Oncology Patients With
Cylinders for Intracavitary
of Uterine Afterloading Applicators
for Intracavitary Radiation Therapy
Injection of Chromic Phosphate
Omental Pedicle "J"
With Bilateral Inguinal
Lymph Node Dissection
Vulva With Gracilis Myocutaneous Flaps
Flap and Vertical Rectus
Bilateral Pelvic Lymph
Node Dissection and With Extension of the Vagina
"J" Pouch Rectal
Omental "J" Flap
Continent Urostomy (Miami Pouch)
Gracilis Dynamic Anal
System Versus Skin Grafting
Pelvic Flap for
Augmentation of Continent Urostomy or Neovagina
of Hemorrhage in Gynecologic Surgery
of the Punctured
of a Lacerated
Internal Iliac Vein and
Suturing of a Lacerated Common Iliac Artery
Suspension of the Vagina
Not to Do in Case of Pelvic Hemorrhage
Associated With Abdominal Pregnancy
Application of Vaginal Cylinders for
Intracavitary Radiation Therapy
Vaginal intracavitary radiation therapy is applied for two reasons:
(1) to treat carcinoma directly in the vagina, the subvaginal mucosa
and, in adenocarcinoma of the endometrium, the lymphatic and (2) to
add radiation to point A in the isodose curve.
The largest cylinder that can comfortably fit the vagina should be
used to achieve the most favorable isodose curve with the lowest surface
dose. An intrauterine tandem can be inserted through the vaginal cylinder
and can be loaded as the length of the uterus dictates. If the uterus
is absent, the cylinders can be used alone to apply radiation therapy
to the vagina.
The purpose of applying intracavitary therapy to the vagina is to irradiate
the vaginal canal with ionizing radiation. In general, attempts are
made to deliver 4000 cGy of radiation to the depth dose of 1.5 cm.
Physiologic Changes. The physiologic changes in this
procedure are the same as for all procedures in which ionizing radiation
is passed through normal and malignant tissue.
Points of Caution. The vaginal cylinders should be
constructed so that they will fill the entire vaginal canal up to,
but not beyond, the introitus. Care should be taken that no radium
source extends beyond the vaginal introitus for fear that ulceration
of the labia minora and majora will occur.
Fixation of the device should be made to ensure that the cylinder will
not slip toward the introitus. This usually can be performed by suturing
the labia together in the midline.
Cylinders of varying diameter can be easily
constructed out of Silastic. The cylinder can be fashioned so
that they can be added to each other in tandem to accommodate
different vaginal lengths.
If a Fletcher uterine tandem is to be used,
it should be inserted into the entire length of the endometrial
canal. The vaginal cylinders can then be loaded on the tandem.
The radium sources can be inserted through the center of the
tandem in a manner that will deliver the desired isodose curve
for the uterus, cervix, and vagina.