A vaginal applicator for radium therapy of carcinoma in the vagina.

Abstract

Carcinoma in the vagina often arises by extension from carcinoma of the cervix. Not infrequently an isolated metastatic nodule is found in the vaginal submucosa distal to the primary cervical lesion, separated from it by apparently healthy mucous membrane. Classical intracavitary radium therapy technics for cervical cancer may be inadequate for such vaginal extensions unless adjunctive radiation therapy is utilized. Tubular applicators containing radium or cobalt-60 sources (1, 3–6), radium plaques of linen or lead sheets (spoons), and interstitial implantations of various radioisotopes have been used in the treatment of such isolated vaginal lesions. These have not proved entirely satisfactory, however, and no surface-type vaginal applicator was available that could be reliably employed for each case encountered. At the Johns Hopkins Hospital, use has been made of an aluminum surface-type vaginal applicator designed to apply a radium source to an isolated metastatic nodule or recurrence of carcinoma in the vaginal mucosa or submucosa. Because of its simple design and construction, ease of loading, decreased time required for handling, and reliability of application, this has come to be employed routinely for such lesions seen on the gynecological service. Description of Applicator The applicator (Fig. 1) is constructed of sheet aluminum, 1∕16 inch thick, and Lucite, 1∕4 inch thick. It consists of a U-bar of aluminum, 10 × 3 cm. (A) or 8 × 2.5 cm. (B), on which is positioned an aluminum container (C), 2.1 × 2.2 × 0.7 cm., which houses two 25-mg. radium sources. The radium tubes (2.0 × 0.6 cm.) fit tightly in the container and are spaced 1 cm. apart by a hexnut and cotton plug. A central aluminum screw and wing nut fasten the radium container to the U-bar via holes drilled 1 cm. apart along the axis of the bar. A Lucite separator (2.1 × 2.2 × 0.6 cm.) is attached on the mucosal side of the container. Two holes in the proximal end of the bar permit suturing of the applicator to the labia. Method of Application After clinical examination has established the existence of a metastatic lesion or recurrence in the vaginal mucosa or submucosa, exact measurements of its position are obtained, by digital examination. The radium container is attached to the bar, the screw passing through a hole the correct distance from the cervix and the vaginal orifice, so that its head will be against the tumor. U-bars of two sizes are available in order that all vaginas will readily accept the assembled applicator, thereby obviating the necessity for relaxing incisions occasionally required for the introduction of other forms of applicators (6). The assembled applicator is introduced into the vagina by radium forceps with the Lucite separator placed against the affected side.