Introduction
Intracavitary brachytherapy (ICBT) is a part of standard treatment for loco-regionally advanced cervical cancers. ICBT requires a tandem applicator insertion through cervical canal into uterine cavity. Accurate placement through cervical canal, which is distorted by cancer, is crucial to successful treatment. The objective of this study was to investigate actual complication rate of a Smit sleeve insertion performed by experienced gynecologists in a tertiary referral center.

Material and methods
Clinical data of 328 patients with cervical cancer treated using ICBT, between January 2013 and August 2019, were retrospectively evaluated. Predisposing factors that could have increased the risk of uterine perforation were recorded. Pre-operative ultrasound was carried out for visualization of uterine curvature and selection of an appropriate Smith sleeve length. All applications were performed by a gynecologic oncology fellow or an expert gynecologist.

Results
317 patients were suitable for analysis. Only one (0.3%) applicator placement resulted in uterine perforation. In two patients, Smit sleeve dislocated after first brachytherapy and reinserted. Adequate applicator placement was achieved, and treatment was completed as planned in 316 cases.

Conclusions
A cervical sleeve technic, which reduced the need for multiple insertions and placement of this instrument by an expert gynecologist minimize the risk of complication relative to historical controls.



中文翻译：

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宫颈癌腔内近距离放射治疗中子宫穿孔的预防

简介
腔内近距离放射治疗 (ICBT) 是局部晚期宫颈癌标准治疗的一部分。ICBT 需要串联施药器通过宫颈管插入子宫腔。通过被癌症扭曲的宫颈管准确放置是成功治疗的关键。本研究的目的是调查由经验丰富的妇科医生在三级转诊中心进行的 Smit 套管插入的实际并发症发生率。

材料与方法
回顾性评估了 2013 年 1 月至 2019 年 8 月期间使用 ICBT 治疗的 328 例宫颈癌患者的临床数据。记录了可能增加子宫穿孔风险的诱发因素。进行术前超声检查以观察子宫曲率并选择合适的史密斯袖长度。所有申请均由妇科肿瘤学研究员或妇科专家执行。

结果
317例患者适合分析。只有一个 (0.3%) 的涂药器放置导致子宫穿孔。在两名患者中，Smit 套管在第一次近距离放射治疗后脱臼并重新插入。316 例完成了充分的涂药器放置，并按计划完成了治疗。

结论
一种宫颈套管技术，减少了专家妇科医生多次插入和放置该仪器的需要，从而将并发症的风险降至最低，相对于历史对照而言。