Magné Nicolas, Chargari Cyrus, SanFilippo Nicholas, Messai Taha, Gerbaulet Alain, Haie-Meder Christine
Department of Radiotherapy, Brachytherapy Service, Institut Gustave-Roussy, Villejuif Cedex, France.
Brachytherapy. 2010 Jul-Sep;9(3):274-7. doi: 10.1016/j.brachy.2009.08.014. Epub 2010 Feb 13.
The importance of the quality of cervical cancer brachytherapy applicators has been reported, suggesting a direct influence of competent technical implant performance on outcome. In our institute, an original brachytherapy technique based on the use of a molded applicator for genital tract brachytherapy has been applied routinely in clinical practice. Here, we report the technical aspects of this customized applicator and perspectives on its use.
The first step consists of a vaginal impression that accurately shows the topography and extension of the tumor as well as the anatomy of the vagina and cervix. From this impression, an acrylic applicator is made. Then, the intended positions of the vaginal catheters are drawn on the surface of the mold by the radiation oncologist. Two plastic vaginal catheters are introduced and fixed on the internal surface of the molded applicator. A hole for the cervical os is made through which the uterine probe will be positioned.
This method allows for high specificity within the framework of a modern brachytherapy procedure, integrating the tumor topography, anatomy of the patient, and internal movements of target and critical volumes. This technique has been successfully extended to other tumor locations, such as genital tract rhabdomyosarcoma in children and postoperative endocavitary brachytherapy in patients with endometrial cancer.
Customization of a vaginal brachytherapy applicator allows for the maintenance of morphologic optimization throughout the treatment course, which better takes into account a fourth dimension: internal organ motion during the course of brachytherapy.
已有报道指出宫颈癌近距离放疗施源器质量的重要性，这表明熟练的技术植入操作对治疗结果有直接影响。在我们研究所，一种基于使用定制施源器进行生殖道近距离放疗的原创近距离放疗技术已在临床实践中常规应用。在此，我们报告这种定制施源器的技术要点及其应用前景。
第一步是进行阴道印模，精确显示肿瘤的形态和范围以及阴道和宫颈的解剖结构。根据该印模制作一个丙烯酸施源器。然后，放射肿瘤学家在模具表面画出阴道导管的预定位置。将两根塑料阴道导管插入并固定在定制施源器的内表面。制作一个宫颈口孔，通过该孔放置子宫探针。
这种方法在现代近距离放疗程序框架内具有高度特异性，整合了肿瘤形态、患者解剖结构以及靶区和危及器官的内部运动。该技术已成功扩展到其他肿瘤部位，如儿童生殖道横纹肌肉瘤以及子宫内膜癌患者术后腔内近距离放疗。
定制阴道近距离放疗施源器可在整个治疗过程中保持形态优化，更好地考虑到第四个维度：近距离放疗过程中内部器官的运动。
