An indwelling intrauterine tube to facilitate intracavitary radiotherapy of carcinoma of the cervix

Smit, Ben; Toit, J. P. Du; Groenewald, Wilhelm

doi:10.1259/0007-1285-62-733-68

Cited by 28 publications

(12 citation statements)

References 7 publications

(6 reference statements)

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“…During or after the fifth week of EBRT, each patient is EUA, and her response is categorized as either complete or partial. A smit sleeve is then placed in the cervical os, and HDR brachytherapy is planned with a standard plan, straight source to a total dose of 20 to 26 Gy in 4 to 5 fractions 13. The dose is delivered on a Varian GammaMed machine (Varian Medical Systems, Palo Alto, Calif).…”

Section: Methodsmentioning

confidence: 99%

“…A smit sleeve is then placed in the cervical os, and HDR brachytherapy is planned with a standard plan, straight source to a total dose of 20 to 26 Gy in 4 to 5 fractions. 13 The dose is delivered on a Varian Gam-maMed machine (Varian Medical Systems, Palo Alto, Calif). Overall treatment time recommended is 55 days or less as per the American Brachytherapy Society.…”

Section: Treatmentmentioning

confidence: 99%

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Completion of and early response to chemoradiation among human immunodeficiency virus (HIV)‐positive and HIV‐negative patients with locally advanced cervical carcinoma in South Africa

Simonds

Wright

Toit

et al. 2011

Cancer

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Background Very few published studies have dealt with the management of locally advanced cervix carcinoma among HIV-positive patients. The objective was to compare the clinical characteristics, radiation and chemotherapy treatments, and outcomes in a cohort of HIV-positive and –negative women with cervical cancer. Methods We reviewed the charts of 59 HIV-positive patients and 324 HIV-negative patients with stage IBi – IIIB cervical carcinoma, who received radiation therapy. We compared demographic and clinical characteristics at diagnosis and radiation dose, chemotherapy cycles, and response at time of brachytherapy and six-week follow-up. We developed logistic regression models of response to treatment. Results 49 (88.1%) of the HIV-positive patients but only 213 (65.7%) HIV-negative patients presented with stage IIIB disease (p=0.009). 47 (79.7%) HIV-positive patients and 291(89.8%) HIV-negative patients completed the equivalent radiation dose of 68Gy EBRT and HDR brachytherapy (p=0.03). Of the 333 patients who commenced concurrent chemotherapy, 26 (53.1%) HIV-positive patients and 212 (74.6%) HIV-negative patients completed four or more weekly cycles of platinum-based treatment. Follow-up was censured at six weeks. In models that included age, stage, HIV status, and treatment, poor response at six weeks was associated only with having stage IIIB disease (OR=2.39, 95%CI 1.45 – 3.96) and receiving less than 68Gy EQD2 radiation (OR=3.14, 95%CI 1.24 – 7.94). Conclusions HIV-positive patients fared worse than HIV-negative patients due to later presentation and a decreased likelihood of completion of treatment. Our findings emphasise the importance of completing irradiation therapy. Further studies will address the association of these variables with survival.

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Section: Methodsmentioning

confidence: 99%

Section: Treatmentmentioning

confidence: 99%

Completion of and early response to chemoradiation among human immunodeficiency virus (HIV)‐positive and HIV‐negative patients with locally advanced cervical carcinoma in South Africa

Simonds

Wright

Toit

et al. 2011

Cancer

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“…It is a disposable, silicone-based indwelling intrauterine tube that can be used during brachytherapy treatment for cervical cancer to allow for easier insertion of the tandem [1]. The tube has a flange on the distal side, which acts as a stopper during tandem insertion [1,2,3,4]. The cannula of the Smit sleeve marginally increases the radius around the tandem, while the base of the Smit sleeve, which lies distal to the external cervical os, displaces the ovoids distally.…”

Section: Purposementioning

confidence: 99%

Dosimetric effects of the Smit sleeve on high-dose-rate brachytherapy tandem and ovoids plans for patients with locally advanced cervical cancer

Mehta

Farnia

Zerda

et al. 2019

jcb

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Purpose: Smit sleeves are used to facilitate insertion of the intrauterine tandem during brachytherapy for cervical cancer. When a tandem and ovoids system is used the base of the Smit sleeve displaces the ovoids distally. The dosimetric impact of this displacement is not known. Herein we performed a dosimetric analysis to quantify this impact on the integral dose and dose delivered to the organs at risk (OARs). Material and methods: Eleven high-dose-rate brachytherapy plans in which a Smit sleeve was used with a tandem and ovoids were reviewed. A second set of plans was generated modifying the position of the ovoids to simulate absence of the Smit sleeve. The high-risk clinical tumor volume (HR-CTV) dose coverage was maintained the same for both sets of plans by appropriately rescaling the dwell times of the simulated plan. The mean integral dose, D 2cc to the OARs (bladder, bowel, sigmoid and rectum) and the ICRU rectum point dose were compared between the original and modified plans using a paired two-sample t-test. Results: Simulating removal of the Smit sleeve was associated with an average reduction in the mean integral dose of 6.1% (p < 0.001) and an average reduction of 10.9% (p = 0.004) to the rectal D 2cc. Doses to the remaining OARs decreased to a lesser magnitude with only that of the sigmoid being statistically significant. Conclusions: The use of a Smit sleeve with a tandem and ovoids system could lead to the delivery of a higher mean integral dose to achieve similar HR-CTV coverage. In addition, it could increase the dose to surrounding OARs, primarily the rectum. The clinical significance of these findings is unknown, but the potential dosimetric impact of using a Smit sleeve should be taken into consideration during the planning when this device is used.

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“…Some physicians place a Smit sleeve into the cervical os at the time of the first applicator insertion. This allows the cervical os to be easily identified and dilated, allowing easier insertion of the tandem at subsequent treatments 33,34…”

Section: Applicator Placementmentioning

confidence: 99%

Brachytherapy in the treatment of cervical cancer: a review

Banerjee¹,

Kamrava²

2014

IJWH

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Dramatic advances have been made in brachytherapy for cervical cancer. Radiation treatment planning has evolved from two-dimensional to three-dimensional, incorporating magnetic resonance imaging and/or computed tomography into the treatment paradigm. This allows for better delineation and coverage of the tumor, as well as improved avoidance of surrounding organs. Consequently, advanced brachytherapy can achieve very high rates of local control with a reduction in morbidity, compared with historic approaches. This review provides an overview of state-of-the-art gynecologic brachytherapy, with a focus on recent advances and their implications for women with cervical cancer.

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An indwelling intrauterine tube to facilitate intracavitary radiotherapy of carcinoma of the cervix

Cited by 28 publications

References 7 publications

Completion of and early response to chemoradiation among human immunodeficiency virus (HIV)‐positive and HIV‐negative patients with locally advanced cervical carcinoma in South Africa

Completion of and early response to chemoradiation among human immunodeficiency virus (HIV)‐positive and HIV‐negative patients with locally advanced cervical carcinoma in South Africa

Dosimetric effects of the Smit sleeve on high-dose-rate brachytherapy tandem and ovoids plans for patients with locally advanced cervical cancer

Brachytherapy in the treatment of cervical cancer: a review

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