title: Adjuvant brachytherapy for endometrial cancer: advantages of the vaginal mold technique.
abstract: OBJECTIVE
  Treatment of endometrial carcinoma in the adjuvant setting includes in most cases vaginal brachytherapy. In our institution, we use the customized vaginal mold technique. Herein, we report the advantages of this personalized applicator in terms of target coverage, normal tissue preservation, the incidence of air pockets, and its potential impact on dosimetry.
  
  
  METHODS
  A total of 15 patients receiving postoperative vaginal cuff high-dose-rate brachytherapy with the mold applicator technique were enrolled in this prospective data collection study. Patients were treated with either two or four fractions of 5 Gy prescribed to the clinical target volume, which consisted of an irradiation of the vaginal cuff and the upper third of the vagina. Target coverage; dose to organs at risk, in addition to the volume; and the dosimetric impact of air pockets surrounding the mold were evaluated.
  
  
  RESULTS
  In 15 patients, a total of 27 air pockets were identified. The average number of air pockets per patient was 1.8 (range, 0-4), with the average total air pocket volume being 0.1 cc (range, 0.01-0.54). The average dose reduction at 5mm from the air pocket was 26% (range, 6-45%). The minimal clinical target volume coverage reported was 95% and the maximal dose received by 2 cc of the bladder, rectum, and sigmoid never exceeded 110% of the prescribed dose.
  
  
  CONCLUSIONS
  Vaginal cuff high-dose-rate brachytherapy using the molded applicator provides personalized tailored treatment in terms of anatomical conformity. This translates into a dosimetrical advantage with smaller and fewer air pockets than reported in the literature with the use of cylinders.
authors.affiliation: Department of Radiation Oncology, Brachytherapy Unit, Gustave Roussy Cancer Campus, Villejuif, France. Electronic address: clement.elkhoury@gustaveroussy.fr.
authors.forename: Clement
authors.initials: C
authors.lastname: El Khoury
authors.affiliation: Department of Medical Physics, Gustave Roussy Cancer Campus, Villejuif, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Dumas
authors.affiliation: Department of Radiation Oncology, Brachytherapy Unit, Gustave Roussy Cancer Campus, Villejuif, France.
authors.forename: Anne
authors.initials: A
authors.lastname: Tailleur
authors.affiliation: Department of Surgery, Gynecology Unit, Gustave Roussy Cancer Campus, Villejuif, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Morice
authors.affiliation: Department of Radiation Oncology, Brachytherapy Unit, Gustave Roussy Cancer Campus, Villejuif, France.
authors.forename: Christine
authors.initials: C
authors.lastname: Haie-Meder
mesh_terms: D000368:Aged; D001918:Brachytherapy / Q000295:instrumentation* / Q000379:methods; D012809:Colon, Sigmoid / Q000528:radiation effects; D016889:Endometrial Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D005260:Female; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D058958:Organs at Risk; D057285:Precision Medicine / Q000295:instrumentation / Q000379:methods; D011446:Prospective Studies; D011829:Radiation Dosage; D011874:Radiometry / Q000379:methods; D011879:Radiotherapy Dosage; D018714:Radiotherapy, Adjuvant / Q000295:instrumentation / Q000379:methods; D012007:Rectum / Q000528:radiation effects; D001743:Urinary Bladder / Q000528:radiation effects; D014621:Vagina / Q000473:pathology
keywords: Air pockets; Endometrial cancer; HDR brachytherapy; Vaginal mold