Freiburg flap used as vaginal applicator with/without free-hand interstitial needles in three-dimensional high-dose-rate brachytherapy for vaginal stump recurrence of cervical cancer

Purpose: To present an innovative deformable applicator that used Freiburg flap as vaginal applicator with or without free-hand interstitial needles in three-dimensional (3D) high-dose-rate (HDR) brachytherapy for vaginal stump recurrence of cervical cancer. Material and methods: Between September 2017 and January 2020, all patients with vaginal stump recurrence after radical hysterectomy of cervical cancer treated with vaginal stump brachytherapy using Freiburg flap as vaginal applicator with or without free-hand interstitial needles were retrospective analyzed. Characteristics related to patients and treatment modality as well as preliminary outcomes and side effects were investigated. Results: Thirteen patients were enrolled, aged between 44 and 77 years, with a median age of 53 years. The number of fractions in Freiburg flap vaginal applicator was 1-5, with a median of 3. At the median follow-up of 54 months (range, 6-72 months), three-year local control and three-year overall survival were 90% and 75%, respectively. Nine patients (69.2%) were evaluated with grade 1 early side effects upon completion of treatment. For late side effects, one patient experienced grade 3 rectal and urinary side effects, with rectum and bladder D2cc EQD2 of 69.8 and 76.7 Gy. Another patient developed grade 3 rectal side effect, with rectum D2cc EQD2 of 63.2 Gy. Conclusions: Based on the limited cohort, external beam radiotherapy (EBRT) combined with 3D HDR brachytherapy using Freiburg flap vaginal applicator with or without free-hand interstitial needles is an effective treatment option for patients with vaginal stump recurrence of cervical cancer.