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patients to measure the effectiveness of the intervention, and evaluated
improvements in practice and reduction in critical errors.
Results: The project clearly demonstrates the benefit and importance of
interdepartmental collaboration and communication in improving patient
care and quality outcomes. This intervention proved to be a successful
application of adult learning theory that addresses relevance of the topic
to the adult learner and practical and useful application of knowledge. All
expected measurements improved after the educational intervention.
Conclusions: Due to the highly-specialized care required by this patient
population, it is imperative that inpatient nurses caring for High-Dose-
Rate brachytherapy patients receive intensive education consisting of both
didactic and hands-on learning. It is important that this training be
received as part of initial staff orientation and at least annually thereafter.
It is very valuable to include leadership from both the brachytherapy team
and the inpatient units to build a collaborative, sustainable educational
program that will benefit both the health care providers and the patients
receiving HDR brachytherapy in the inpatient setting.
GYN ePOSTER
PO81
Primary Malignantmelanomaof
Thevagina: Report of Two Cases and
Review of the Literature
Guler Yavas, MD
1
, Irem Oner, MD
2
, Cagdas Yavas, MD
1
, Erdem Sen,
MD
2
, Pinar Karabagli, MD
3
, Cetin Celik, MD
4
, Ozlem Ata, MD
2
.
1
Radiation Oncology, Selcuk University, Konya, Turkey;
2
Medical
Oncology, Selcuk University, Konya, Turkey;
3
Pathology, Selcuk
University, Konya, Turkey;
4
Gynecology and Obstetrics, Division of
Gynecologic Oncology, Selcuk University, Konya, Turkey.
Purpose: Vaginal malignant melanoma is a rare form of mucosal
melanoma, and accounts for only !1% of all melanomas and 1.6% of
female genital tract melanomas. Unfortunately, vaginal melanomas are
often only diagnosed at an advanced stage, and treatment options include
local excision with wide margins, radical surgery, radiotherapy,
chemotherapy, and immunotherapy. Despite these aggressive treatment
approach, the prognosis of vaginal melanoma is poor, and the 5-year
overall survival rate is 0-25%. Herein we report two cases of vaginal
melanoma
Material and Methods: The first case was a 66-year-old woman with a
4-month history of feeling a mass in the vagina. Histopathological
examination of the mass revealed a nodular melanoma. According to
the American Joint Committee on Cancer (AJCC) classification system
the patient was staged as T4bN0M0, stage IIC. She denied surgery
therefore underwent definitive radiotherapy. We performed external
radiotherapy to pelvisþbilateral groin chains and vagina using 3-
dimensional conformal radiotherapy to a dose of 50 Gy in 25 daily
fractions of 2 Gy each. After external radiotherapy, the patient
underwent vaginal brachytherapy to a dose of 28 Gy in 4 fractions
over 2 weeks. Treatment was given without interruption. She had
grade 2 cystitis and grade 2 diarrhea which respond to medical
treatments. In addition she had grade 2 -3 radiation dermatitis in
vulvo-vaginal area. The second case was a 67-year-old woman with
stage III (T4bN1bM0) primary vaginal melanoma. Wide local excision
with vaginectomy and bilateral inguinal lymph node dissection was
done. During operation there was a urethral infiltration of the tumor;
therefore inferior 1/3 part of the urethra was also resected. The patient
underwent adjuvant radiotherapy (50.4 Gy in 28 fractions; 1.8 Gy per
fraction) to the primary tumor and bilateral inguinal lymph nodes in
frog-leg position followed by a 30 MU interferon-atreatment every
other day for 2 years.
Results: The first case is on routine follow-up, and now after 15 months of
the completion of the treatment, she is still free of disease. And the second
case is still free of disease for 36 months.
Conclusion: Due to the rarity of vaginal melanoma there is no consensus
regarding to optimal treatment modality. Available data demonstrates that
if possible the initial surgery is the best option; however still there is not
enough evidence supporting an aggressive surgery. Therefore more
conservative surgery with adjuvant therapies including immunotherapy,
chemotherapy and radiotherapy may be reasonable. Further studies with
more patients and longer follow-up period are warranted in order to
define the best treatment strategy.
PO83
Modeling of The Direction Modulated
Brachytherapy (dmbt) Tandem
Applicator in a Commercial Oncentra
Brachy Tps Using The Advanced Collapse
Cone Engine (ace) Algorithm
Habib Safigholi, Ph.D.
1
, Yury Niatsetski, Ph.D.
2
, William Y. Song, Ph.D.
3
.
1
Department of Electrical Engineering, Shiraz Branch, Islamic Azad
University, Shiraz, Iran, Islamic Republic of;
2
Elekta Brachytherapy,
3905TH Veenendaal, Netherlands;
3
Department of Radiation Oncology,
Virginia Commonwealth University, Richmond, VA, USA.
Purpose: Direction Modulated Brachytherapy (DMBT) tandem applicator
has six symmetric peripheral grooves (1.4 mm) made from non-magnetic
tungsten alloy rod (18 g/cc) (Figure1a-c), with an exceptional capability
to modulate dose with directionality for the treatment of cervical cancer.
In this research, the dose distributions of the DMBT tandem were
calculated with the Advanced Collapsed Cone Engine (ACE) of the
Oncentra Brachy treatment planning system (TPS) and validated against
Monte Carlo (MC) calculations.
Materials and Methods: The 3D applicator model of the DMBT tandem,
combined with the CT/MR ring, was made for the Oncentra Brachy TPS
(Figure 1a). Then, a two-level dosimetric validation was performed. First,
the Ir-192 source (model: microSelectron HDR-v2) was placed inside a
conventional tandem in a water medium. Second, the Ir-192 source was
placed inside the DMBT tandem in a water medium. Dose calculations were
performed by the ACE and MCNP MC code independently and compared.
Results: The overlapping isodose lines generated by the ACE and MCNP
for the first scenario are shown in Figures 1d-g (in both transverse and
longitudinal cuts). Dose distribution is normalized to the point at 10 mm
distance from the DMBT central axis. The agreement was excellent with
deviations !1.5% for the high dose region (O10%), and !3% for the low
dose region (!10%). The overlapping isodose lines generated by the ACE
and MCNP for the second scenario are shown in Figures 1h-k. As can be
seen, the visual agreement is excellent and reflected in the overall
deviations !3.2%. At isodose lines !10%, the visual disagreement were
more observable with having some ‘‘ripple effect’’ shown by the ACE
S106 Abstracts / Brachytherapy 17 (2018) S15eS142
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