Treatment of extensive carcinoma of the cervix with the “transperineal parametrial butterfly”

The sculpted pear: An unfinished brachytherapy tale

“…The depth of needle insertion remained subjective and poorly controlled (43). Both the multiple-site perilinear applicator (MUPIT) and the Syed-Neblett applicators were introduced in 1974 in concert with computerized dosimetry (44)(45)(46)(47)(48)(49)(50)(51)(52)(53). The concept of preplanning was introduced with the development of template techniques due to the predicability of dose distribution as a result of the fixed positions of the sources in the template (54,55).…”

Transperineal Low-Dose Rate Iridium-192 Interstitial Brachytherapy in Cervical Carcinoma Stage IIB

“…Transperineal interstitial brachytherapy has been used as an alternative method in locally advanced and recurrent cervical cancer [2,3,16,17,36,39,42,43]. One of the main indications has been its application in cases with distorted local anatomy where a standard intracavitary application is not possible [1].…”

Interstitial implantation of gynecologic malignancies

“…Results from large series using the Syed-Neblett or MUPIT systems for various gynecologic sites are listed in Table II detailing local control, survival, and complication rates particularly for cervical and vaginal cancers [1,[16][17][18][19][20]22,23,35,38,40,42,46,47,50,[53][54][55][56].…”

“…When first introduced in 1974, the Syed-Neblett vaginal obturator surface was routinely loaded, usually in association with a central intrauterine tandem [15][16][17]22,56]. Long-term follow-up, however, revealed a substantial incidence of rectovaginal and vesicovaginal fistulae, and vaginal necrosis [22,56].…”

“…Renewed interest emerged in 1974 [11] with the development of a prefabricated perineal template, the MUPIT (Martinez Universal Perineal Interstitial Template, Beaumont Hospital, Royal Oak, MI), through which steel needles were inserted and afterloaded with Ir-192 or I-125 [12,13]. Concurrently, Feder et al [14][15][16] revived Waterman's approach [17] of interstitial implantation of extensive cervical carcinomas and vaginal carcinomas utilizing the Syed-Neblett transperineal template system. Transperineal interstitial implantation techniques currently employed are traceable to the evolution of these two systems.…”