title: Eradicative brachytherapy with hyaluronate gel injection into pararectal space in treatment of bulky vaginal stump recurrence of uterine cancer.
abstract: The purpose of this study is to develop a procedure for eradicative brachytherapy that can deliver a curative boost dose to bulky (>4 cm) vaginal stump recurrence of uterine cancer without risk of damaging surrounding organs. We separated risk organs (the rectum and sigmoid) from the target during brachytherapy, with a hyaluronate gel injection into the pararectal space via the percutaneous paraperineal approach under local anesthesia. The rectum anchored to the sacrum by native ligament was expected to shift posteriorly. We encountered a patient with bulky stump recurrence of uterine cancer, approximately 8 cm in maximum diameter. She was complaining of abdominal pain and constipation due to bowel encasement. Following 50 Gy of external beam radiotherapy, we applied a single fraction of brachytherapy under gel separation and delivered 14.5 Gy (50.8 GyE: equivalent dose in 2-Gy fraction calculated with linear quadratic model at α/β = 3) to the target. The gel injection procedure was completed in 30 min without complications. A total irradiation dose of 100.8 GyE was delivered to the target and the cumulative minimum dose to the most irradiated rectosigmoidal volume of 2 cc (cumulative D(2cc)) was calculated as 58.5 GyE with gel injection, and was estimated to be 96 GyE without. Over three years, the local stump tumor has completely disappeared, with no complications. Brachytherapy with a pararectal gel injection can be a safe and effective eradicative option for bulky vaginal stump recurrence.
authors: Department of Radiation Oncology, Wakayama Medical University, Wakayama City, Japan. kazushi.kishi@gmail.com
authors: Kazushi
authors: K
authors: Kishi
authors: Yasushi
authors: Y
authors: Mabuchi
authors: Tetsuo
authors: T
authors: Sonomura
authors: Shintaro
authors: S
authors: Shirai
authors: Yasutaka
authors: Y
authors: Noda
authors: Morio
authors: M
authors: Sato
authors: Kazuhiko
authors: K
authors: Ino
mesh_terms: D001918:Brachytherapy / Q000379:methods*; D004307:Dose-Response Relationship, Radiation; D005260:Female; D005782:Gels; D006801:Humans; D006820:Hyaluronic Acid / Q000737:chemistry*; D008279:Magnetic Resonance Imaging / Q000379:methods; D008875:Middle Aged; D008953:Models, Anatomic; D009339:Needles; D012007:Rectum / Q000473:pathology; D012008:Recurrence; D012306:Risk; D013997:Time Factors; D014594:Uterine Neoplasms / Q000532:radiotherapy*; D014621:Vagina / Q000473:pathology; D014625:Vaginal Neoplasms / Q000532:radiotherapy*
chemical_list: D005782:Gels; D006820:Hyaluronic Acid