Role of Ultrasound-Guided Brachytherapy Applicator Placement in Cancer Cervix

  • Subbiah ShanmugamEmail author
  • S. Saravanan
  • Sujay Susikar
  • Hussain Syed Afroze
  • Samanth Kumar Mendu
Original Article



Intracavitary brachytherapy is a very important part in the treatment of locally advanced cancer cervix by radiation. But this procedure is not without difficulties. Many times, the radiotherapists find difficulties in identifying the external os and end up placing the brachytherapy applicator out of the endometrial cavity leading to altered dose exposure to the lesion proper and surrounding organs at risk. Ultrasound (USG) is a good helping tool in such instances. This study is to describe the role and benefits of intraoperative sonographic guidance in intracavitary brachytherapy applicator placement in cervical cancer.


Sixty patients who were to receive brachytherapy for locally advanced cancer cervix routinely with or without USG guidance were randomized into a study arm (USG) and control arm (non-USG) with 30 patients in each group. They were assessed with respect to tumor coverage, local toxicity profile, duration of procedure, complication rates and overall satisfactory levels of treating doctor.


The tumor coverage was significantly better when ultrasound-assisted placement of applicator was done (z = 2.653, p value = 0.004), and bladder toxicity profile was better (z = 2.505, p value = 0.006). There were few complications and better satisfactory levels of treating doctor when the applicator placement was done using ultrasound.


Real-time USG provided safe and effective guidance for intracavitary brachytherapy applicator placement for treatment of cervical cancer with decreased rates of complications and misplacement of applicator.


Cancer cervix Fletcher’s applicator Brachytherapy Ultrasound 


Author’s Contributions

SSh was involved in protocol/project development, data analysis, manuscript writing and editing. SSa, SSu and SAH were involved in data analysis and manuscript editing. SK contributed to data collection and management.


This study was not funded by any agency.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

This study has been taken up after proper institutional ethical clearance, and the data have been harvested from the hospital records of the patients undergoing routine brachytherapy applicator insertion with or without USG guidance, but have been randomized only for the sake of study.

Informed Consent

Proper informed consent was taken from all patients in study, and none of the patient details have been disclosed at any instance.


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Copyright information

© Association of Gynecologic Oncologists of India 2019

Authors and Affiliations

  1. 1.Department of Surgical OncologyRoyapettah Govt. HospitalRoyapettah, ChennaiIndia
  2. 2.Department of Radiation OncologyRoyapettah Govt. HospitalRoyapettah, ChennaiIndia

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