Study Finds Brachytherapy can Continue Safely in Cervical Cancer Patients Following Uterine Perforation

Brachytherapy can safely continue in cervical cancer patients following uterine perforation without delay or antibiotics, according to the results of a new study. In the  study, researchers sought to determine the incidence of uterine perforations, review associated complications, and propose guidelines for the management of perforations after brachytherapy.

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.”

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.