16 Cervix Carcinoma

316 Cervix Cancer

Fig 14.8: Stockholm based Technique (continued) C: CT/MRI compatible carbon ring applicator set for Iridium, which is also available for Cesium. The ring and tube dimensions are comparable to the metallic version. The outer diameters are slightly larger. Therefore no cap is necessary. The whole system is fixed with a screw (Nucletron ®). The length and the curvature of the intrauterine tandem is chosen dependent on the size and the bending of the uterine cavity. The diameter of the ring which is perpendicular to the axis of the intrauterine tube is also chosen according to the individual anatomical situation. The ring is covered by a cap for reduction of the dose to the vaginal mucosa. The ring is fixed to the intrauterine tandem. The angle between the ring and the tandem is always 90 degrees. The angle between the ring and the axis of the vagina is selected according to the angle between the axis of the vagina and the uterus. The applicator is fixed against the cervix by an individual packing device (8). 7.5 Institut Gustave- Roussy technique (37,38) The classical “Paris method” was based on two “corks” (ovoids) situated in each lateral fornix perpendicular to the intrauterine tube connected by a transverse metal spring and, independent of this, a hollow gum elastic tube in the uterine cavity (see Fig 6.21 in chapter on reporting). Later, a vaginal cork was sometimes added to ensure a more uniform dose distribution in the cervix. The Manchester and Fletcher based techniques (see above) are in regard to their application techniques related to the original “Paris method”. The other techniques developed in Paris (Créteil (95)), Saint-Cloud (23)) have much further advanced and individualised the application techniques by introducing the mould technique systematically. This method developed at the IGR has four basic aims: personalized tailored irradiation, perfect knowledge of dose distribution, total radioprotection, and good tolerance by the patient. To realise these four aims, four means are used: mould applicator (specific for this technique), miniaturized radioactive sources, computerized dosimetry, remote afterloading machine: moulded applicator (moulage) In order to construct this personalized applicator perfectly adapted to each case (anatomy, tumour volume, vaginal extensions…) four steps are necessary: Taking a cervico-vaginal impression: lithotomy position, introduction of speculum; placement of strips of gauze into each lateral fornix; injection inside the vagina of liquid paste which is, extracted from