PURPOSE: It is not a simple task to achieve the ideal isodose curve with a standard vaginal applicator or single plane needle impant in the paravaginal tissue when primary or recurrent gynecological neoplasms (cervical cancers, vaginal cancers and vulvar cancers) are treated as a boost following external beam radiotherapy. The authors introduce the development and construction of a simple, inexpensive, customized applicator for volume implant to maximize the radiation dose to the tumor while minimizing the dose to the rectum and the bladder. MATERIALS AND METHODS: Nine patients underwent Ir-192 transperineal interstitial implantation for either recurrent (5 cases) or primary (3 cases) cervical cancers or primary vaginal cancer (1 case) between August 1994 and February 1998 at Ajou university hospital. First 3 cases were performed with a single plane implant guided by digital palpation. Because of inadequate isodose coverage in the tumor volume in first 3 cases, we designed and constructed interstitial vaginal applicator for volume implant to improve tumor dose distribution and homogeneity while sparing the surrounding normal tissue. Our applicators consist of vaginal obturator and perineal template that made of the clear acrylamide and dental mold material (Provil ). The applicators were customized individually according to the tumor size and its location. Both HDR and LDR irradiation were given with these applicators accomodating 6 Fr needles (Microselectron, Nucletron). The pretreatment planning prior to actual implant was performed whenever possible. RESULTS: Needles can be inserted easily and evenly into the tumor volume through the holes of templates, requiring less efforts and time for the implant prodecure. Our applicators made of materials available from commercial vendors. These have an advantage that require easy procedure, and spend relatively short time to construct. Also it was possible to fabricate applicators to individualize according to the tumor size and its location and to achieve the ideal isodose coverage. We found an accurate needle arrangement and ideal dose distribution through the CT scan that was obtained in 3 cases after needle implant. Three patients with primary cervical and vaginal cancers were controlled locally at final follow up. But all recurrent cases failed to do so. CONCLUSION: The authors introduce inexpensive, simple interstitial vaginal templates which were self-designed and constructed using materials available from commercial vendors such as acrylamide and dental mold material (Provil ).
Acrylamide ; Brachytherapy ; Commerce ; Follow-Up Studies ; Fungi ; Humans ; Needles* ; Palpation ; Radiotherapy ; Rectum ; Tomography, X-Ray Computed ; Tumor Burden ; Urinary Bladder ; Vaginal Neoplasms

PURPOSE: It is not a simple task to achieve the ideal isodose curve with a standard vaginal applicator or single plane needle impant in the paravaginal tissue when primary or recurrent gynecological neoplasms (cervical cancers, vaginal cancers and vulvar cancers) are treated as a boost following external beam radiotherapy. The authors introduce the development and construction of a simple, inexpensive, customized applicator for volume implant to maximize the radiation dose to the tumor while minimizing the dose to the rectum and the bladder. MATERIALS AND METHODS: Nine patients underwent Ir-192 transperineal interstitial implantation for either recurrent (5 cases) or primary (3 cases) cervical cancers or primary vaginal cancer (1 case) between August 1994 and February 1998 at Ajou university hospital. First 3 cases were performed with a single plane implant guided by digital palpation. Because of inadequate isodose coverage in the tumor volume in first 3 cases, we designed and constructed interstitial vaginal applicator for volume implant to improve tumor dose distribution and homogeneity while sparing the surrounding normal tissue. Our applicators consist of vaginal obturator and perineal template that made of the clear acrylamide and dental mold material (Provil ). The applicators were customized individually according to the tumor size and its location. Both HDR and LDR irradiation were given with these applicators accomodating 6 Fr needles (Microselectron, Nucletron). The pretreatment planning prior to actual implant was performed whenever possible. RESULTS: Needles can be inserted easily and evenly into the tumor volume through the holes of templates, requiring less efforts and time for the implant prodecure. Our applicators made of materials available from commercial vendors. These have an advantage that require easy procedure, and spend relatively short time to construct. Also it was possible to fabricate applicators to individualize according to the tumor size and its location and to achieve the ideal isodose coverage. We found an accurate needle arrangement and ideal dose distribution through the CT scan that was obtained in 3 cases after needle implant. Three patients with primary cervical and vaginal cancers were controlled locally at final follow up. But all recurrent cases failed to do so. CONCLUSION: The authors introduce inexpensive, simple interstitial vaginal templates which were self-designed and constructed using materials available from commercial vendors such as acrylamide and dental mold material (Provil ).
Acrylamide ; Brachytherapy ; Commerce ; Follow-Up Studies ; Fungi ; Humans ; Needles* ; Palpation ; Radiotherapy ; Rectum ; Tomography, X-Ray Computed ; Tumor Burden ; Urinary Bladder ; Vaginal Neoplasms

PURPOSE:BK virus associated nephropathy (BKVAN) affects 1-10% of kidney transplant (KT) patients and it produces a progressive destruction of allograft. Reducing immunosuppression is the only way to save the graft, while it needs tight monitoring of the graft rejection and graft survival is poorer in advanced case. Leflunomide has immunosuppressive effect and also antiviral activity. Addition of leflunomide may improve BK virus clearance and graft survival. METHODS:6 KT patients with biopsy proven BKVAN (Histological pattern B) were treated with leflunomide and reduced immunosuppression. All patients were monitored with serial determination of viral load in blood and graft function. RESULTS:BKVAN was diagnosed at 14 months (7-28) post transplant, at that time median serum creatinine concentration was 2.8 mg/dL (1.8-3.6). 12.5 months (6-16) later of leflunomide treatment, median serum creatinine was 2.3 mg/dL and no graft loss was found. CONCLUSION:Leflunomide therapy with reduced immunosuppression may be effective in the treatment for BKVAN.
Biopsy ; BK Virus ; Creatinine ; Graft Rejection ; Graft Survival ; Humans ; Immunosuppression ; Isoxazoles ; Kidney ; Kidney Transplantation ; Transplantation, Homologous ; Transplants ; Viral Load ; Viruses