Banerjee Susovan, Kaliyaperumal Venkatesan, Kataria Tejinder, Kamaraj Dayanidhi
Division of Radiation Oncology, Medanta - The Medicity, Gurgaon, Haryana, India.
J Contemp Brachytherapy. 2020 Feb;12(1):44-47. doi: 10.5114/jcb.2020.92528. Epub 2020 Feb 28.
In advanced cervical cancers, improved techniques using both intracavitary and interstitial brachytherapy (IC + IS) should be used to adequately cover the residual tumor volume, resulting in better clinical results. Confronted with some limitation in implementing available applicators, we devised our own indigenous template that would also serve as an applicator.
First, a graphical design was drawn, keeping in mind the extent of volumes that need to be targeted in various brachytherapy scenarios. It was validated in a computer system and a physical template was manufactured. The template underwent modified versions through iterative dosimetric and planning exercises. The final model was successfully implemented in a clinical scenario.
Cylindrical templates of diameter 3, 4, and 5 cm were produced with central aperture for central tandem, combining surrounding holes spaced at pre-planned points. The instrument can be used for IC + IS brachytherapy in cervical cancers. This easy to use applicator/template can direct needles to treat a distance of 4.5 cm laterally at the level of point A. In two initial applications 55 and 54 cc of high-risk clinical target volumes (HRCTV) were treated, and 90% of the HRCTV was covered by 96% and 97% of prescribed doses, respectively. Additionally, the needles guided by the template helped in sculpting the dose from bladder and rectum.
We have developed an easy to use IC + IS type of template/applicator, which was successfully implemented in our clinical practice.
在晚期宫颈癌中，应采用改进的腔内和组织间近距离放射治疗技术（IC + IS）来充分覆盖残留肿瘤体积，从而取得更好的临床效果。鉴于在使用现有施源器时存在一些局限性，我们设计了自己的本土模板，该模板也可作为施源器使用。
首先，绘制图形设计，同时考虑到各种近距离放射治疗场景中需要靶向的体积范围。在计算机系统中对其进行验证，然后制造物理模板。通过反复的剂量测定和计划练习，对模板进行修改。最终模型在临床场景中成功实施。
制作了直径为3厘米、4厘米和5厘米的圆柱形模板，带有用于中央串联的中心孔，周围孔按预先计划的点间隔排列。该仪器可用于宫颈癌的IC + IS近距离放射治疗。这种易于使用的施源器/模板可将针引导至在A点水平横向4.5厘米处进行治疗。在最初的两次应用中，分别治疗了55立方厘米和54立方厘米的高危临床靶区（HRCTV），90%的HRCTV分别被96%和97%的处方剂量覆盖。此外，由模板引导的针有助于塑造膀胱和直肠的剂量。
我们开发了一种易于使用的IC + IS型模板/施源器，并在临床实践中成功实施。
