title: Is there a subset of patients with recurrent cancer in the vagina who are not candidates for interstitial brachytherapy that can be treated with multichannel vaginal brachytherapy using graphic optimization?
abstract: OBJECTIVE
  To evaluate recurrent vaginal cancer treated with vaginal brachytherapy (VBT) using graphic optimization in patients not amenable to surgery and interstitial brachytherapy (ISBT).
  
  
  METHODS
  We retrospectively reviewed the records of 5 patients with recurrent cancer in the vagina that were deemed not to be good candidates for ISBT implant because of medical reasons. All patients received computed tomography/magnetic resonance imaging (CT/MRI) based evaluation in addition to a detailed clinical examination, and were noted to have recurrent nodules in the vagina with size ranging from 10-25 mm. Four of the 5 patients had recurrent disease in the vaginal apex, whereas one patient had recurrence in the lateral vaginal wall. Subsequently, all patients were treated with external beam radiation therapy (EBRT) followed by multichannel vaginal cylinder (MVC)-based VBT using graphic optimization for shaping the isodose to improve the clinical target volume (CTV) coverage, as well as to spare the organs at risk (OAR). The dose to the bladder and rectum with regard to 0.1 cc, 1 cc, and 2 cc were recorded.
  
  
  RESULTS
  Median age of the patients was 78 years (range 58-86 years). Thickness of the lesions before VBT ranged from 6-15 mm. All patients were followed up with MRI at 3 months. All patients but one demonstrated complete clinical/ radiological response of the tumor. No patient had any grade III/IV toxicity at 24 months.
  
  
  CONCLUSIONS
  MVC-based VBT using graphic optimization is safe and yields favorable results if used judiciously.
authors.affiliation: Department of Radiation Oncology, University of Rochester Medical Center, Rochester, NY, USA.
authors.forename: Deepinder P
authors.initials: DP
authors.lastname: Singh
authors.affiliation: Department of Radiation Oncology, University of Rochester Medical Center, Rochester, NY, USA.
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Bylund
authors.affiliation: Department of Radiation Oncology, University of Rochester Medical Center, Rochester, NY, USA.
authors.forename: Ahmad
authors.initials: A
authors.lastname: Matloubieh
authors.affiliation: Department of Radiation Oncology, University of Rochester Medical Center, Rochester, NY, USA.
authors.forename: Ali
authors.initials: A
authors.lastname: Mazloom
authors.affiliation: Department of Radiation Oncology, University of Rochester Medical Center, Rochester, NY, USA.
authors.forename: Alexander
authors.initials: A
authors.lastname: Gray
authors.affiliation: Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY, USA.
authors.forename: Ravinder
authors.initials: R
authors.lastname: Sidhu
authors.affiliation: Department of Radiation Oncology, University of Rochester Medical Center, Rochester, NY, USA.
authors.forename: Lucille
authors.initials: L
authors.lastname: Barrette
authors.affiliation: Department of Radiation Oncology, University of Rochester Medical Center, Rochester, NY, USA.
authors.forename: Yuhchyau
authors.initials: Y
authors.lastname: Chen
keywords: brachytherapy; graphic optimization; interstitial; vaginal cancer