PROSTAGLANDIN-INDUCED CERVICAL DILATATION PRIOR TO INTRACAVITARY RADIOTHERAPY FOR CARCINOMA OF THE CERVIX - A PILOT-STUDY

The efficacy of 1 mg 16,16-dimethyl-trans-Delta 2 prostaglandin E1 (Ge meprost) pessaries in achieving cervical dilatation prior to intracavi tary brachytherapy was investigated in 16 post-menopausal women with c ervical carcinoma. All had received external beam pelvic radiotherapy in the preceding 6 weeks. Four patients were nulliparous and 12 multip arous (mean parity 1.9). FIGO stages were IB (2), IIA (4), IIB (5), II IA (1), IIIB (3), IVB (1). The cervical os was assessed before pessary insertion and again at the time of intracavitary insertion. The os wa s closed in 100% (16/16) of patients before and open in 75% (12/16) of patients after pessary insertion. The maximum size of Hegar dilator p assed without mechanical dila-tation was recorded. Mean cervical dilat ation was 4.25 H (5.5 H in those with a clinical response). The 12 res ponding patients had rapid and uncomplicated procedures with no need f or additional mechanical dilatation. Both patients in whom attempted m echanical dilatation failed had had previous conization of the cervix. The following mild side-effects were reported: abdominal cramps (43.8 %), headache (12.5%) and fever (6.3%). These data support the use of G emeprost pessaries to achieve cervical dilatation in post-menopausal w omen undergoing intracavitary brachy-therapy following external beam r adiotherapy.