VAGINAL TEMPLATE IMPLANT FOR CERVICAL-CARCINOMA WITH VAGINAL STENOSISOR INADVERTENT DIAGNOSIS AFTER HYSTERECTOMY

Purpose: For cervical carcinoma patients with poor geometry for conven tional intracavitary radiotherapy, a simple vaginal template for inter stitial implantation as a substitute was used. This template has also been used to treat patients who had hysterectomy done without knowledg e of an early tumor in the cervix, and for patients with recurrent dis ease. This is a report of the treatment results. Methods and Material: A total of 21 patients were treated over from July 1987 to June 1991 with this vaginal template implant forming part of the treatment, 12 o f these were performed for vaginal stenosis. The applicator consists o f a front piece and an end piece. Holes were drilled in the front piec e to guide the implantation of the cervix or vaginal vault. The diamet er of applicators varied from 2 cm to 3.5 cm. Depending on the diamete r of the applicators, six to eight needles on the periphery, or eight peripheral plus one central needle were used. The activity of the need les were around 8 mCi with a total length of 5.5 cm. The end piece was locked onto the front piece by a bayonet-type locking device. The pur pose of the end piece was two-fold: to make up the length of the whole applicator to fit the vagina and to keep the implanted needles in pla ce without being extruded. The implantation was performed under genera l anesthesia. Results: One of the twelve patients treated with the vag inal template implant for vaginal stenosis had relapsed centrally but subsequently died of intercurrent disease. Two other patients died of intercurrent disease at 26.2 and 41.9 months, respectively, without ev idence of relapse. Nine other patients had been followed with no evide nce of local relapse for 23.7 to 54.6 months. Conclusion: This vaginal template implantation is a satisfactory means of treating patients wi th vaginal stenosis and those who had hysterectomy done without knowle dge of an early tumor in cervix.