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ISSN: 1689-832X
Journal of Contemporary Brachytherapy
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1/2014
vol. 6
 
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abstract:

Case report
Cervical brachytherapy technique for locally advanced carcinoma of the cervix in a patient with septate uterus

Christopher S. Platta
,
Charlie Wallace
,
Vinai Gondi
,
Rupak Das
,
Margaret Straub
,
Ahmed Al-Niaimi
,
Glenn Applegate
,
Kristin A. Bradley

J Contemp Brachytherapy 2014; 6, 1: 76–81
DOI: https://doi.org/10.5114/jcb.2014.40768
Online publish date: 2014/02/19
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Purpose: To describe an approach to cervical brachytherapy in a patient with congenital septate uterus and locally advanced cervical carcinoma.

Material and methods: The patient is a 34-year-old female with septate uterus presenting with pelvic pain. Workup demonstrated a stage IIB cervical adenocarcinoma with imaging evidence of an involved right external iliac lymph node. The patient received whole pelvic radiation, with concurrent weekly cisplatin (40 mg/m2), to a dose of 45 Gy in 25 fractions followed by a parametrial boost of 5.4 Gy and an additional nodal boost of 9 Gy.

Results: The patient was initiated on cervical brachytherapy following fraction 23 of pelvic radiation. To conform to her septated uterus, a Rotte-Y tandem was used. Additionally, 2 CT-compatible ovoids were placed in the vaginal apex to enhance dose distribution and coverage of the target volume. Each fraction of brachytherapy was performed with CT-based planning. A high-risk clinical target volume (HR-CTV) and normal structures were defined and constrained per American Brachytherapy Society (ABS) and Groupe Européen de Curiethérapie/European Society for Therapeutic Radiology and Oncology (GEC-ESTRO) guidelines. The brachytherapy dose was 27.5 Gy in 5 fractions of 5.5 Gy each, prescribed to the HR-CTV.

Conclusions: Herein, we report the first documented case of cervical brachytherapy in a patient with septate uterus and locally advanced cervical carcinoma. Using CT-guided planning, in conjunction with the ABS and GEC-ESTRO guidelines, the patient was effectively treated with adapted cervical brachytherapy, meeting criteria for HR-CTV coverage and normal tissue tolerances.
keywords:

brachytherapy, cervical cancer, Rotte-Y tandem, septate uterus

  
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