University Hospitals Seidman Cancer Center launches use of Elekta’s Venezia gynecological applicator for patients with advanced cervical cancer
On June 23, University Hospitals Seidman Cancer Center became the first clinic in North America to begin using Venezia™, a sophisticated gynecologic brachytherapy applicator from Elekta designed to treat advanced cervical cancer, including disease with extra-cervical spread such as the parametrium and vagina. UH Seidman Cancer Center radiation oncologists used Venezia to deliver a high dose rate (HDR) interstitial brachytherapy boost to a patient with stage IIB cervical cancer with bilateral parametrial extension.
“To reach the cancer that has spread beyond the cervix, we have traditionally implanted interstitial needles using an unguided ‘freehand’ technique, which takes a lot of skill,” says Bryan Traughber, MD, a radiation oncologist at UH Seidman Cancer Center and one of the clinic’s two full-time brachytherapists. “The design of Venezia makes needle insertion much more straightforward, enabling us to easily guide both parallel and oblique needles to reach disease extensions. Combined intracavitary and interstitial brachytherapy will now be more reproducible and consistent than the freehand method.”
Each year, clinicians at UH Seidman Cancer Center perform about 300 HDR brachytherapy procedures, approximately one-third for patients with cervical cancer. About half of these patients will receive interstitial brachytherapy either alone or combined with an intracavitary technique.
The first patient’s interstitial brachytherapy procedure consisted of five treatment sessions over a two-and-a-half week period. Ovoid holes in the forward (i.e., ring) component of Venezia act as needle guides, enabling Dr. Traughber to easily implant two parallel needles and one needle at an oblique angle to reach the parametrial disease.
The Venezia workflow will be significantly different from UH Seidman’s previous practice, he says.
“For small tumors like IB2’s and IIA cervical cancers, I would typically use our tandem-and-ovoid applicator and I might freehand needles – and clip or tape the needle to the tandem to keep it in place,” Dr. Traughber explains. “For the locally advanced or bulky cases like an IIB or IIIB, I performed those procedures in the operating room to do a modified interstitial case that was very complex and invasive. Venezia is going to really simplify many of these cases. I will be able to perform some of them on an outpatient basis.”
Another key design feature of Venezia is its “clickable” ovoids. The two lunar-shaped ovoids of Venezia form a ring that, when clicked together inside the patient, provide the ease of insertion of a tandem-and-ovoid applicator.
Some cervical cancer cases are characterized by extensive disease spread to the vagina. For these patients, Venezia features a large perineal template (sold separately) for the placement of parallel needles.
“The template will really help patients with an IIA or IIIA tumor with substantial vaginal involvement,” Dr. Traughber notes. “It will allow us to implant as many parallel interstitial needles as the case warrants. It’s a significantly better design than other applicators.”
Because Venezia combines the best characteristics of both ring and tandem-and-ovoid applicators, he predicts that Seidman’s existing tandem-and-ovoid devices probably will be retired.
“I’ll most likely use Venezia more and more often,” he says. “It will give us the same anatomical coverage as a traditional applicator. Then if you need needles, you’re ready to go.”
For more information, visit elekta.com/Venezia.
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