Novel use of a vaginal cylinder purposed dually as obturator and localiser for stereotactic ablative radiotherapy delivery

J Spencer Thompson,J Nathan Cantrell,Salahuddin Ahmad,Yong Chen,Imad Ali,Christina Henson,Laura Holman,Julie Arntzen

doi:10.1017/s1460396921000169

Abstract

AbstractBackground:Vaginal cancer is a rare malignancy that poses a challenge to treat and cure, as surgical excision requires life-changing procedures because of the proximity and involvement of rectum, bladder and anus. We report in this case study the successful delivery of stereotactic ablative radiotherapy (SABR) for a patient with vaginal cancer after previous radiotherapy.Methods:A 71-year-old white female who presented with dyspareunia and irritative urinary symptoms proven by biopsy was our candidate patient. Subsequent PET/CT revealed a hypermetabolic 3 cm lesion at the 12–1 o’clock position in the distal vagina involving the clitoris. The patient was initially treated with volumetric-modulated arc therapy (VMAT) with simultaneous integrated boost technique to the involved nodes, and later upon recurrence treated with SABR using 30 Gy in six fractions.Findings:To our knowledge, this is the first report of a vaginal cylinder used to physically distance organs at risk from the treatment target and also as a localising device with image guidance for the delivery of SABR using an external beam.

Highlights

Vaginal cancer is a rare malignancy affecting 6,230 patients per year and resulting in 1,450 annual deaths.[1]
We report the successful delivery of salvage stereotactic ablative radiotherapy for a patient with persistent vaginal cancer at the introitus involving the urethra and clitoris after previous radiotherapy
A vaginal biopsy at an outside facility confirmed the presence of welldifferentiated squamous cell carcinoma in a 2 cm lesion in the distal vagina near the urethral orifice

Summary

Introduction

Vaginal cancer is a rare malignancy affecting 6,230 patients per year and resulting in 1,450 annual deaths.[1]. The examination at that time showed a 3 cm lesion at the 12–1 o’clock position in the distal vagina and extending into paravaginal tissue, slightly to the left side of the urethral orifice and involving the clitoris.

Results

Conclusion