Modification of the Syed-Neblett template system to enable loading of the vaginal obturator

Interstitial implantation of vaginal disease, whether primary or representative of a recurrence or extension of a uterine malignancy, is an important aspect of definitive irradiation. Irradiation of vaginal disease is theoretically appealing with the Syed-Neblett template, obturator, and needle system due to the presence of a vaginal obturator with grooves to accommodate six needles and a central tandem that can irradiate both uterine and vaginal disease. In this manner, simultaneous interstitial and intracavitary techniques can be accomplished with one applicator. Long-term follow-up has suggested a correlation between loading of the surface of the obturator with late vaginal, rectal, and bladder complications. To enable use of the vaginal obturator surface while attempting to decrease complications, we have devised an obturator 'sleeve' to distance the obturator sources from the vaginal mucosa. With this modification, vaginal, perivaginal, and uterine tissues can be irradiated with both intracavitary and interstitial techniques simultaneously with one applicator.