477 Hysteroscopy significantly increases the proportion of patients having successful brachytherapy insertion in advanced cervical cancer

Introduction/Background Current national guidance recommends external beam radiotherapy, followed by intra-uterine brachytherapy, as standard treatment for locally advanced cervical cancer. Intra-uterine insertion of brachytherapy applicators into a recently irradiated uterus can, however, be challenging – carrying significant risk of perforation and associated sequelae. To mitigate such risk, we have developed a novel technique – replacing the traditional approach of blind placement with instead performing applicator insertion under direct hysteroscopic vision. Methodology All cases of intra-uterine brachytherapy undertaken for the treatment of cervical cancer in a large UK cancer centre between 2015–2022 were identified from a Trust operative database – and intra-procedural details reviewed, providing early comparison of blind versus hysteroscopic techniques. Results N=150. 131/150 cases were performed by oncologists alone. 122 (81%) of these were successful and 2% resulted in perforation. In 19 cases (13%), a gynaecological oncologist was called to assist and 15 (79%) were successful. These insertions would have otherwise been abandoned. The gynaecologist employed hysteroscopy in 9 cases and 8 (89%) were successful, with no perforations. Conclusion Multi-disciplinary team working between oncology and gynaecology promotes more effective and safer insertion of intra-uterine brachytherapy applicators in this challenging patient cohort. In our limited series, involvement of gynaecology improved success rates of the procedure by 10% (p= 0.01) – enabling completion of treatment in patients for whom the attempted procedure would have otherwise been abandoned. With the increasing availability of portable and disposable hysteroscopic equipment, use of such as standard appears viable. We propose a trial to fully evaluate this proposed technique. Disclosures None