Should uterine tandem applicators ever be placed without ultrasound guidance? no a brief report and review of the literature

William Small*, Jonathan B. Strauss, Catherine S. Hwang, Leeber Cohen, John Lurain

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

29 Scopus citations


Background: Brachytherapy is an integral component of the curative treatment of locally advanced cervical cancer. Optimal applicator placement is associated with improvements in local control and treatment-related toxicity. Uterine perforation by the tandem is common and often undetected by orthogonal radiographs. The role of ultrasound in guiding tandem placement remains controversial. Methods: A 55-year-old woman with International Federation of Gynecology and Obstetrics stage IIB cervix cancer underwent placement of a Fletcher-Suit-Delcos tandem and ovoids applicator. Postoperative computed tomography was used for treatment planning. Results: The applicator appeared to be appropriately placed on clinical exam and orthogonal radiographs. Postoperative computed tomography revealed the tandem had perforated the anterior uterine wall. In a second procedure, the tandem was placed correctly under intraoperative ultrasonography. Conclusions: A review of the literature finds a relatively high rate of uterine perforation of the uterus that is undetected by orthogonal radiographs or clinical examination. Multiple reports support the use of real-time ultrasound for patients with especially challenging anatomy. As this report illustrates, uterine perforation is possible in any patient. Therefore, routine real-time ultrasonography should be considered for all uterine tandem insertions.

Original languageEnglish (US)
Pages (from-to)941-944
Number of pages4
JournalInternational Journal of Gynecological Cancer
Issue number5
StatePublished - Jun 1 2011


  • Brachytherapy
  • Cervical cancer
  • Radiotherapy
  • Ultrasound

ASJC Scopus subject areas

  • Oncology
  • Obstetrics and Gynecology

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