SA Journal of Radiology

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Treatment optimisation using external beam radiation in gynaecological cancers

V Sharma, U Majeed, D Joseph, S Lindikile, N Madhoo, H Copelyn, J Kotzen, M Mohiuddin, B Donde, D van der Merwe


The majority of patients with gynaecological cancers present with advanced stages in which external beam radiation forms a major component
of the treatment. These patients undergo simulation for treatment
planning prior to radiation. Currently the lower extent of the disease
is evaluated by vaginal examination and marked using a lead wire on
the anterior abdominal wall in the pelvic region. A 2 cm margin inferior
to this level is used as the lower border of the treatment field. The suggested modified technique includes the placement of an indigenously
designed perspex vaginal obturator with graduations at 1 cm distance
from its tip. Following vaginal examination the obturator can be inserted
into the vagina and fixed at the predefined length using a fixation device.
The radio-opaque markers can be seen even in the lateral films. Twentyfive consecutive patients underwent the procedure and the differences between the two methods of marking the lower border were calculated. The external lead wire was inferior to the internal obturator in 19 patients (76%) ranging from 0.5 cm to 3 cm (median 1.5 cm, mean 1.37 cm). It was at the same level in 4 patients (16%) and 1 cm superior to the internal obturator in 2 (8%). With the modified technique using the internal obturator application for delineating the lower border of vaginal disease or vault, it was possible to decrease the length of field thereby reducing the chances of treatment-related toxicity, especially groin and vulval reactions, as well as avoiding treatment interruptions.

AJOL African Journals Online