Application value of individualized 3D-printed vaginal template for cervical cancer brachytherapy
Wang Binbing1, Zheng Guanghao2, Zhang Xiang1, Liu Jiping1
1Department of Radiation Physics,Zhejiang Cancer Hospital,Cancer Hospital of University of Chinese Academy of Sciences,Institute of Cancer Research and Basic Medical Sciences of Chinese Academy of Sciences,Hangzhou 310022,China; 2Department of Radiation Oncology,Akesu First People′s Hospital of Xinjiang Uygur Autonomous Region,Akesu 864300,China
Abstract：Objective To introduce the workflow of individualized 3D-printed intracavitary/interstitial vaginal template design. Dosimetric parameters and operation safety were investigated to evaluate the performance of 3D-printed template and freehand implantation. Methods Forty patients previously treated with intracavitary/interstitial Ir-192 HDR brachytherapy were enrolled in this study. All patients were randomly divided into the treatment (n=20) and control groups (n=20). In the treatment group, twenty patients were treated with individualized 3D-printed template. CT-based preplan was carried out to determine the needle implantation cannels. Template with customized shape and implantation cannels was then produced by a 3D printer. Finally,the template was inserted under CT guidance. In the control group, twenty patients received freehand implantation. Needle insertion was decided empirically without the preplan process. Results The difference of D90 for high risk CTV was found to be minor,while the D2cm3 in the rectum,bladder and sigmoid was significantly improved in the treatment group. Meanwhile,the high dose region and conformal index were also improved in the treatment group. A total of 273 needles were inserted and one (0.3%) not-used needle was found. No normal tissues were penetrated during needle insertion in the treatment group. In the control group,a total of 203 needles were inserted and 4(2.0%) not-used needles were observed,and normal tissue penetration occurred in 3(1.5%) needle insertion. Conclusions The individualized 3D-printed template implantation approach has advantages in terms of dosimetry and safety compared with freehand implantation. The actual treatment can achieve the dosimetric design requirements of the preplan.
Wang Binbing,Zheng Guanghao,Zhang Xiang et al. Application value of individualized 3D-printed vaginal template for cervical cancer brachytherapy[J]. Chinese Journal of Radiation Oncology, 2020, 29(4): 283-288.
[1] Haie MC, Potter RvLE, Briot E, et al. Recommendations from Gynaecological (GYN) GEC-ESTRO Working Group (I):concepts and terms in 3D image based 3D treatment planning in cervix cancer brachytherapy with emphasis on MRI assessment of GTV and CTV[J]. Radiother Oncol J Eur Soc Ther Radiol Oncol,2005,74(3):235-245. DOI:10.1016/j.radonc.2004.12.015.
[2] Pötter R, Haie-Meder C, Van Limbergen E, et al. Recommendations from gynaecological (GYN) GEC ESTRO working group (Ⅱ):Concepts and terms in 3D image-based treatment planning in cervix cancer brachytherapy-3D dose volume parameters and aspects of 3D image-based anatomy, radiation physics, radiobiolo[J]. Radiother Oncol,2006,78(1):67-77. DOI:10.1016/j.radonc.2005.11.014.
[3] Neamat H, Richard P, Christian K, et al. High-risk clinical target volume delineation in CT-guided cervical cancer brachytherapy:impact of information from FIGO stage with or without systematic inclusion of 3D documentation of clinical gynecological examination[J]. Acta Oncol (Madr),2013,52(7):1345-1352. DOI:10.3109/0284186X,2013.813068.
[4] Menon G, Huang F, Sloboda R, et al. Practically achievable maximum high-risk clinical target volume doses in MRI-guided intracavitary brachytherapy for cervical cancer:a planning study[J]. Brachytherapy,2014,13(6):572-578. DOI:10.1016/j.brachy.2014.06.006.
[5] Arenas M, Sabater S, Sintas A, et al. Individualized 3D scanning and printing for non-melanoma skin cancer brachytherapy:a financial study for its integration into clinical workflow[J]. J Contemp Brachyther, 2017,9(3):270-276. DOI:10.5114/jcb.2017.68134.
[6] Harris BD, Nilsson S, Poole CM. A feasibility study for using ABS plastic and a low-cost 3D printer for patient-specific brachytherapy mould design[J]. Australas Phys Eng Sci Med,2015,38(3):1-14. DOI:10.1007/s13246-015-0356-3.
[7] Ricotti R, Vavassori A, Bazani A, et al.3D-printed applicators for high dose rate brachytherapy:Dosimetric assessment at different infill percentage[J]. Phys Med,2016,32(12):1698. DOI:10.1016/j.ejmp.2016.08.016.
[8] Lindegaard JC, Madsen ML, Traberg A, et al. Individualised 3D printed vaginal template for MRI guided brachytherapy in locally advanced cervical cancer[J]. Radiother Oncol,2016,118(1):173-175. DOI:10.1016/j.radonc.2015.12.012.
[9] Sekii S, Tsujino K, Kosaka K, et al. Inversely designed, 3D-printed personalized template-guided interstitial brachytherapy for vaginal tumors[J]. J Contemp Brachyther,2018,10(5):470-477. DOI:10.5114/jcb.2018.78832.
[10] Li JP, Meng X, Dang YZ, et al. Pure interstitial brachytherapy using 3D-printed vaginal template for improved catheter tracks in treating cervical cancer[J]. J Biomater Tissue Eng, 2017,7(6):499-503. DOI:10.1166/jbt.2017.1591.
[11] Vyas S, Le Y, Zhang Z, et al. Reduced dose to urethra and rectum with the use of variable needle spacing in prostate brachytheray: apotential role for robotic technology[J]. J Contemp Brachytherapy, 2015,7(4):252-257. DOI:10.5114/jcb.2015.53526.
[12] Cunha JAM, Hsu I, Pouliot J. Dosimetric equivalence of nonstandard HDR brachytherapy catheter[J]. Med Phys,2009,36(1):233-239. DOI:10.1118/1.3041166.
[13] Hanania AN, Myers P, Yoder AK, et al. Gynecologic Oncology Inversely and adaptively planned interstitial brachytherapy:asingle implant approach[J]. Gynecol Oncol,2019,152(2):353-360. DOI:10.1016/j.ygyno.2018.11.020.
[14] Oike T, Ohno T, Noda S, et al. Can combined intracavitary/interstitial approach be an alternative to interstitial brachytherapy with the martinez universal perineal interstitial template (MUPIT) in computed tomography-guided adaptive brachytherapy for bulky and/or irregularly?[J]. Radiat Oncol,2014,9(1):1-7. DOI:10.1186/s13014-014-0222-6.
[15] Battisti MB, Maenhout M, Senneville BD, et al. An automated optimization tool for high-dose-rate (HDR) prostate brachytherapy with divergent needle pattern[J]. Phys Med Biol,2015,60:7567-7583. DOI:10.1088/0031-9155/60/19/7567.
[16] Olson AC, Craciunescu O, Meltsner S, et al. Dosimetry, feasibility, and acute toxicity of combined intracavitary brachytherapy and free-hand interstitial needle placement for locally advanced cervix and uterine cancer[J]. Brachytherapy,2016,15(1):S86-S87. DOI:10.1016/j.brachy.2016.04.140.
[17] Wang Y,Ye WJ,Du LH,et al. Dose-volume parameters and clinical outcome of CT-guided freehand high-dose-rate interstitial brachytherapy for cervical cancer[J]. Chin J Cancer,2012,31(12):598-604. DOI:10.5732/cjc.011.10452.
2020, Vol. 29 
