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Developing next generation 3D-printing for cervical cancer hybrid brachytherapy: a guided interstitial technique enabling improved flexibility, dosimetry, and efficiency.

Developing next generation 3D-printing for cervical cancer hybrid brachytherapy: a guided interstitial technique enabling improved flexibility, dosimetry, and efficiency. International journal of radiation oncology, biology, physics Marar, M., Niedermayr, T., Kidd, E. 2023

Abstract

We developed a 3D-printed tandem anchored radially guiding interstitial template (TARGIT) to increase the simplicity of intracavitary/interstitial (IC/IS) technique for tandem-and-ovoid (T&O) procedures in cervical cancer brachytherapy. This study compared dosimetry and procedure logistics between T&O implants using the original TARGIT versus the next-generation TARGIT-Flexible-eXtended (TARGIT-FX) 3D-printed template designed for practice-changing ease-of-use with further simplified needle insertion and increased flexibility in needle placement.This single-institution retrospective cohort study included patients undergoing T&O brachytherapy as part of definitive cervical cancer treatment. Procedures utilized the original TARGIT from November 2019 through February 2022 and the TARGIT-FX from March 2022 through November 2022. The FX design features full extension to the vaginal introitus with 9 needle channels and allows for needle additions or depth adjustments intra-procedure and post-CT/MRI imaging.A total of 148 implants were performed, 68 (46%) with TARGIT and 80 (54%) with TARGIT-FX, across 41 patients. Across implants, the TARGIT-FX achieved higher mean V100% (+2.8%, p?=?0.0019), and across patients, the TARGIT-FX achieved higher D90 (+2.0 Gy, p?=?0.037) and higher D98 (+2.7 Gy, p?=?0.016) compared to the original TARGIT. Doses to organs at risk were overall similar between templates. Procedure times for TARGIT-FX implants were 30% shorter on average than for those using the original TARGIT (p < 0.0001), and 28% shorter on average for the subset of implants with HR-CTV =30 cc (p?=?0.013). All residents (100%, N?=?6) surveyed regarding the TARGIT-FX indicated ease-of-use for needle insertion and interest in applying the technique in future practice.The TARGIT-FX achieved shorter procedure times with increased tumor coverage and similar normal tissue sparing compared to the previously applied TARGIT and illustrates the potential of 3D-printing to enhance efficiency and shorten the learning curve for IC/IS procedure technique in cervical cancer brachytherapy.

View details for DOI 10.1016/j.ijrobp.2023.04.005

View details for PubMedID 37059235