The choice of a brachytherapy applicator in patients with cervical cancer in whom contraindication

Abstract

We compared dose distributions of the tandem and ring with different commercial available applicators – tandem and ovoids, tandem and cylinder and tandem and ring to verify if this is a suitable replacement in specific clinical situations. The knowledge of the benefits and limitations of the applicators is important in deciding about the clinical applicability. We have limited our research to patients treated for cervical cancer in whom absence (asymmetry) of vaginal fornices or a narrow proximal vagina were detected. These patients have suboptimal applicator geometry with tandem and ovoids applications and have usually undergone tandem and cylinder insertions, which are associated with a higher risk of rectal complications. Point doses to the bladder, rectum, point B and vaginal wall were calculated and compared for different applicators in the same patients. Our experience has shown that the tandem and ring applicator provides a better dose distribution particularly when compared with that tandem and cylindral applications. The ease of insertion and a predictable geometry make this arrangement an applicator of choice in clinical conditions and make it possible to decrease the complication rate.