A new technique for performing Syed template interstitial implants for anterior vaginal tumors using an open retropubic approach

The Syed template (Alpha-Omega Services, Bellflower, CA) has been establish ed as an advance in interstitial gynecologic brachytherapy. Unfortunately, enthusiasm for the technique is often tempered by certain tumor geometries which require blind insertion of the interstitial needles, potentially risk ing inaccurate placement of the radioactive sources and viscus perforation. These concerns arise particularly in the management of anterior vaginal tu mors where difficulties in negotiating the pubic arch can prevent optimal n eedle placement. In answer to this problem, a technique utilizing an open r etropubic approach for Syed template interstitial implants in anterior vagi nal tumors under direct visualization is described. To date, six procedures have been performed. The disease entities include advanced cervical squamo us cell carcinoma, clear cell carcinoma of the vagina, recurrent vaginal ca rcinoma, recurrent endometrial carcinoma, and urethral adenocarcinoma. Comp lete response was noted in five of six patients but persistent local contro l of disease was achieved in only one of five complete responses over a rel atively short follow-up interval. Complications included paravaginal absces s (n = 1), postoperative deep venous thrombosis (n = 1), abdominal incision cellulitis (n = 1), and radiation enteritis (n = 1). An open retropubic ap proach allows direct visualization of the bladder and urethra during inters titial implantation of anterior vaginal malignancies and facilitates negoti ation of the pubic arch. In our experience, this technique results in impro ved needle positioning and is thus intuitively likely to aid in avoiding in jury to surrounding normal tissues. Additional accrual of a larger cohort w ill be necessary to arrive at any meaningful objective conclusions regardin g the technique's benefit over current modalities. (C) 1999 Academic Press.