Brachytherapy insertion

Oral anxiolytic and stool softener were given to the patient the night before the procedure. Intracavitary insertion was done under intravenous sedation by an experienced radiation oncologist. Tandem-ring and the Fletcher-style tandem ovoid applicators (Nucletron, an Elekta company, Stockholm, Sweden) were used for same patients in two different insertions. For each patient included in this study, the type of applicators and sequence of insertion were randomly assigned using a blind envelope method. Patients were randomly assigned to receive first insertion using either ring or Fletcher applicator; the other type being used for the second insertion. This random assignment of the insertion sequence ensured that changes in local anatomy due to progressive tumor shrinkage, as well as general patient condition at the time of insertion would be balanced between uses of two applicator systems. To engender comparability, the selected basic parameters for insertion according to patient’s utero-vaginal anatomy, e.g. the intra-uterine tandem length, angulation, and lateral separation were kept as similar as feasible for both applicators. Ovoid separation or ring diameter used were both the same, as permitting by patient’s anatomy. All patients underwent a computerized tomographic (CT) scan (3 mm slice) using Philips Brilliance CT simulator (Philips Healthcare, Inc., Andover, MA, USA) after every insertion with the applicators in position.