Brachytherapy in endometrial cancer: Quantification of air gaps around a vaginal cylinder

Cameron, Alison; Cornes, Paul; Al-Booz, Hoda

doi:10.1016/j.brachy.2008.07.004

Cited by 36 publications

(31 citation statements)

References 7 publications

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Section: Advances In Knowledgementioning

confidence: 99%

“…In 2008, in this radiotherapy centre, Cameron et al [1] carried out a retrospective study of 25 patients receiving vaginal vault brachytherapy. It was found that 8 out of 25 patients had air gaps .2 mm in the superior 2 cm of vagina [1]. An observational study by Richardson et al [2] found 90 air pockets in 150 procedures for a cohort of 25 patients, 80% having one or more air pockets.…”

Section: Advances In Knowledgementioning

confidence: 99%

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Vaginal vault brachytherapy in endometrial cancer: verifying target coverage with image-guided applicator placement

Humphrey¹,

Cornes²,

Al-Booz³

2013

The British Journal of Radiology

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Objective: This quality assurance study assesses whether CT image-guided verification has led to improvements in the technique when compared with previous studies. Methods:The CT images were studied from a cohort of 105 consecutive patients with endometrial cancer having adjuvant brachytherapy to the vaginal vault in 2010. Images were taken at first insertion, checked for air gaps and treatment delivered. Images were later transferred to the planning system and air gaps between vaginal mucosa and vaginal cylinder were measured. Comparisons were made with the 2008 results from this centre and the literature series.Results: Images from two patients were not assessable owing to artefacts from hip replacements. Air gaps .2 mm were seen in 11/103 patients. Repositioning or use of a larger cylinder reduced air gaps to 7/103 patients. In total, 96/103 patients (over 93%) were able to achieve good vaginal contact throughout the treatment volume. This shows a significant improvement in applicator positioning in our centre since 2008 and also a significant improvement over the total data published in 2010 (Pearson x 2 test546.19; p,0.0001). Conclusion:The vaginal cylinder technique with CT imaging was proven to be effective for 96/103 patients. It is necessary to consider whether there is a better technique for the few patients with air gaps .2 mm. Advances in knowledge:For the vast majority of patients, this technique is well tolerated, without the need for analgesia, and will continue to be the first choice technique in this centre.

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Section: Advances In Knowledgementioning

confidence: 99%

Section: Advances In Knowledgementioning

confidence: 99%

Vaginal vault brachytherapy in endometrial cancer: verifying target coverage with image-guided applicator placement

Humphrey¹,

Cornes²,

Al-Booz³

2013

The British Journal of Radiology

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“…13 One possible cause of vaginal relapse is that the vaginal mucosa does not receive the prescribed dose because of the presence of air gaps. In a study by Cameron et al, 5 18 of 25 (72%) patients had an average of 1 air gap, with a mean average area of the air gap of 0.20 cm 2 (range, 0.02-1.65 cm 2 ). This resulted in a mean average of 0.86% of the vaginal surface being displaced from the surface of the cylinder.…”

Section: Discussionmentioning

confidence: 93%

“…However, the entire vaginal mucosal dose was not reported. Cameron et al 5 found that the dose at the mucosa over the air gaps received at 0.5 cm was on average 86.7% (range, 54.7-97.3%) of that which it would have received if there was no air gap. However, the dose at 0.5 cm of the whole vaginal mucosa within the target volume was 99.6% (range, 96-100%) of that prescribed.…”

Section: Discussionmentioning

confidence: 99%

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The impact of air pockets around the vaginal cylinder on vaginal vault brachytherapy

Onal

Güler²,

Dolek³

2015

BJR

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Objective: To evaluate the incidence, size and predisposing factors for air pockets around the vaginal cylinder and their dosimetric effect on the vaginal mucosa. Methods: We investigated 174 patients with endometrial carcinoma treated with external radiotherapy (RT) and brachytherapy (BRT) (101 patients, 58%) or BRT alone (73 patients, 42%). The quantity, volume and dosimetric impact of the air pockets surrounding the vaginal cylinder were quantified. The proportions of patients with or without air pockets during application were stratified according to menopausal status, treatment modality and interval between surgery and RT. Results: Air pockets around the vaginal cylinder were seen in 75 patients (43%), while 99 patients (57%) had no air pockets. Only 11 patients (6.3%) received less than the prescribed dose (average 93.9% of prescribed dose; range, 79.0-99.2%). Air pockets were significantly fewer in pre-menopausal patients or in patients treated with the combination of external RT and BRT than in postmenopausal patients or patients treated with BRT alone. A significant correlation existed between the mucosal displacement of the air gap and the ratio of the measured dose at the surface of the air gap and prescribed dose (Pearson r 5 20.775; p , 0.001). Conclusion: Air pockets were still a frequent problem during vaginal vault BRT, especially in post-menopausal patients or in patients treated with BRT alone, which may potentially cause dose reductions at the vaginal mucosa. Advances in knowledge: Air pockets around the vaginal cylinder remain a significant problem, which may potentially cause dose reduction in the target volume.The primary treatment of choice in localized endometrial cancer is surgery. Adjuvant radiotherapy (RT) is recommended in intermediate-and high-risk patients in order to diminish disease recurrence. RT can be in the form of external RT (ERT) with vaginal vault brachytherapy (BRT) or BRT only, depending on the risk factors and stage of disease.The purpose of vaginal vault BRT is to eradicate a microscopic tumour at the lymphatics located in the vaginal vault. It was demonstrated that .90% of lymphatics lie within 2-3 mm from the surface of stretched mucosa.1 For this reason, in order to deliver adequate doses to the submucosal lymphatics, the vaginal cylinder must be in direct contact with the vaginal surface, as recommended by the American Brachytherapy Society (ABS).2 The Group Europeén de Curiethérapie and the European Society for Radiotherapy & Oncology (GEC-ESTRO) guidance 3 is to prescribe vaginal BRT to 5 mm from the applicator surface with a 2-mm tolerance. The most commonly used applicator for vaginal vault high-dose-rate BRT is a segmented cylinder. 4 However, during application, air gaps may be observed, which may potentially cause underdosage of the vaginal mucosa.Cameron et al 5 found that 18 of 25 patients (72%) had air gaps .2 mm in the cranial part of the vagina, with the median number of air pockets per patient being 1 (range, 0-5). Richardson et al 6 reported that 20 o...

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Implementation of radiation therapist cylinder insertion for vaginal vault brachytherapy

Paterson

Pearson

Johnson

2019

J of Medical Radiation Sci

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Vaginal vault brachytherapy is a common treatment for endometrial cancer. Historically, applicator insertion has been the domain of a radiation oncologist (RO). This commentary outlines a project to improve efficiency and workforce utilisation by introducing a competency framework and training module allowing entitled radiation therapists to perform single‐channel cylinder applicator insertions and treatment delivery under RO supervision for fraction one and without supervision for subsequent fractions. The rationale, relevant regulations, implementation process and barriers are explored.

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Brachytherapy in endometrial cancer: Quantification of air gaps around a vaginal cylinder

Cited by 36 publications

References 7 publications

Vaginal vault brachytherapy in endometrial cancer: verifying target coverage with image-guided applicator placement

Vaginal vault brachytherapy in endometrial cancer: verifying target coverage with image-guided applicator placement

The impact of air pockets around the vaginal cylinder on vaginal vault brachytherapy

Implementation of radiation therapist cylinder insertion for vaginal vault brachytherapy

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