Use of Smit Sleeve in cervix HDR brachytherapy

Discussion in 'Radiation Oncology' started by CanRadOnc, Apr 1, 2009.

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  1. CanRadOnc

    CanRadOnc Canadian member

    Apr 27, 2008
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    Fellow [Any Field]

    I am currently looking into the use of the Smit sleeve for the insertion of intrauterine applicators in HDR brachytherapy to see if they would be something that our centre would use. We have no practical experience regarding its use.

    I have not found much literature discussing its use but I am still continuing with my research. Does anyone have any experience and opinion regarding its use?

    So far, I have come up with a list of pros and cons:

    1. Eliminate multiple dilations of the cervix and hence less need for anaesthesia (1-2 vs 3-4)
    2. Decreased risk of perforation (with closed end sleeve)
    3. Shorter treatment time due to faster insertion
    4. Less traumatic insertions (no seed markers needed, no need to grasp cervix)
    5. Easier insertions for the brachytherapist

    1. Potential? patient discomfort/pain for 4 weeks (in addition to side effects from chemoRT)
    2. Sleeve has to be sutured on cervix which can slough off and sleeve will not stay in place
    3. Difficult/Not possible for advanced cases
    4. Potentially more trauma/anxiety/anaesthesia esp. if sleeve does not stay in place

    Thanks in advance. I look forward to the replies and discussions.
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  3. Palex80

    Palex80 RAD ON 7+ Year Member

    Dec 17, 2007
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    Attending Physician
    1. Why 4 weeks? We usually insert the Smit sleeve after completion of EBRT and then complete brachytherapy within 2 weeks. We don't use a central block and do HDR-boost after EBRT with 4x7 Gy for HR-PTV and 5x7 Gy for IR-PTV 2times/week.
    2. This does happen sometimes, but usually only when you insert the sleeve during EBRT and while tumour is still collapsing. If you insert the sleeve just before you start HDR-boost (we generally apply the first fraction on the same day we insert the sleeve), you don't have that much of a tumour falling apart before you can take the sleeve off again.
    3. That's true, but in these cases HDR-brachytherapy is not always the best option. A patient with extensive lymph node metastasis or cT3 may not profit that much from HDR-boost.
    4. That rarely happens. Especially in patients with anteflected uterus (did I spell that right?), the sleeve tends to stay in place on its own.

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