3D打印模板辅助标准化施源器在ⅢB期宫颈癌影像引导自适应近距离治疗中的应用

doi:10.3760/cma.j.cn113030-20200511-00246

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Abstract Objective To explore the application of 3D printing technology-assisted standardized applicator in the image-guided adaptive brachytherapy (IGABT) for cervical cancer. Methods Twenty-three patients with stage ⅢB cervical cancer with extensive paracervical invasion after external irradiation (45Gy/25f) were treated with IGABT, and the prescription dose was 7Gy/f×4f. According to the regression of tumor on MRI before and after external irradiation, the range of brachytherapy was determined, and the under dose area of standard intracavitary/interstitial applicator (IC+IS) was estimated. The virtual transperineal needle channel was inserted in the under dose area, the angle, spacing and depth of implantation were optimized. The auxiliary templates were designed with graphic design software, and 3D printing technology was utilized to print the auxiliary templates. The auxiliary templates were closely combined with the standardized applicator. Under the anesthesia condition, ultrasound-guided applicator was completed, and patients were scanned with MRI image after operation. The MRI images were introduced into treatment planning system (TPS) to delineate the target area and organs at risk, and the treatment plans were optimized to complete the plan evaluation and treatment. Results The average printing time of templates was (3.5±1.0) h, 382 implant needles were inserted guided by auxiliary templates,(4.2±1.5) template-guided implant needles were used in each fraction and the weight ratio was (16.49±9.50)%. The total dose of HR-CTV D90% EQD2Gy,α/β=10 was (90.45±3.03) Gy, and IR-CTV D90% EQD2Gy,α/β=10 was (66.46±3.68) Gy. The D2cm³EQD2Gy,α/β=3of the bladder, rectum, small intestine and sigmoid colon were (82.69±2.60) Gy,(73.20±2.52) Gy,(69.35±3.32) Gy and (69.39±3.27) Gy, respectively, all of which met the clinical dose requirements. The 1-and 2-year local control rates were 96% and 87%, 87% and 70% for the distant metastasis-free survival rates, and 96% and 78% for thea overall survival rates, respectively. Conclusion The auxiliary applicators made by 3D printing technology can effectively compensate for the dose insufficiency of the standard applicator in the paracervical and other areas during the clinical brachytherapy in patients with stage ⅢB cervical cancer, providing an effective method for the brachytherapy of advanced cervical cancer.

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	Articles by authors
	Zhao Zhipeng
	Guan Wei
	Zhao Hongfu
	Mao Zhuang
	Cheng Guanghui

Key words： Cervical neoplasm/brachytherapy Standardized applicator Auxiliary template 3D print

Received: 11 May 2020

Fund:National Natural Science Foundation of China (81703034);Project of Science and Technology Department of Jilin Province (Bethune Project)(20160101079JC);Project of Science and Technology Department of Jilin Province (20190303151SF)

Corresponding Authors: Cheng Guanghui, Email:chenggh@jlu.edu.cn

Cite this article:

Zhao Zhipeng,Guan Wei,Zhao Hongfu et al. Application of 3D printing technology-assisted standardized applicator in image-guided adaptive brachytherapy of stage ⅢB cervical cancer[J]. Chinese Journal of Radiation Oncology, 2020, 29(8): 661-665.

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http://journal12.magtechjournal.com/Jweb_fszlx/EN/10.3760/cma.j.cn113030-20200511-00246 OR http://journal12.magtechjournal.com/Jweb_fszlx/EN/Y2020/V29/I8/661

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