Brachy in Tricky Situations: A Trans Perineal Interstitial Implant in a Case of Carcinoma Cervix Co-occurring with Uterine Didelphys

Abstract

A 43 year old lady with an uterine anomaly was diagnosed to have FIGO stage II B -HPV associated poorly differentiated cervix adenocarcinoma. She has a bicornuate unicolis uterus -class U3b, subclass C0,  subclass V0 as per ESHRE/ESGE classification system of female genital anomalies.Post 50 Gy of chemo radiotherapy to the pelvis, her peculiar anatomical configuration posed a challenge for delivering HDR brachytherapy boost. We decided to proceed with a transperineal interstitial implant & achieved a total EqD2 of 80 Gy to HRCTV. The target coverage was achieved with 11 needles held up by Syed Neblett template guided by transrectal ultrasound [TRUS]. Interstitial implant using TRUS is a safe technique in a resource limited setting allowing an image guided approach for brachytherapy. Patient is on follow up since 2 years with no evidence of disease.