Transrectal ultrasound-guided optimization of needle insertion for interstitial brachytherapy in the treatment of vaginal stump recurrence of cervical cancer

To evaluate the clinical value of real‑time transrectal ultrasound (TRUS) guidance in interstitial brachytherapy (ISBT) for patients with vaginal stump recurrence after hysterectomy for cervical cancer. This retrospective, non-randomized study included 32 patients receiving ISBT who were categorized into two groups: Group A (TRUS‑guided ISBT, n=16) and Group B (non‑TRUS‑guided ISBT, n=16). A total of 39 procedures were performed in Group A, involving 137 implanted interstitial needles, while Group B underwent 37 procedures with 145 needles implanted. Postoperative computed tomography (CT) was used to evaluate vaginal stump unintended perforation rates, penetration depth, and rectal or bladder perforation. A total of 282 interstitial needles were implanted across both groups.The vaginal stump unintended perforation rate in Group A was significantly lower than in Group B (16.06% vs. 40.69%, P < 0.05). Furthermore, In Group A, 22 (22/137) needles perforated the vaginal stump, with a mean penetration depth of 3.36 ± 1.32 mm, while in Group B, 59 (59/145) needles perforated the vaginal stump, with a mean penetration depth of 5.29 ± 3.51 mm; The mean penetration depth in Group A was significantly lower than that in Group B (t = -3.576; P < 0.05). Additionally, the incidence of rectal and bladder perforation was significantly lower in Group A compared to Group B (2.92% vs. 12.41%, P < 0.05). The use of TRUS guidance in ISBT for vaginal stump recurrence significantly reduces the incidence and depth of unintended perforations and is anticipated to lower the risk of fistula formation. These findings support TRUS as a promising technique for enhancing the safety of ISBT in patients with recurrent cervical cancer.