Technical Aspects of Radiation Therapy in Endometrial Carcinoma

Radiation therapy in the definitive management of medically inoperable endometrial cancer

“…The original Heyman method consisted of direct loading of the uterine cavity with a number of ‘hot’ radium capsules by the radiation oncologist or surgeon. This method was subsequently modified several times including incorporating the use of afterloading devices to limit radiation exposure of involved personnel and to increase ease of implants 5 21–23…”

“…Simon–Heyman capsules (modified Heyman) are capsules with diameters of 6, 8, and 10 mm (Figure 3A). The capsules are placed through the cervical os into the uterine cavity to fill the entire body of the uterus 21–23. The capsule size that should be used is determined by the size of the uterine cavity.…”

“…Vaginal ovoids are then placed at the vaginal fornices. Individual packing with capsules allows for adaptability to the individual anatomy of the cavity implanted, and this method is likely best suited for larger uterine cavities 22…”

“…Rigid standard applicators such as the Y-shaped ‘Rotte’ applicator consist of two or three tandems that are suitable for small- to medium-sized uterine cavities 22 24. The use of two tandems angled such that they fill the uterine horns helps to optimize coverage of the endometrial surface compared with a single tandem and should be considered in patients who have significant tumor burden at the time of implantation 24 25.…”

“…A one-channel standard applicator such as a tandem and cylinder, or a single tandem with ring or vaginal ovoids, may be used for smaller uterine cavities (Figure 4). A single tandem applicator is best reserved for patients with a maximum uterine width of 5 cm or less, otherwise a two- or three-tandem applicator should be considered if greater lateral dose coverage is needed to encompass the tumor 22 27. Ultrasound guidance may be used to ensure the single channel used reaches to the uterine fundus and placement of a cervical smit sleeve may help ease implantation when multiple fractions are planned.…”