A modified technique for high-dose-rate intracavitary brachytherapy in advanced cancer of the cervix

Purpose To develop a modified technique for high-dose-rate intracavitary brachytherapy in cervical cancer stage IIIb. Methods and materials Cervical carcinoma FIGO Stage III accounts for >60% of all cervical cancers with radiation being the mainstay of treatment for most patients. After external beam radiation therapy (EBRT), the cervix is often flush with the vagina and the shape of the vagina may be conical with its apex at the external os level. All patients receive 2 applications with HDR brachytherapy. At the first application after the placement of the central tandem, only one ovoid is inserted and the other ovoid is replaced by a rubber tube, and the applicator assembly is fixed as usual. The contralateral ovoid is inserted at the subsequent application. Results To date, 21 locally advanced cervical cancer patients have been treated using this technique. In these patients, the mean dose to right and left Point A was 93% (range, 86–100%; median, 93%) and 95% (range, 90–100%; median, 95%), respectively. The variation of doses to the contralateral Point A was 1–14%. The mean dose to the rectal and bladder mucosa was 62% (range, 43–80%; median, 64%) and 80% (range, 50–110%; median, 71%), respectively. Conclusion This modified HDR intracavitary technique may prove an alternative for centers where interstitial brachytherapy for cancer of the cervix is not available.