How do you plan for excess nonconforming vaginal tissue with a HDR cylinder?
In women receiving HDR intracavitary brachytherapy to treat the vaginal cuff, how do you overcome the challenge of excess lateral vaginal tissue ("dog ears") or superior tissue that doesn't conform to cylinders, regardless of cylinder size?
Answer from: Radiation Oncologist at Community Practice
CT based plan. You do end up seeing paravaginal tissue not covered by single channel cylinder. We have not chased that in adjuvant setting with outcome data showing low recurrence rate. Similar thoughts about small air gaps Richman et al., PMID 33384254.
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Answer from: Radiation Oncologist at Academic Institution
Unfortunately, I have found that there is not much that can be done for this excess tissue when using a vaginal cylinder alone. If treating for a cuff recurrence and I am concerned about this excess tissue (i.e. that it was involved with recurrent disease), then I often will do an interstitial impla...
Answer from: Radiation Oncologist at Academic Institution
When we evaluate for postoperative elective vaginal cylinder brachytherapy, the vaginal cuff has various shapes and surfaces which depend on surgical techniques.The single channel cylinder brachytherapy is ideal to treat ≤0.5 cm depth of vaginal mucosa with minimal toxicity. The pressure of vagin...