Brachytherapy can be continued after uterine perforation in patients with cervical cancer

A new study found that brachytherapy, a common technique that provides cancer cells directly with radiation, can be safely continued in patients with cervical cancer after a uterine perforation, possibly without delay or with antibiotics.

According to the World Health Organization, cervical cancer is the fourth most common cancer in women. Treatment for cervical cancer often includes brachytherapy combined with daily radiation therapy. Brachytherapy delivers radiation directly to cancer cells through a tube in the uterus.

“Sometimes this tube can pierce the uterus and perforate it,” said William Small, Jr., lead study author and professor and chair of radiation oncology at Loyola Medicine and Chicago Stritch School of Medicine at Loyola University. “Many doctors will not continue treatment if a perforation occurs. This can lead to delays in therapy, which can increase the risk of recurrence and potentially lead to poorer survival rates.”

In the new study, “Uterine perforation during brachytherapy for cervical cancer: complications, results, and best practices for predictive treatment planning and management,” researchers sought to determine the incidence of uterine perforations, review associated complications, and guidelines for treatment for cervical cancer propose perforations after brachytherapy.

The researchers performed a retrospective review of 123 cervical cancer patients who received single or multiple high-dose therapeutic implants between April 2006 and May 2017 at Loyola University Medical Center. The patients’ CT and MRI images were reviewed to identify the uterine perforation caused by the tandem, with the tube being inserted into the uterus to deliver radiation. Acute and long-term complications during and after treatment were assessed 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 a total of 482 implants. Three patients developed acute infectious complications; Two of these patients had mild urinary tract infections that got better without complications or treatment delays. The third patient had a complex perforation, was on antibiotics, and required a one-week treatment delay. Of the different categories of adverse events, only the rate of acute infectious complications in patients with perforations (13.6%) compared to patients without perforations (3%) was significant.

“Our study finds that if there is perforation, treatment can be resumed immediately, which may improve survival,” said Dr. Small, who is also the director of the Cardinal Bernardin Cancer Center in Loyola. Treatment can also be done without prophylactic antibiotics.

“If this is confirmed by additional data, the results could lead to a new standard of care that has the potential to save significant lives around the world,” said Dr. Small.

The study first appeared online on March 17, 2021 in the journal Brachytherapy.


About the Stritch School of Medicine

Loyola University Chicago’s Stritch School of Medicine was founded in 1909 and is one of only four Catholic medical schools in the country. This fall, Stritch welcomed 170 students from 75 colleges in its 2024 class from more than 14,000 applicants. With its partner at the Academic Medical Center, Loyola Medicine, Stritch’s clinical and basic science faculty is helping educate the next generation of doctors and scientists. To learn more about Stritch, like us on or follow us on Twitter @LoyolaHSD.

About Loyola Medicine

Loyola Medicine, a member of Trinity Health, is a nationally recognized academic quaternary care system based in the western suburbs of Chicago. The three-hospital system includes Loyola University Medical Center, Gottlieb Memorial Hospital, and MacNeal Hospital, as well as convenient locations that provide primary, special, and immediate care from more than 1,800 doctors in Cook, Will, and DuPage counties. Loyola is a 547 licensed bed hospital in Maywood that is certified by the William G. & Mary A. Ryan Center for Cardiovascular Medicine, the Cardinal Bernardin Cancer Center, a Level 1 trauma center, the largest burn center in Illinois comprehensive stroke include center and a children’s hospital. Loyola also trains the next generation of caregivers through its academic affiliation with the Stritch School of Medicine at Loyola University Chicago and the Marcella Niehoff School of Nursing. Gottlieb is a 247 licensed bed hospital in Melrose Park with Judd A. Weinberg’s newly renovated Emergency Room, Loyola Metabolic Surgery and Bariatric Care Center, and Loyola Cancer Care & Research facility at 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 qualified care facility and a behavioral health program with 68 beds and community clinics. The Loyola Medical Group, a team of general practitioners and specialists, provides care in over 15 locations in the Chicago area. More information is available at 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 systems in the country, serving diverse communities that include more than 30 million people in 22 states. Trinity Health has 92 hospitals and 100 ongoing care locations that include PACE programs, facilities for the elderly, and home care and hospice services. The ongoing nursing programs offer nearly 2.5 million visits annually. Based in Livonia, Michigan, with $ 18.8 billion in annual operating revenues and $ 30.5 billion in net worth, the organization gives $ 1.3 billion annually to its communities through charity programs and other nonprofit activities Programs back. Trinity Health has approximately 123,000 employees, including 6,800 salaried doctors and clinicians. Trinity Health is committed to serving the poor and needy in its communities and is known for its focus on the country’s aging population. As a single unified ministry, the organization is the innovator of the Senior Emergency Departments, the nation’s largest nonprofit provider of home health services by number of visits, and the nation’s leading provider of PACE (program of all-inclusive care for elderly) based on the number of programs available. More information is available at You can also follow Trinity Health on LinkedIn, Facebook, or Twitter.

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