title: A new applicator design for endocavitary brachytherapy of cancer in the nasopharynx.
abstract: BACKGROUND
  In attempting to improve local tumor control by higher doses of radiation, there has been a resurgence of interest in the implementation of brachytherapy in the management of primary and recurrent cancers of the nasopharynx. Brachytherapy with its steep dose fall-off is of particular interest because of the proximity of critical dose limiting structures. Recent developments in brachytherapy, such as the introduction of pulsed-dose-rate and high-dose-rate computerized afterloaders, have encouraged further evolution of brachytherapy techniques.
  
  
  METHODS
  We have designed an inexpensive, re-usable and flexible silicone applicator, tailored to the shape of the soft tissues of the nasopharynx, which can be used with either low-dose-rate brachytherapy or high (pulsed)-dose-rate remote controlled afterloaders.
  
  
  CONCLUSIONS
  This Rotterdam nasopharynx applicator proved to be easy to introduce, patient friendly and can remain in situ for the duration of the treatment (2-6 days). The design, technique of application and the first consecutive 5 years of clinical experience in using this applicator are presented.
authors.affiliation: Department of Radiation Oncology, Daniel den Hoed Cancer Center/Dijkzigt Hospital, University Hospital Rotterdam, The Netherlands.
authors.forename: P C
authors.initials: PC
authors.lastname: Levendag
authors.forename: R
authors.initials: R
authors.lastname: Peters
authors.forename: C A
authors.initials: CA
authors.lastname: Meeuwis
authors.forename: L L
authors.initials: LL
authors.lastname: Visch
authors.forename: D
authors.initials: D
authors.lastname: Sipkema
authors.forename: C
authors.initials: C
authors.lastname: de Pan
authors.forename: P I
authors.initials: PI
authors.lastname: Schmitz
mesh_terms: D001918:Brachytherapy / Q000295:instrumentation* / Q000379:methods; D002294:Carcinoma, Squamous Cell / Q000532:radiotherapy*; D004307:Dose-Response Relationship, Radiation; D004867:Equipment Design; D004869:Equipment Safety; D006801:Humans; D009303:Nasopharyngeal Neoplasms / Q000532:radiotherapy*; D011879:Radiotherapy Dosage; D016896:Treatment Outcome