In a patient with locally advanced cervical cancer that has extensive residual disease (>7 cm in greatest dimension) after chemoradiation, how do you weigh the geometric advantages of a Syed-Neblett template against the superior toxicity profile and outpatient feasibility of an advanced hybrid applicator?

Kilar et al., PMID 41737510, explains applicator selection. If residual disease is less than 4 cm on either side (still a total of 7 cm), a hybrid with straight and oblique needles can help to cover the disease. However, if it is more than 4 cm on one side, then you have to look at geometry, and som...

It depends on the type and geometry of the hybrid applicator you have and whether or not you think you can adequately implant the tumor vs a full interstitial implant.

This is also weighed against the possibility of significant bleeding in a large tumor with poor response. Be ready with supplies to ...