2017 were included. Results: 184 patients were included, accounting for 325 procedures. 101 implants were sub-optimal (14.5% insertion failures, 10.8% sub-serosal insertion and 5.8% uterine perforation on post-implant CT-scan), for 88 patients (48% of patients). Risk factors were age, uterine retroversion and myometrium invasion. Such an event was associated with decreased local control (p limit of significance: OR=1.95 [0.96 – 3.97], p=0.059) but without any impact on overall survival. Brachytherapy completion and total dose to the tumor were significantly associated with local relapse-free survival. Discussion: one can see in our cohort that insertion failure or uterine perforation as such weren’t associated with decreased local control. Nevertheless, local relapse-free survival was significantly worse after an abortion of brachytherapy procedure due to insertion difficulties if patients were addressed for an external radiotherapy boost, because of suboptimal doses delivered to central pelvis. Conclusion: intra-uterine tandem insertion failures are a genuine issue in intracavity brachytherapy. Real-time ultrasound guidance could be useful to reduce uterine perforation rates.
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Master Thesis
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Submitted on : Wednesday, April 17, 2019 - 3:14:13 PM
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Manon Kissel. Échec de cathétérisation cervicale en curiethérapie utéro-vaginale : facteurs de risque, complications et valeur pronostique. Médecine humaine et pathologie. 2018. ⟨dumas-02102623⟩



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