The narrow vagina, the antecedent for irradiation injury

Abstract

The narrow vagina may result in an overirradiation of the normal pelvic organs. This inadequate spatial relationship cannot be avoided by packing or choosing another applicator. Since this problem often occurs in the elderly patient, surgery is not seriously considered as an alternative. The prediction of radionecrotic complications is important for both the radiation therapist and the gynecologic oncologist. The narrow vagina can be defined in terms of the ratio of Point A dose to that of the bladder and/or rectum. It is important that a poor therapeutic ratio be recognized in order to prevent excessive radiation to the normal structures. Alternates to the “routine” intracavity Curie therapy will be presented. The role of the colpostats, the protruding source, and the tandem will be discussed in a manner which will yield better communication between the radiation therapist and the gynecologic oncologist. The deliverance of overtolerance radiation in order to gain cancer cure in select patients must be a combined radiotherapeutic surgical decision. Guidelines for management will be presented.