Fletcher suit or ring: A comparison of Fletcher suit and ring applicators for retroverted uteri.

Purpose: Approximately 20% of women worldwide have a retroverted uterus. A retroverted uterus is closer to the rectum and may cause toxicity during brachytherapy. Upon manipulation, a small percentage turn anteverted. Conventional brachytherapy applicators are designed for an anteverted uterus and can pose issues during insertion. Modified Fletcher suit and ring applicators have major differences in their geometry to achieve similar target coverage, and were analyzed in this study with respect to immediate adverse events and dosimetry. Material and methods: Three hundred seventy-four consecutive applications performed over a 20-month period were studied retrospectively to identify intra-cavitary applications (ICAs) in retroverted uteri. Cases were divided into 2 groups: modified Fletcher suit applicator with hemi-ovoids (group A) and ring applicator (group B). D Results: Seventy-five applications were identified, out of which 47 cases used Fletcher suit applicator, and 28 cases used ring applicator. The median bladder D Conclusions: In most parameters, the two applicators demonstrated comparable results. The control of rectal dosage is superior in the ring applicator at the cost of higher pain incidence. Patient's comfort and rectal dose in EBRT should be taken into consideration, with preference given to the ring applicator.