Brachytherapy in Carcinoma Cervix

Flashcards about Brachytherapy applicators, patient selection, and procedures in Carcinoma Cervix

What is the Venezia Applicator?

Recently launched by Elekta, this applicator can be used for intracavitary, interstitial, and intravaginal brachytherapy in cervical cancers, and is called a universal template.

What is the Modified Fletcher-Suit applicator?

This applicator adds a unique insertion tool to place needles at exact depths, allowing better preplanning, and is a commonly used ICRT applicator.

What is the MR compatible intracavitary applicator?

Thicker in size, this applicator is difficult for placement in stenosis of cervical OS and vagina, but can be used in CT based reconstruction as well.

What is Utrecht CT/MR interstitial applicator?

Used Ovoids as template for interstitial needles

What is Rotterdam Cervix applicator?

Made of titanium, has insertion tool to guide depth of needle placement

What is Fletcher Williamson Cervix applicator?

Has in built rectal and bladder shield; Additions for treating vaginal extensions; Fixed geometry applicator. Easily inserted if smit sleeve is in situ

What is Henschke Cervix applicator?

Made of titanium

What is Vienna ring applicator?

It has 2 locks placed at fixed distances making placement difficult in short vagina; The angle of the ring is also fixed; Only parallel needles can be placed and so the lateral throw into parametrium is less

What are the advantages of spinal anaesthesia during intracavitary brachytherapy?

Pelvic muscle relaxation, Good analgesia, Minimal voluntary movement of lower limbs decreases risk of displacement of applicators

What are the risks of spinal anaesthesia specific to carcinoma cervix patients?

Prolonged immobilization may lead to higher risk of deep vein thrombosis, Full analgesia may make it difficult to detect vaginal tears and uterine perforations early during the procedure

What are the tumour specific criteria for patient selection of ICRT?

No vaginal stenosis; Os negotiable; Tumour size <4 cm; No or minimal parametria extension; No involvement of lower vagina; No adjacent organ involvement

What are the patient specific criteria for patient selection of ICRT?

Normal hemogram and prothrombin time; Patient can be placed in lithotomy position or at least with lower limb abducted and externally rotated >30 degrees

What to identify from Transrectal ultrasound (TRUS) during brachytherapy?

Identify Uterine position, Presence or absence of pyometra, Approximate length of uterus

What are general recommendations for Contouring for MR Guided Brachytherapy?

Pre-RT MR imaging is ideal for imaging of the primary cervical disease; Information on clinical examination is also helpful in addition to MRI; A pelvic surface improves resolution of the MR imaging; Ideal time for MR imaging for BT contouring is while the BT applicators are in situ; GEC-ESTRO recommends MRI imaging for BT in 3 T2WI planes-axial, coronal and sagittal; Advantage of T2 images-even with treatment tumour shows intermediate to high signal intensity; Enlarging pelvic lymph nodes could be a sign of disease.

What are some Patient Selection and Indications for Interstitial Brachytherapy (Carcinoma Cervix)?

Vaginal stenosis present; Os not negotiable; Tumour size >4 cm; Parametria extension at the time of brachytherapy; Involvement of lower vagina present; Adjacent organ involvement present at baseline; Normal hemogram and prothrombin time