# The Utility of a Y-tandem Applicator in a Patient With Stage IVA Locally Advanced Cervical Cancer in the Setting of a Bicornuate Uterus

## TL;DR

A patient with a rare uterine shape and advanced cervical cancer was successfully treated with a specialized Y-tandem applicator during radiation therapy.

## Contribution

Demonstrates the use of a Y-tandem applicator to overcome challenges in brachytherapy for a bicornuate uterus with cervical cancer.

## Key findings

- The Y-tandem applicator enabled effective brachytherapy in a patient with a bicornuate uterus.
- The patient showed no signs of locoregional disease for six months after treatment.
- The patient ultimately died from pulmonary metastases, not local recurrence.

## Abstract

We report a case of a patient with a bicornuate unicollis uterus who developed International Federation of Gynecology and Obstetrics (FIGO) Stage IVA adenocarcinoma of the cervix invading the bladder neck, proximal urethra, upper vagina, and parametrium. The patient was treated with definitive chemoradiation therapy, including external beam radiation therapy (EBRT), brachytherapy, and weekly cisplatin infusions. Our patient required an interstitial brachytherapy boost, which was challenging to deliver due to her congenital anatomic anomaly. We were able to utilize the Syed-Neblett template to treat bilateral uteri using the holes in the template base as the entry points for brachytherapy catheters. In addition, a Y-tandem applicator was used to achieve the required angulation at the level of the cervix to reach both uterine walls. After completing both EBRT and brachytherapy, she was free of signs of disease on a follow-up visit approximately two months after treatment. The patient did not have any signs of locoregional disease six months later when she ultimately expired due to widespread pulmonary metastases.