Intracavitary plesiotherapy as boost treatment in a patient of cancer cervix

Abstract

Purpose: Mold brachytherapy is an age old treatment for superficial tumors. Vaginal mold brachytherapy for gynecological malignancies of vaginal vault and vagina is being practiced in different institutes across the globe. We are reporting the technical aspects of vaginal mold and optimal treatment to the patient. Materials and Methods: This is a case of Carcinoma Cervix International Federation of Gynaecology and Obstetrics st-IIIA(lower one-third vaginal involvement) with residual disease in the anterior wall of lowerd one-third of vagina after the completion of external beam radiotherapy. The patient was reluctant for interstitial implant brachytherapy and hence was planned for vaginal mold brachytherapy with an aim to boost residual tumor. Five stainless steel Implant needles attached to the sorbo from 9'o clock to 3'o clock position with adequate spacing between the needles. Modeling wax, which is nearly tissue equivalent, was used for making mold. The material was molded into a cast cylindrically over the needles and sorbo homogeneously taking care that there were no air gaps. After taking aseptic precautions the cylindrical mold with needles and sorbo was inserted into the vaginal cavity and stabilized with a T-bandage. Computed tomography scan was performed and images were imported to treatment planning system. Clinical target volume was contoured along with organs at risk (bladder and rectum) and geometric optimization was done to obtain proper dwell times and positions where the D90was kept at 100% of the prescribed dose. Conclusion: Vaginal mold brachytherapy may be used as an alternative technique to interstitial implant brachytherapy as a boost treatment in vaginal malignancies. Patient-specific mold brachytherapy technique can be used in the cases where the target volume is superficial and limited to vagina. It is a minimally invasive technique which mimics the dose distribution of interstitial brachytherapy.