32 Paediatric Malignancies

622 Paediatric Malignancies

Based on the mould technique different techniques of application may be used with plastic tubes that can be afterloaded. (11,12,15) For clear-cell adenocarcinoma the same technique is used (Fig 31.6A-C).

Fig 31.6: Clear cell adenocarcinoma of the vagina A/B: vaginal impression, perfectly showing tumour site and size (posterior and lateral views) C: corresponding applicator with plastic tubes and delineation of GTV and projection of one radioactive source line on the surface of the applicator 7.6 Vulva The same interstitial-brachytherapy technique used in adult patients can be employed for children. 7.7 Anus-Rectum

Fig 31.7: Interstitial fractionated HDR brachytherapy in recurrent rhabdomyosarcoma.

Almost one half of the circumference was involved. Brachytherapy was performed for microscopic residual disease after salvage combination chemotherapy with a specific applicator (A) based on X- ray (B) and MRI assisted treatment planning (C, see next page). A dose of 44 Gy was applied in multiple fractions of HDR brachytherapy.