A new study finds that brachytherapy, a common procedure that delivers radiation directly to cancer cells, may continue safely, potentially without delay or antibiotics, in cervical cancer patients following uterine perforation.
According to the World Health Organization, cervical cancer is the fourth most common cancer in women. Treatment for cervical cancer often involves brachytherapy combined with daily radiation therapy. Brachytherapy delivers radiation directly to cancer cells through a tube placed within the uterus.
"At times this tube can pierce the uterus and lead to a perforation," said William Small, Jr., MD, lead study author and professor and chair of radiation oncology at Loyola Medicine and Loyola University Chicago Stritch School of Medicine. "Many clinicians will not proceed with the treatment when a perforation occurs. This can lead to delays in therapy that may increase the recurrence risk and potentially lead to worse survival rates."
In the new study, "Uterine perforation during brachytherapy for cervical cancer: Complications, outcomes, and best practices for forward treatment planning and management," researchers sought to determine the incidence of uterine perforations, review associated complications, and propose guidelines for the management of perforations after brachytherapy.
Researchers conducted a retrospective review of 123 patients with cervical cancer who received single or multiple high-dose therapy implants between April 2006 and May 2017 at Loyola University Medical Center. Patient CT and MRI images were reviewed to identify uterine perforation caused by the tandem, the tube placed within the uterus to deliver radiation. Acute and long-term complications during and after treatment were scored using the National Cancer Institute's Common Terminology Criteria for Adverse Events Version 4.0.
Perforations were observed in 22 patients (17.9%) and 31 (6.4%) of the 482 total implants. Three patients developed acute infectious complications; two of these patients had mild urinary tract infections, which resolved without complications or treatment delays. The third patient had a complex perforation, received antibiotics and required a one-week treatment delay. Of the different categories of adverse events, only the rate of acute infectious complications among those with perforations (13.6%) versus those without perforations (3%) was significant.
"Our study notes that when perforation occurs, treatment can proceed without delay, potentially improving survival," said Dr. Small, who is also director of Loyola's Cardinal Bernardin Cancer Center. Treatment also may proceed without prophylactic antibiotics.
"If confirmed with additional data, the findings could lead to a new standard of care with the potential to save significant lives around the world," said Dr. Small.
The study first appeared online March 17, 2021 in the journal Brachytherapy.
About Stritch School of Medicine
Founded in 1909, Loyola University Chicago's Stritch School of Medicine is one of only four Catholic-affiliated medical schools in the nation. This fall, Stritch welcomed 170 students from 75 colleges to its 2024 class out of more than 14,000 applicants. With its academic medical center partner Loyola Medicine, Stritch clinical and basic science faculty help train the next generation of physicians and scientists. Learn more about Stritch, "like" us on facebook.com/StritchMedicine, or follow us on Twitter @LoyolaHSD.
About Loyola Medicine
Loyola Medicine, a member of Trinity Health, is a nationally ranked academic, quaternary care system based in Chicago's western suburbs. The three-hospital system includes Loyola University Medical Center, Gottlieb Memorial Hospital and MacNeal Hospital, as well as convenient locations offering primary care, specialty care and immediate care services from more than 1,800 physicians throughout Cook, Will and DuPage counties. Loyola is a 547-licensed-bed hospital in Maywood that includes the William G. & Mary A. Ryan Center for Heart & Vascular Medicine, the Cardinal Bernardin Cancer Center, a Level 1 trauma center, Illinois's largest burn center, a certified comprehensive stroke center and a children's hospital. Loyola also trains the next generation of caregivers through its academic affiliation with Loyola University Chicago's Stritch School of Medicine and the Marcella Niehoff School of Nursing. Gottlieb is a 247-licensed-bed community hospital in Melrose Park with the newly renovated Judd A. Weinberg Emergency Department, the Loyola Center for Metabolic Surgery and Bariatric Care and the Loyola Cancer Care & Research facility at the Marjorie G. Weinberg Cancer Center. MacNeal is a 374-licensed-bed teaching hospital in Berwyn with advanced medical, surgical and psychiatric services, acute rehabilitation, an inpatient skilled nursing facility and a 68-bed behavioral health program and community clinics. Loyola Medical Group, a team of primary and specialty care physicians, offers care at over 15 Chicago-area locations. For more information, visit loyolamedicine.org. You can also follow Loyola Medicine on LinkedIn, Facebook or Twitter.
About Trinity Health
Trinity Health is one of the largest multi-institutional Catholic health care delivery systems in the nation, serving diverse communities that include more than 30 million people across 22 states. Trinity Health includes 92 hospitals, as well as 100 continuing care locations that include PACE programs, senior living facilities, and home care and hospice services. Its continuing care programs provide nearly 2.5 million visits annually. Based in Livonia, Mich., and with annual operating revenues of $18.8 billion and assets of $30.5 billion, the organization returns $1.3 billion to its communities annually in the form of charity care and other community benefit programs. Trinity Health employs about 123,000 colleagues, including 6,800 employed physicians and clinicians. Committed to those who are poor and underserved in its communities, Trinity Health is known for its focus on the country's aging population. As a single, unified ministry, the organization is the innovator of Senior Emergency Departments, the largest not-for-profit provider of home health care services -- ranked by number of visits -- in the nation, as well as the nation's leading provider of PACE (Program of All Inclusive Care for the Elderly) based on the number of available programs. For more information, visit trinity-health.org. You can also follow Trinity Health on LinkedIn, Facebook or Twitter.