Potential decreased morbidity of interstitial brachytherapy for gynecologic malignancies using laparoscopy: A pilot study

Objectives. This pilot study was designed to prospectively assess whether t he addition of laparoscopy at the time of interstitial brachytherapy is saf e, provides verification and/or guidance of needle placement, and results i n a reduction of treatment-related morbidity. Methods. Between 7/93 and 2/97 15 consecutive eligible patients were entere d into this study. All patients received external pelvic radiation to a dos e range between 45 and 61.20 Gy using 1.8-Gy fractions. In each patient the minimum prescribed dose for the brachytherapy portion was 20 Gy. Minimum c umulative doses to sites of gross disease ranged from 71.8 to 115.3 Gy. A S yed-Neblett afterloading perineal template was used in all the procedures. Laparoscopy using established guidelines was performed during placement of interstitial needles. During template placement, verification of interstiti al needles on laparoscopy and any subsequent changes or needle rearrangemen t were noted. Results. No acute radiation toxicity greater than Grade 2 was noted during the external beam portion of treatment, and no perioperative complications were encountered. These needles were withdrawn under laparoscopic guidance to just below the peritoneal reflection, avoiding proximity to the bowel an d improving tumor coverage. Median follow-up time was 26 months. No late ra diation morbidity greater than Grade 2 nor any laparoscopic-related complic ations were noted. To date, one patient has died of disease; six are alive with disease; and eight are alive free of disease with a mean disease-free survival of 17.3 months. Conclusion. Laparoscopy at the time of interstitial brachytherapy appears t o be safe. No radiation toxicity greater than Grade 2 has developed. No per ioperative complications were seen with the addition of laparoscopy. The ad dition of laparoscopy to the placement of transperineal interstitial implan ts impacted needle arrangement and/or loading of sources in 50% of patients . (C) 1999 Academic Press.